Adolescents Self-Injurious Behavior
Self-Injurious behaviors (SIB) are typically behaviors that involve people intentionally harming themselves for socially unidentified reasons without suicidal intent. Studies have extensively sought to highlight the causes, nature, and possible treatments for SIBs. SIB is sometimes regarded as suicidal behavior yet it is normally done without the intention of committing suicide (Whitlock, Eckenrode, & Silverman, 2006).
SIB includes a number of behaviors that comprise: scratching, intentional skin puncturing, ripping of hair or skin, self-bruising and cutting of the skin (Whitlock et al., 2006). Body piercings and tattoos may not fall under this category unless they get imposed with the aim of harming the body. The injuries sustained from inflicting self-injurious wounds may be superficial or may end up becoming a permanent disfigurement. In an attempt to explain why people engage in SIB, various hypotheses were formulated since no one can single out the sole cause of self-inflicted behaviors.
The social learning hypothesis elaborates that most of our behaviors is a result of observation and assimilation of other people’s behaviors (Nock, 2010). The assertion can apply validly in explaining both pathological e. g. playing football, and non-pathological e. g. drug use behaviors. People may be attracted to SIBs from the influence of what they have learned or observed from other people regarding this heinous behavior. Adolescents are more likely to get influenced through peer groups and social pressure to engage in SIBs like risky sexual behavior and drug use in an attempt to fit in with their fellow peers.
Self-punishment hypothesis also forms a credible reason for adolescents to engage in SIBs in a struggle to punish themselves for a wrong-doing or a physical reflection of self-deprecation and self-injury. Recent research findings have established that self-reprimanding is one of the main causes of SIBs while self-hatred and self-criticism are the cognitive gears that trigger self-injury episodes. Self-punishment may also be aggravated by self-criticism of perceived failures, thus resulting in self-abuse manifested as SIB (Nock, 2010).
The implicit attitude hypothesis (also known as the identification hypothesis) highlights adolescents’ tendency to adopt behaviors based on how they identify with that particular behavior. Adolescents’ perceptions of behaviors are predictive of their behavioral responses (Nock, 2010). An adolescent may engage in SIB as a result of his/ her implicit attitude towards an act relative to other similar behaviors. The obnoxious act is normally prompted by the adolescent’s urge to realize emotional, cognitive, or social control.
Social signaling hypothesis is another causative factor to heed when trying to explain why adolescents engage in self-injurious behaviors (SIBs). The hypothesis asserts that people harm themselves as a way of communicating or showing distress since its more effective than other forms of communication. Adolescents may resort to using SIBs to elicit social attention that they may not get when they use other communicational signals like talking (Nock, 2010).
Pain analgesia/ opiate hypothesis’ role in triggering self-injurious behavior should not get undermined. The anticipated pain of engaging in self-injury keeps many adolescents away from engaging in SIBs. The few adolescents who do not experience the pain aversion feeling are more likely to engage in self-injurious behaviors since they reportedly feel little or no pain during the self-injury infliction process.
Lastly, the pragmatic hypothesis highlights self-injurious behavior’s fast, effective and simple nature as the stem reason behind adolescents engaging in SIBs as a form of controlling their experiences. Since adolescents are more unlikely to possess resilience skills essential for handling stressful experiences, they are more likely to engage in self-injurious behaviors as a suitable alternative (Nock, 2010).
In spite of the malicious and recurrent nature of SIBs, the adolescents who engage in self-injurious behaviors can seek treatment to help them get rid of this gruesome behavior. Clinicians who handle adolescents that suffer from SIBs may adopt two psychological approaches to help their clients outgrow the urge to engage in SIBs.
They may employ the use of behavioral therapy in treating adolescents of self-injurious behaviors especially those with developmental disabilities (Hollander, Nock, & Teper, 2007). The therapy encompasses conducting a keen behavioral assessment and singling out of the purpose self-injury serves in each case. The process is subsequently followed by dispensing of reinforcement-based interventions. That procedure can be productive for adolescents with or without developmental disabilities.
The second form of treatment, dialectical behavior therapy (DBT), is a treatment usually dispensed to both suicidal and non-suicidal clients. Application of DTB has been proven to be quite effective in reducing self-injury cases especially when administered to adolescents (Hollander et al., 2007). The therapeutic approach integrates concepts of cognitive therapy and behavior therapy amongst other approaches.
When using DTB, the clinician identifies the target behavior that requires alteration and forms strategies to counter it. The clinician assists the clients to understand the triggers and aftermath of their behavior in an effort to help them modify such behaviors. Similar to the behavior therapy, the clinician also attempts to create a conducive atmosphere for behavior change. The clinician shares the treatment plan with the adolescent’s family and advises them on how to interact with the client (Hollander et al., 2007).
Although DBT highly borrows concepts from behavioral therapy, it highly recommends acceptance. The delicate nature of seeking equilibrium of change and acceptance forms a distinctive aspect of DBT. The term dialectic implies a philosophical strategy in which truth gets salvaged from two opposing concepts into a new whole. It is the mixing of thesis and antithesis to produce a synthesis. Paying attention to both truth and acceptance is essential in the treatment of self-injury (Hollander et al., 2007). SIB gets triggered by an adolescent’s inability to avert thoughts and feelings, thus accepting and learning to cope with one’s situation rather than struggling to change these situations can be highly beneficial.
DBT’s focus on tolerance and acceptance is also common with exposure-based approaches used in treatments that involve clinicians aiding their clients to face feared or avoided stimuli rather than avoiding them. Adolescents who participate in DBT sessions take part in weekly therapeutic sessions that subsequently commence after the clinician and the client unanimously agree to commit to the treatment process. Some of the weekly set periodical targets include reducing risky harmful behaviors, reducing therapy-distracting behaviors, and increasing behavioral skills (Hollander et al., 2007).
The outpatient form of DBT takes around 16 weeks to conclude, which is noticeably shorter than the prescribed time span allotted for grown-ups DBT. A rigorous program for DBT patients is currently being tested. The program is expected to demand for a shorter time with clients attending 4 hours of intensive DBT group therapy sessions. The program is meant as a treatment for suicidal adolescents and those that face a high risk of engaging in highly perilous behaviors (Hollander et al., 2007).
In conclusion, adolescent self-injury is a common yet harmful behavior that responds to psychological treatment. The adverse consequences make it a condition deserving of great concern and urgency.
Hollander, M., Nock, M. K., & Teper, R. (2007). Psychological Treatment of Self-Injury among Adolescents. Journal of Clinical psychology, 63(11), 1081-1089. Retrieved from: http://www. brown. uk. com/selfinjury/nock%26teper. pdf
Nock, M. K. (2010). Self-Injury. Annual Review of Clinical Psychology. Annual Review of Clinical Psychology, 6, 339-3363. Retrieved from http://www. wjh. harvard. edu/~nock/nocklab/Nock_ARCP_2010. pdf
Whitlock, J. L., Eckenrode, J. E.,& Silverman, D. (2006). Self-injurious behavior in a college population. Pediatrics, 117(6). Retrieved fromhttp://www. researchgate. net/profile/Janis_Whitlock/publication/7041804_Self-injurious_behaviors_in_a_college_population/links/09e41510d38ab3086c000000