What Factors Influence Self-Injurious Behavior

Non-suicidal self-injury (NSSI) is an act of self-harm taken by a person without any intent to die. Examples of NSSI behaviors include cutting, head banging, or burning. The prevalence of NSSI is greatest among adolescents and young adults, with 20 percent of adolescents reporting that they have engaged in NSSI behavior at least once in their lifetime (Gilbert et al., 2020). Young people who perform self-injurious actions tend to have lower self-esteem and a negative body image (Cipriano et al., 2017). Causes that explain why young people engage in NSSI behaviors include individual issues, such as emotional dysregulation, as well as environmental factors like abuse, exposure to trauma, or disrupted attachment (Cipriano et al., 2017). NSSI among adolescents is highly concerning as it is a strong predictor of a suicide attempt (Clarke et al., 2019).Self-cutting is the most common form of NSSI (Cipriano et al., 2017). Self-cutting is more common among females than males and the typical age of onset is between the ages of 12-14 years old (Cipriano et al., 2017). The majority of young people who engage in self-cutting behaviors perform such self-harm in more than one area, such as the arms, legs, wrists, and abdomen (Cipriano et al., 2017). Self-cutting is linked to other mental health disorders, including borderline personality disorder, eating disorders, anxiety and mood disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and substance abuse (Cipriano et al., 2017).Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are both evidence-based treatment modalities for managing self-harm behaviors like self-cutting (Gilbert et al., 2020). In CBT, the therapist helps clients to construct new frameworks that shape their thoughts and attitudes (Gilbert et al., 2020). Peer-reviewed research findings indicate that CBT is correlated with improvements in self-soothing, problem-solving, and decreased thoughts of self-harm (Gilbert et al., 2020). Meanwhile, in DBT, the therapist works with the client to develop mindfulness and regulation of emotions (Gilbert et al., 2020). Research findings for DBT show a reduction of NSSI behaviors (Gilbert et al., 2020). For adolescent patients, family intervention is critical as family conflict is a notable risk factor for self-harm behaviors (Clarke et al., 2019).CBT+ integrates the CBT and DBT modalities. Evidence-based practices under the CBT+ model for treating self-injurious clients include treating the risk for self-harm independent of the patient’s psychiatric diagnosis, encouraging social connection, helping the patient to develop a more meaningful daily life, and removing access to dangerous items like firearms, sharp blades, and medications (CBT+, 2021). The CBT+ treatment modality also includes a chain analysis in which the therapist and client identify thoughts or emotions that precipitate self-harm behaviors, and then develop skills to manage those precipitating elements (CBT+, 2021).

References  CBT+. (2021). Managing and treating suicide risk and non-suicidal self-injury (NSSI): Clinicaltips. CBT+. Retrieved from https://depts.washington.edu/uwhatc/PDF/TF-%20CBT/pages/11%20Suicide%20and%20Self%20Injury/Managing%20and%20Treating%20Suicide%20Risk%20and%20Non-Suicidal%20Self-Injury%20-%20Clinical%20Tips.pdf

Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematicreview. Frontiers in Psychology, 8, 1946. doi: 10.3389/fp-syg.2017.01946

Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding andmanaging self-harm in adolescents. F1000Research, 8. doi: 10.12688/f1000research.19868.1

Gilbert, A. C., DeYoung, L. L., Barthelemy, C. M., Jenkins, G. A., MacPherson, H. A., Kim, K.L., … & Dickstein, D. P. (2020). The treatment of suicide and self-injurious behaviors in children and adolescents. Current Treatment Options in Psychiatry, 7(1), 39-52. doi: 10.1007/s40501-020-00201-3

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