Adding Insult to Injury: The Accumulation of Stigmatizing Language on Individuals With Lived Experience of Self-Injury

ABSTRACT

Language is a powerful form of communication that not only conveys ideas and knowledge but also can assign meaning and value to the world around us. As such, language has the power to shape our attitudes toward individuals, behaviors, and ideas, by labeling them (indirectly or not) as "good" or "bad." In this way, language can be used to propagate stigma and other unhelpful attitudes toward individuals who already experience stigma. One behavior that may be particularly prone to the impact of unhelpful language is nonsuicidal self-injury (NSSI). In this article, we draw on Staniland's NSSI stigma framework to demonstrate how an individual with lived experience of NSSI may be exposed to stigmatizing messaging through 30 different channels, and propose that the accumulation of these messages may be particularly damaging. We conclude by offering practical tips for clinicians and researchers wishing to empathically work with individuals who self-injure.

Exposure to and experience of self-harm and self-harm related content: An exploratory network analysis

Exposure to the self-harm behaviour of others plays a role in individuals' own self-harm thoughts and behaviours, but there has been little consideration of the broader range of mediums through which exposure to self-harm related content may occur. N = 477 participants completed an online study, including questions regarding lifetime history of self-harm thoughts and behaviours and the frequency with which they had been exposed to self-harm via various mediums. Gaussian Markov random field network models were estimated using graphical LASSO and extended Bayesian information criterion. Bootstrapping revealed that exposure mediums with a direct connection to self-harm thoughts and behaviours were the internet (rrp = .34, 95% CI [.26, .42]) and in-passing 'miscellaneous' exposure (rrp = .14, 95% CI [.00, .23]). However, stability of the network centrality was low (expected influence stability = 0.52). The node with the greatest increase in expected influence within the network was miscellaneous "in-passing" exposure. In-passing exposure is an understudied exposure medium. Our results may suggest new types of exposure mediums for future research. Data were cross-sectional, so temporal relationships between exposure and behaviour could not be determined. Low stability of the networks suggests that future similar studies would benefit from larger sample sizes.

Depiction of personal protective equipment in popular war films

Background. Personal protective equipment (PPE) is worn by military personnel to protect from combat trauma. War films may not represent PPE accurately, even when considered realistic. There is a risk that the subtle influence of films may subvert the understanding of PPE amongst military personnel and civilians. Methods. An observational study compared the depiction of PPE within popular war films to real-life. Films were included if they depicted land-based warfare. Depiction of helmets, body armour, eye protection, gloves, combat boots and hearing protection was compared to benchmarks. Trends in PPE over time were analysed using linear regression. Results. There were 73 combat scenes viewed from 16 films. Combat boots were the most depicted (72 scenes; 99%); hearing protection was the least (two scenes; 3%). There were statistically significant differences in PPE adherence between real life and films for all items of PPE (p < 0.05), except for combat boots (p = 0.621). There were improvements over time for all PPE except for hearing protection. Conclusions. PPE adherence in modern war films is poor, but has improved over time. There is a hypothetical risk that this has a negative impact on perceptions by both civilians and military personnel.

Thoughts, images, and appraisals associated with acting and not acting on the urge to self-injure

OBJECTIVES

The aim of this study was to examine the frequency, content, and appraisals of thoughts and images occurring during urges to engage in non-suicidal self-injury (NSSI).

METHOD

Undergraduates (N = 154) with a history of NSSI completed an online survey of their thoughts, images, and appraisals when they acted on urges to engage in NSSI as well as when they resisted urges to self-injure.

RESULTS

Most (>90%) participants reported experiencing both thoughts and images during urges to engage in NSSI. During urges that resulted in self-injury, self-critical and hopeless thoughts were most distressing, and thoughts about relief from emotional distress were most comforting. Images of the anticipated injury were most common. During urges that did not result in self-injury themes of the futility of NSSI, positive self-talk, and the impact on others were most common. Images were most frequently of the negative impact on self and others, and the anticipated injury. Appraisals encouraging NSSI occurred when individuals did and did not act on their urges, but concurrent strong discouraging appraisals appeared to be protective on occasions when urges did not result in self-injury.

LIMITATIONS

Retrospective self-report was used to assess cognitive content. Generalisability of findings to non-student samples needs to be assessed.

CONCLUSIONS

Findings from this study may inform comprehensive assessment of thoughts and images associated with urges to engage in NSSI. NSSI interventions may need to promote thoughts, imagery and appraisals that discourage NSSI whilst simultaneously modifying cognitions that encourage NSSI.

Social exposure and emotion dysregulation: Main effects in relation to nonsuicidal self-injury

We examined the relation of interpersonal and media exposure to nonsuicidal self-injury (NSSI) among 340 university students in the southeastern United States (73.5% female, M age = 19.38 years, SD = 1.15). We also assessed interactions and main effects of each exposure and emotion dysregulation in relation to NSSI, testing the social learning hypothesis of NSSI. Most participants endorsed medium to high levels of exposure to NSSI via media sources. More than one-third of participants were somewhat or very familiar with someone who engaged in NSSI. Almost half reported occasional or frequent conversations about NSSI. Both exposure forms were significantly related to NSSI history. However, hurdle regression analyses revealed that interpersonal exposure and emotion dysregulation, but not media exposure, were significantly associated with NSSI history and frequency. We did not find evidence for an emotion dysregulation-by-interpersonal-exposure interaction. We discuss implications for theoretical models of NSSI, limitations, and future directions.

Examining the scope and patterns of deliberate self-injurious cutting content in popular social media

BACKGROUND

Social networking services (SNS) have rapidly become a central platform for adolescents' social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram.

METHODS

Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching "#cutting" on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined.

RESULTS

Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and <1% included formal recovery resources. Instagram posts displayed the greatest proportion of graphic content and negative self-evaluations, whereas Twitter exhibited the smallest proportion of each.

CONCLUSIONS

Findings characterize the graphic nature of online SNS deliberate self-injury content and the relative absence of SNS-posted resources for populations seeking out deliberate self-injurious cutting content. Mental health professionals must recognize the rapidly changing landscape of adolescent media consumption, influences, and social interaction as they may pertain to self-harm patterns.

Adolescent Daughters and Ritual Abjection: Narrative Analysis of Self-injury in Four US Films

Media representations of illnesses, particularly those associated with stigma such as non-suicidal self-injury (NSSI), not only define health conditions for mass audiences, but generally do so in ways that are consistent with dominant ideologies. This article examines the construction of non-suicidal self-injury as practiced by female adolescents and young adults in four US films: Girl, Interrupted, Painful Secrets, Prozac Nation, and Thirteen. The methodology used to examine the films' narrative structure is Kenneth Burke's dramatism, while Julia Kristeva's concept of abjection informs the analysis. On one hand, a paradigmatic reading suggests that the films frame self-injury as resistance to repressive maternal domination of female adolescents. On the other hand, syntagmatic analysis reveals a privileged response to NSSI in the form of pacification administered by psychotherapists functioning as the return of the phallic-mother fantasy.

Frequency of Exposure to and Engagement in Nonsuicidal Self-Injury Among Inpatient Adolescents

This study examined the relationship between frequency of exposure to non-suicidal self-injury (NSSI) and engagement in NSSI among adolescents. Ninety inpatient adolescents with a history of NSSI, ages 12 to 17, completed a structured interview. The majority of participants had learned about NSSI prior to initiating the behavior themselves. More frequent exposure to specific methods of NSSI was associated with greater frequency of using those same methods. Greater exposure to NSSI in the media and seeking out NSSI content were related to greater frequency of engagement in NSSI. Clinicians may help those who self-injure to become more knowledgeable and educated consumers of media to prevent NSSI behavior and contagion.

The Relationship Between Nonsuicidal Self-Injury and Family Functioning: Adolescent and Parent Perspectives

We explored parent and adolescent reports of family functioning, how this differed if the parent was aware that their child self-injured, and how parental awareness of self-injury was related to self-injury frequency, self-injury severity, and help seeking. Participants were 117 parent-adolescent dyads, in 23 of which the adolescent self-injured. Adolescents who self-injured reported poorer family functioning than their parents, but parents who did not know about their child's self-injury reported similar functioning to parents whose children did not self-injure. Parents were more likely to know that their child self-injured when the behavior was severe and frequent. Help-seeking was more likely when parents knew about self-injury. Family-based interventions which emphasize perspective-taking could be used to effectively treat self-injury.