Self-injury found to be common in high-school students

“The findings are important because it suggests that NSSI is more prevalent among adolescents in the general population than previously thought,” says lead author Elizabeth Lloyd-Richardson, PhD, a psychologist at The Miriam Hospital and assistant professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

“If this is the case - it’s essentially a wake-up call to take better notice of these behaviors in the community and learn how to help teens manage stress without harming themselves,” adds Lloyd-Richardson.

Researchers decided to explore the frequency and breadth of NSSI engaged in by teens in the community because little is known about self-harming behavior in this particular population.

“Although NSSI is commonly encountered in inpatient and outpatient psychiatric and other institutionalized settings, little research has looked at NSSI in community samples,” says Lloyd-Richardson.

A total of 633 high school students (grades 9-12) from schools in the southern and midwestern United States voluntarily and anonymously participated in the study by completing a survey administered by the researchers. The survey asked the participants whether they purposefully engaged in 11 different NSSI behaviors in the past year, and if so, the frequency of occurrence. In addition, the survey assessed the motivations for engaging in NSSI behavior.

“We were surprised to find that 46 percent of the teens in the study reported injuring themselves in the past year on multiple occasions,” says Lloyd-Richardson.

Furthermore, 60 percent of these (or 28 percent of the entire sample) endorsed moderate/severe forms of NSSI including cutting skin, burning skin, giving self a tattoo, scraping skin, or using a pencil to “erase” skin.

The researchers note it was important to distinguish between minor and moderate/severe forms of self-injury, since severe forms of NSSI may be predictive of more serious outcomes. Minor forms of NSSI consisted of behaviors such as pulling out hair, biting self, or picking at areas of the body to the point of drawing blood. Moderate/severe self-injurers were more likely than minor self-injurers to report a history of psychiatric treatment and hospitalizations, suicide attempt, and current suicide ideation.

Results from the study also indicated that the most common reasons teens in the study engaged in NSSI included “to get control of a situation”, “to stop bad feelings”, and “to try and get a reaction from someone.”

“This suggests that adolescents are engaging in NSSI for several reasons, including both regulating their own internal emotional states and trying to manage situations in their environment,” says Lloyd-Richardson. “Once thought of as a phenomenon only found in teens with mental health issues, the results support the notion that many adolescents in the community are self-harming as way to cope with emotional distress.”

Accordingly, intervention efforts should be tailored to the individual and contribute to building alternative skills for positive coping, communication, stress management, and strong social support, the authors note.

“While there remains few proven treatments for NSSI, understanding the specific motivations behind an adolescents’ behavior – namely to influence the behaviors of others, as well as to manage their own internal emotions as our study shows - allows for the development of an individual treatment plan that could help prevent future episodes,” she says.

In this study, no gender, race, or age differences were noted in overall NSSI rates – however, the researchers suggest that future studies examine NSSI in nationally representative samples. They also recommend exploring how NSSI and its functions may change over time, given additional exposure, as well as changes in interpersonal and intrapersonal variables.

Lloyd-Richardson adds, “For example, a question that arises is if long-term exposure of repeated NSSI leads to a decreased fear threshold in teens, and therefore, a greater attraction to suicide and death. The answer could lead to significant changes in how we initially treat adolescents who start to exhibit self-harming behavior.”

The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with The Warren Alpert Medical School of Brown University. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (www.miriamhospital.org) offers particular expertise in angioplasty, stroke care and women’s cardiac care. One of 18 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS. The hospital’s Centers for Behavioral and Preventive Medicine attracts over $17 million in research funding annually, studying the leading lifestyle causes of disease burden and death with an emphasis on weight control, physical activity and smoking cessation. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.