What Factors Influence Self-Injurious Behavior?

What Factors Influence Self-Injurious Behavior? by Heather P.

The purpose of this post is to discuss the causes and manifestations of self-injurious behaviors in the youth population. This author will discuss evidenced-based treatment modalities that will be helpful in managing self-injurious behaviors in this population. According to Son et al. (2021) self-injurious behavior is a broad class of behaviors that occur from the direct and deliberate harm of an individual’s own body tissue without the intent of dying. This behavior usually manifests in early adolescence between the ages of 12-14 for the purpose of helping the child regulate their emotions, resolve conflict or to fulfill a social purpose that helps the child get their needs met (Boland et al, 2022; Son et al, 2021). Self-harming behaviors are generally described in terms of mild, moderate, or extreme depending on the level of injury or amount of harm done to the body (Yearwood et al., 2012). Mild to Moderate forms of injury include hitting or head banding, picking wounds, 1st degree burns and needle sticking. More severe manifestations can include deep cutting or carving of skin, object insertion, 2nd /3rd degree burns or purposeful ingestion of toxic substances (Son et al, 2021; Yearwood et al, 2012).

Self-injurious behaviors occur more often in adolescents who have psychiatric diagnosis such as anxiety, depression, borderline personality disorder (Son et al, 2021), PTSD, or eating disorders (Yearwood et al, 2012). Adolescents with poor impulse control, history of physical or sexual abuse, low self-esteem or those experiencing chronic or overwhelming stress also show a higher prevalence for engaging in self-injurious behaviors (Yearwood et al, 2012). To help these adolescents have the best outcomes it is important for advance practice nurse practitioners to watch for signs such as wearing clothing not appropriate for the season examples would be wearing long sleeve/jack in the summer, unexplained injuries or histories that do not match the presentation of wounds or vague complaints of headache, sleep disturbances, anxiety, or depression (Yearwood et al, 2012). Early recognition and referral for treatment is very important to prevent behaviors from escalating and becoming the adolescents go to coping skill when faced with unpleasant emotions or situations.

Evidence-based treatment modalities that are currently recognized for the treatment of self-injurious behaviors include Dialectical Behavior Therapy (DBT), Cognitive-Behavioral Therapy (CBT) and Mentalization-Based Treatment for adolescents (MBT-A) (Glenn et al, 2019; Kaess et al, 2019). DBT for adolescents involves participation in weekly individual therapy, weekly multifamily group skills training (i.e., mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills), telephone coaching with the therapist, and weekly consultation among the treatment team. The goal of DBT is to support the child in developing skills needed to reduce emotional, interpersonal, and behavioral dysregulation therefore reducing or eliminating the need for self-injurious behaviors (Glenn et al, 2019). Cognitive- Behavioral Therapy (CBT) aims to reduce the use of self-injurious maladaptive behaviors by modifying cognitive distortions and enhancing emotional regulation, problem solving and communication skills (Glenn et al, 2019). It is important to identify treatment options available in your area as they may be limited do to patient insurance, location, and provider or agency options.

References- Hanging indentation was not retained

Boland, R. J., Verduin, M. L., Ruiz, P., & Sadock, B. J. (2022). Substance Use and Addictive Disorders. In Kaplan & Sadock's Synopsis of Psychiatry (12th ed., pp. 333). essay, Wolters Kluwer.

Glenn, C. R., Esposito, E. C., Porter, A. C., & Robinson, D. J. (2019). Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth. Journal of Clinical Child & Adolescent Psychology, 48(3), 357–392. https://doi.org/10.1080/15374416.2019.1591281

Kaess, M., Koenig, J., Bauer, S., Moessner, M., Fischer-Waldschmidt, G., Mattern, M., Herpertz, S. C., Resch, F., Brown, R., In-Albon, T., Koelch, M., Plener, P. L., Schmahl, C., & Edinger, A. (2019). Self-injury: Treatment, Assessment, Recovery (STAR): online intervention for adolescent non-suicidal self-injury - study protocol for a randomized controlled trial. Trials, 20(1), 425. https://doi.org/10.1186/s13063-019-3501-6

Son, Y., Kim, S., & Lee, J.-S. (2021). Self-Injurious Behavior in Community Youth. International Journal of Environmental Research and Public Health, 18(4). https://doi.org/10.3390/ijerph18041955

Yearwood, E. L., Pearson, G. S., & Newland, J. A. (2012). Child and adolescent behavioral health: A resource for advanced practice psychiatric and primary care practitioners in nursing. Wiley Blackwell.