Self-Mutilation: Causes and Help

INTRODUCTION

Self-mutilation carries many similar definitions, referring to the destruction of one's body tissue without suicidal intentions. It is important to understand the serious effects of this maladaptive behavior on individuals, specifically adolescents, as research suggests a stark increase in incidents of self-mutilation among this group (Roth and Heath, 2002). Self-mutilative behavior, according to several studies, occurs at a rate of 4% of the general adult population. Adolescent community samples reported rates as high as 14% - 39% (Nock and Prinstein, 2005). Despite the rise in incidents and the overall danger of this behavior, the paucity of research leaves self-mutilation as a poorly understood maladaptive behavior (Nock and Prinstein, 2005).

This paper explores the topic of adolescent self-mutilation by first defining this injurious behavior and examining several causal factors that motivate young people to engage in self harm. Finally, several counseling techniques that have been studied and applied will be explored and discussed.

HYPOTHESIS

What are the causal factors in adolescent self-mutilation and how can counselors identify and help individuals who engage in this type of behavior?

LITERATURE REVIEW

While self-mutilation has many similar definitions, no general terminology has been agreed upon by researches and a variety of forms have been used to describe the behavior (Ross and Heath, 2002). Self-mutilation has also been referred to as self-injurious behavior, deliberate self-harm, parasuicide, and self-wounding (Ross and Heath, 2002). These terms will be used interchangeably throughout this paper to describe self-mutilation. It is also important to mention that self-mutilation is accomplished by individuals without an intention to commit suicide. While this may be difficult to comprehend, it is important to mention that self-mutilation and suicide attempts carry different etiologies (Ross and Heath, 2002). In a paper on the study of self-mutilation in a community sample of adolescents, Ross and Heath review the current data that exists among the adolescent population with respect to self-mutilation, and exploits their results on a study of 440 students from two high schools (urban and suburban) using screening questionnaires and semi-structured interviews. The authors disclose previous studies of self-mutilation in the adolescent population, categorizing previous studies as (1) those that have explored the frequency of the behavior in high school students, with the majority of studies on suicidal behavior, (2) Studies focusing on self-mutilators who were admitted to emergency rooms, (3) psychiatric impatient adolescents and (4) studies that focused on a wide range of age groups, including adolescents. Ross and Heath examine demographic variables such as age, gender, ethnicity, patterns and the frequency of self-mutilation, and the methods used to self-injure. Emotional factors such as depression and anxiety as antecedents of self-injurious behavior are also discussed. Results of the study determined that despite differences in ethnicity and socioeconomic factors among the urban and suburban high school sample, similar rates of self-mutilation were present. On average, 13.9% of high school students reported at least one occurrence of self-mutilation. Surprisingly to the authors, Caucasians reported the highest rate of self-mutilation, despite the diverse ethnic population among the urban high school population. Girls were likely to self-mutilate as compared to boys, with girls more likely to self-cut and boys engaging in more risk-taking behaviors. The majority of students reported that they utilized only one method to self-mutilate, with the most common being self-hitting and self-cutting. Self-report questionnaires revealed that anxiety and depressive symptoms appeared to be present in students who self-mutilate, regardless of gender.

According to Nock and Prinstein, a correlation exists between self-harm and clinical symptoms such as depression and anxiety, hopelessness, past abuse, perfectionism, and loneliness. Since such symptoms also exist in individuals who do not engage in self-mutilation, it is important to understand the underlying catalyst that motivates an adolescent to engage in behaviors such as cutting oneself. Research has demonstrated that self-mutilative behavior may be a way of tension reduction or communicating with others (Nock and Prinstein 2005).

In their article on the contextual features and behavioral functions of self-mutilation among adolescents, Nock and Prinstein developed and evaluated a theoretical model that proposes four reasons or functions of self-mutilative behavior. The model supports adolescents' engagement in self-mutilation for "automatic negative reinforcement (e.g. 'to stop bad feelings'), automatic positive reinforcement (e.g. 'to feel something, even if it is pain), social negative reinforcement (e.g. 'to avoid doing something unpleasant you do not want to do') and social positive reinforcement (e.g. 'to get attention')" (Nock and Prinstein, 2002). Contextual features such as adolescent impulsiveness to self-mutilate, the use of alcohol and drugs prior to self-mutilation, social modeling prior to the initiation of self-mutilation, and the absence of physical pain as a result of self mutilation are evaluated in the study. Results of the study indicated that individuals think about self-mutilating only for a few minutes or even less before performing the act. This is quite disconcerting as self-mutilative behavior may be difficult to treat or identify if individuals act impulsively. Additionally, the sample population indicated that alcohol or drugs were not used during self-mutilation, and most reported experiencing little or no pain. This is quite interesting as one would hypothesize that the absence of pain during self-mutilation may be associated with drug and alcohol use. It is also hypothesized that the absence of pain during self-mutilation may be due to the release of endorphins that actually block pain and thus reinforce the behavior. Studying behavioral antecedents must be a priority for future research to help counselors and others identify individuals at risk.

According to Victoria E. White Kress, many counselors have little experience with cases of self-injurious behavior. It has been shown that educating counselors on self-injurious behavior has proven effective in helping counselors assess and support clients in this unique population. Proper assessment and diagnose of this behavior is important to get a clear understanding of the level of danger a person is experiencing through self-mutilation.