A Multi-Dimensional Perspective of Adolescents' Self-Cutting

Digital self-harm and suicidality among adolescents

BACKGROUND

Research on digital self-harm - the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself - is still in its infancy. Yet unexplored is whether digital self-harm is related to suicidal ideation or suicide attempts.

METHODS

In the current study, survey data were collected in 2019 from a national sample of 4972 American middle and high school students (M_age  = 14.5; 50% female). Logistic regression analysis was used to assess whether lifetime engagement in two different indicators of digital self-harm was associated with suicidal thoughts and attempts within the past year.

RESULTS

Logistic regression analysis showed that engagement in digital self-harm was associated with a five- to sevenfold increase in the likelihood of reporting suicidal thoughts and a nine- to 15-fold increase in the likelihood of a suicide attempt.

CONCLUSIONS

Results suggest a connection between digital self-harm and suicidality. As such, health professionals must screen for digital self-harm to address underlying mental health problems among youth that may occur prior to or alongside suicidality, and parents/caregivers must convey to children that they are available to dialog, support, and assist with the root issues that may eventually manifest as digital self-harm.

Non-Suicidal Self-Injury Among Adolescents: A Structural Model with Socioecological Connectedness, Bullying Victimization, and Depression

The objective was to examine the associations of socioecological connectedness with bullying victimization and depressive symptoms in early adolescence and with non-suicidal self-injury (NSSI) in mid-adolescence, and how these might differ between genders. Diverse adolescents (N = 4115; 49.1% girls) in the 7th grade reported on connections with parents/family, peers, school, and neighborhood, as well as bullying victimization and depressive symptoms, and NSSI in 10th grade (M^e = 16.1 years). Structural equation modeling with WSLMV indicated that the lower likelihood of NSSI in 10th grade was associated with higher perceptions of connections between adolescents and their families, both directly as well as indirectly through reduced bully victimization and depressive symptoms three years earlier. Higher school connectedness was indirectly associated with the lower likelihood of NSSI through bullying victimization and depressive symptoms. Paths to NSSI varied for girls and boys. Results advance the understanding of developmental pathways leading to NSSI in adolescent girls and boys.

Examining the Neurobiology of Non-Suicidal Self-Injury in Children and Adolescents: The Role of Reward Responsivity

Although prior work has shown heightened response to negative outcomes and reduced response to positive outcomes in youth with a history of non-suicidal self-injury (NSSI), little is known about the neural processes underlying these responses. Thus, this study examined associations between NSSI engagement and functional activation in specific regions of interest (ROIs) and whole-brain connectivity between striatal, frontal, and limbic region seeds during monetary and social reward tasks. To test for specificity of the influence of NSSI, analyses were conducted with and without depressive symptoms as a covariate. We found that NSSI was associated with decreased activation following monetary gains in all ROIs, even after controlling for depressive symptoms. Exploratory connectivity analyses found that NSSI was associated with differential connectivity between regions including the DS, vmPFC, insula, and parietal operculum cortex when controlling for depressive symptoms. Disrupted connectivity between these regions could suggest altered inhibitory control of emotions and pain processing in individuals with NSSI. Findings suggest dysfunctional reward processes in youth with NSSI, even very early in the course of the behavior.

Longitudinal analysis of adolescent NSSI: the role of intrapersonal and interpersonal factors

Non-suicidal self-injury (NSSI) occurs in approximately 10 % of adolescents. To establish effective prevention and intervention initiatives, it is important to understand onset, maintenance and cessation of NSSI. We explored whether the relationships between interpersonal factors (i.e. attachment, social support) and NSSI were mediated by intrapersonal factors (i.e. emotion regulation, self-esteem, self-efficacy). Participants were 1973 students (1414 female and 559 male) aged between 12 and 18 years (M = 13.89, SD = 0.97) recruited from 40 Australian high schools. Participants completed a questionnaire at two time-points with a 12-month interval. At baseline, 8.3 % of adolescents engaged in NSSI, increasing to 11.9 % at follow-up. Family support was most salient in onset, maintenance and cessation of NSSI. Attachment anxiety was related to NSSI onset. Of the intrapersonal variables, self-esteem and self-efficacy were significant in predicting onset of NSSI. Self-esteem, self-efficacy and cognitive reappraisal mediated the relationship between attachment anxiety and NSSI onset. A combination of interpersonal and intrapersonal variables contributes to the onset, maintenance and cessation of NSSI in adolescence. Perceived family support appears to be an important safeguard against NSSI. Strategies targeting family functioning and teaching cognitive reappraisal techniques to adolescents may reduce the number engaging in NSSI.

The attitudes of psychiatric hospital staff toward hospitalization and treatment of patients with borderline personality disorder

BACKGROUND

Negative attitudes towards patients with borderline personality disorder (BPD) may affect their treatment. We aimed to identify attitudes toward patients with BPD.

METHODS

Clinicians in four psychiatric hospitals in Israel (n = 710; psychiatrists, psychologists, social workers and nurses) were approached and completed questionnaires on attitudes toward these patients.

RESULTS

Nurses and psychiatrists reported encountering a higher number of patients with BPD during the last month, and exhibited more negative attitudes and less empathy toward these patients than the other two professions. The whole sample evaluated the decision to hospitalize such a patient as less justified than the decision to hospitalize a patient with Major Depressive Disorder. Negative attitudes were positively correlated with caring for greater numbers of patients with BPD in the past month and in the past 12 months. Nurses expressed the highest interest in studying short-term methods for treating patients with BPD and a lower percentage of psychiatrists expressed an interest in improving their professional skills in treating these patients.

CONCLUSIONS

The findings show that nurses and psychiatrists differ from the other professions in their experience and attitudes toward patients with BPD. We conclude that nurses and psychiatrists may be the target of future studies on their attitudes toward provocative behavioral patterns (e.g., suicide attempts) characterizing these patients. We also recommend implementing workshops for improving staff attitudes toward patients with BPD.

Binge/purge thoughts in nonsuicidal self-injurious adolescents: an ecological momentary analysis

OBJECTIVE

Adolescents who self-injure often engage in bingeing/purging (BP). Ecological momentary assessment (EMA) has potential to offer insight into the relationship between self-injury and BP. The aims of this study were to examine the frequency and context of BP using EMA in a sample of nonsuicidal self-injurious (NSSI) adolescents.

METHOD

Thirty adolescents with a history of NSSI responded to questions regarding self-destructive thoughts/behaviors using a palm-pilot device. Descriptive analyses compared thought/behavior contexts during reports of BP and NSSI thoughts/behaviors (occurring together vs. individually).

RESULTS

BP thoughts were present in 22 (73%) participants, occurring on 32% of the person-days recorded; 59% of these participants actually engaged in BP behavior. Seventy-nine percent of BP thoughts co-occurred with other self-destructive thoughts. Adolescents were more often with friends/peers than alone or with family when having BP thoughts. Worry and pressure precipitated both BP and NSSI thoughts, but perceived criticism and feelings of rejection/hurt were associated more often with BP thoughts than with NSSI thoughts.

DISCUSSION

BP thoughts and behaviors were common in this sample, often occurring with other self-destructive thoughts. Future EMA research is needed to address the function of BP symptoms, the contextual variables that increase risk for BP thoughts, and the factors that predict the transition of thoughts into behaviors in adolescents with and without self-injury.

The role of forgiveness in adolescents who engage in nonsuicidal self-injury

The present study is an exploratory investigation assessing the role of forgiveness of self and forgiveness of others in adolescent nonsuicidal self-injury (NSSI). Participants included a diverse sample of self-injuring adolescents (N = 30). Results indicated that lack of self-forgiveness was associated with engaging in NSSI for specific reasons related to the regulation of emotions and social functioning, namely to get rid of unwanted emotions, to feel something due to feeling numb or empty, and to communicate with others. Lack of self-forgiveness was also associated with greater lifetime frequency of NSSI. No relationship was found between forgiveness of others and NSSI. The implications of these findings are discussed in relation to Dialectical Behavior Therapy for NSSI, traditional forgiveness interventions, and treatment of youth who engage in NSSI.

A systematic literature review: self-mutilation among adolescents as a phenomenon and help for it-what kind of knowledge is lacking?

The aim of this review article is to present current knowledge of self-mutilation among adolescents as a phenomenon and to define what kind of knowledge is lacking based on existing literature. The literature searches were executed in the CINAHL and Medline databases in 2010. The analysed data consisted of 126 articles and inductive content analysis was carried out. Existing knowledge of self-mutilation was categorized into the following two classes: (1) self-mutilation as a phenomenon and (2) caring for persons who self-mutilate or self-harm.

Longitudinal prediction of adolescent nonsuicidal self-injury: examination of a cognitive vulnerability-stress model

Virtually no longitudinal research has examined psychological characteristics or events that may lead to adolescent nonsuicidal self-injury (NSSI). This study tested a cognitive vulnerability-stress model as a predictor of NSSI trajectories. Clinically-referred adolescents (n = 143; 72% girls) completed measures of NSSI, depression, attributional style, and interpersonal stressors during baseline hospitalization. Levels of NSSI were reassessed 3, 6, 9, 15, and 18 months later. Latent growth curve analyses suggested that a cognitive vulnerability-stress interaction significantly predicted increases in NSSI between 9 and 18 months post-baseline. This association remained significant while considering the longitudinal association between depressive symptoms and NSSI; results were not significantly mediated by depressive symptoms at 9 months.

Descriptions of help by Finnish adolescents who self-mutilate

PURPOSE

The purpose of this study is to describe help from the viewpoint of self-mutilating Finnish adolescents.

METHODS

Methodological triangulation was used in data collection. Written descriptions were provided by 62 self-mutilating adolescents (aged 12-21 years) of the help they received and wished to receive, and individual interviews were conducted with 10 self-mutilating adolescents (aged 15-22 years). Qualitative content analysis was applied.

FINDINGS

Three groups of people that can be of help were identified by the self-mutilating adolescents: age-mates, including peers and fellow self-mutilating adolescents; loved ones; and adults, including unknown adults, health and social care professionals, teachers and school counsellors, and parents. Factors contributing and hindering to help were identified.

CONCLUSIONS

Self-mutilating adolescents want to be helped and, in their opinion, adults are duty-bound to help and care for them.

[What is self-harm?]

BACKGROUND

The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm.

MATERIAL AND METHOD

The basis for the article is a non-systematic literature search of the electronic databases Medline, PsychInfo and EMBASE (1985 - 2008). and our own archive of literature on self-harm.

RESULTS

There is some evidence for an increase in the prevalence of self-harm. Among possible risk factors are childhood abuse, abandonment, neglect, trauma and separation, and the affective quality of the attachment bonds in childhood. A common factor is self-harm as a bodily practice for affect regulation, and as such, it can be understood as a dysfunctional competence.

INTERPRETATION

To search for understanding of self-harm in individual, familiar and cultural contexts contributes to meet individuals with such tendencies with empathy and beneficial interventions.

Psychiatric correlates of nonsuicidal cutting behaviors in an adolescent inpatient sample

This archival study of 288 adolescent psychiatric inpatients examined the psychiatric correlates of cutting behavior. Participants were categorized into Threshold cutters (n = 61), Subthreshold cutters (n = 43), and Noncutters (n = 184). Groups were compared on psychiatric diagnoses, suicidality, and self-reported impairment. Results demonstrated that females were more likely to cut relative to males; however, gender did not affect the correlates of cutting behavior. Adolescents in the Threshold group were more likely to be diagnosed with Major Depression and had higher self-reported suicidality, depression, and trauma-related symptoms of depression and dissociation relative to the Noncutting group. The Subthreshold group did not differ from the other groupings except for an elevated risk for Posttraumatic Stress Disorder compared to the Noncutting group.

Deliberate self-harm in children and adolescents: a qualitative study exploring the needs of parents and carers

Deliberate Self-harm (DSH) is a serious public health problem and is becoming more prevalent among young people in Ireland. Research tends to focus on the DSH patient. However, parental involvement is recognized as an important factor in their child's prognosis. This study aimed to describe parents' and carers' experiences of self-harm in their child in order to identify their support needs. A focus group methodology was used to generate qualitative data. Representative participants whose children had engaged in suicidal behaviour were recruited from the Paediatric Emergency, Child and Adolescent Mental Health Teams and Family Support Services. Twenty-five participants attended the focus group meeting. A transcript-based conceptual analysis was conducted to identify and explore emerging themes. Participants expressed the need for support; information about suicidal behaviour in young people; skills for parenting an adolescent; and advice on managing further incidents. Parents described significant difficulties in family communication, in parent-child relationships, and in the area of discipline following self-harm. These findings support current research that identifies the need for service development and information for parents/carers of young people who self-harm.

Rorschach correlates of adolescent self-mutilation

The present study examined various Rorschach variables of aggression, dysphoric affect, and disordered thinking in relation to self-mutilation in samples of self-mutilating (SM; n=16) and nonself-mutilating (N-SM; n=26) adolescent inpatients. Categorical comparisons indicated that SM patients had significantly higher mean scores for Aggressive Past (AgPast), but not for Aggressive Content (AgC), Aggressive Movement (AG), Morbid Content (MOR), Inanimate Movement (m), Sum Shading (SumY), and the Perceptual-Thinking Index (PTI), than N-SM patients. Additionally, logistic regression results suggested that PTI and AgPast were the most robust predictors of group membership. The authors propose that self-mutilating adolescents may struggle with internally directed aggression and victimized sense of self that, when coupled with disordered thinking, significantly predicts self-mutilation.

Descriptions of self-mutilation among Finnish adolescents: a qualitative descriptive inquiry

The purpose of this study was to describe self-mutilation from the perspectives of self-mutilating adolescents. A qualitative descriptive design was adopted. Self-mutilating adolescents were asked to write descriptions of their self-mutilation. Data analysis revealed three major categories: descriptions of the factors contributing to self-mutilation, descriptions of the act of self-mutilation, and descriptions of the sequels of self-mutilation. This study adds to our understanding of self-mutilation and the experiences of self-mutilating adolescents. In nursing practice and education, self-mutilation should be discussed based on existing knowledge to make nurses more familiar with it. Nurses should understand this phenomenon as a challenge for developing effective nursing practices.

A critical review of explanatory models for self-mutilating behaviors in adolescents

The present paper presents critical reviews of studies that have explored models of adolescent self-mutilation. Current definitional problems were addressed, as well as a proposal for a classification system of self-mutilation. Seven historically significant explanatory models were included, the sexual/sadomachistic model, the depersonalization model, the interpersonal/systemic model, the suicide model, the physiological/biological model, the affect regulation model, and the behavioral/environmental model. Each model was briefly described, and studies were critiqued according to methodology, research design, and basis upon which authors provided support or rejection of a model. Suggestions for improvement in the literature were made throughout the paper. Studies often overlapped within the models, and the strongest empirical support was shown for the behavioral/environmental model, which included components of the affect regulation model, interpersonal/systemic model, and depersonalization model. Explaining adolescent self-mutilation is a complex task, and evidence provided in this paper suggests that aspects of several models, or an integration of models, likely contribute to the understanding of this phenomenon.

Learning to observe relationships and coping

Milieu relationships provide the critical background presence to staff's attempts to motivate, regulate, and teach patients how to cope with stress. Forging a connection with hospitalized children and adolescents demands attention to how they respond to adults and engage with staff around milieu expectations. Assessment guides that deal with these issues are presented. Important aspects of children's relatedness are presented in the context of their working models of adults and the influence of these representations on their response to staff. Coping skills are explained with particular emphasis on behavioral coping strategies. Tied to the assessment process are interventions that emphasize staff's role in helping patients manage strong affects and avoid the use of nonproductive behavior regulation strategies.