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Self-Injuring Adolescents on the Rise
Years ago, adolescents who deliberately injured themselves were usually considered to be in danger of suicide or in the throes of serious pathology. But today, an estimated 14 to 17 percent of adolescents deliberately cut, bite, pinch, burn, or abrade themselves, and while such behavior is always a cause for concern, it's no longer necessarily a cause for alarm. Even the behavior's designation has changed, from self-mutilation to the less frightening non-suicidal self-injury (NSSI).
Why the increase in NSSI? For one thing, the behavior has gained more peer acceptance. Among the heavily tattooed and pierced crowd, says Janis Whitlock, director of Cornell University's Research Program on Self-Injurious Behaviors, it's often a ritualistic act—an initiation and a declaration of where you stand. The wider culture has also made NSSI more acceptable. "We've gone from having almost no pop coverage of self-injury to celebrities like Princess Diana, Johnny Depp, and Angelina Jolie saying this is something they themselves used to express their emotional state," says Whitlock. Paradoxically, when the glamorati try to discourage NSSI, they may inadvertently encourage it. A 1999 study of eating disorder prevention programs for college students led by psychologist Traci Mann suggests that young people who see successful people who've survived the behavior believe that they, too, can eventually transcend its negative effects.
Whitlock sees several other motivations for the growing incidence. For some, it's primarily a novelty: their friends have done it and they want to see what it feels like. For others, it's a drive for self-preservation—an attempt to remind themselves that they can physically or emotionally feel something. Amid the confusion, despair, and isolation that goes along with adolescence, NSSI can often be an attempt to achieve self-efficacy, rather than a practice session for annihilation.
But for a small subset of self-injurers, severe pathology and suicide are distinct possibilities. A study in the February 2008 Journal of Consulting and Clinical Psychology by David Klonsky of New York's Stony Book University finds that about 11 percent of self-injuring college students are suicidal risks. Unlike other self-injurers, they're less likely to hurt themselves for socially reinforcing reasons, but do it in private and keep it secret, attempting to deliberately punish themselves.
Many kids who self-injure, says Whitlock, may just need help identifying and coping with their own feelings or with peer or family issues, which can be done relatively quickly with brief counseling. A few sessions often will be enough to help them realize that they have agency and that they can make other choices, like exercising or talking to friends, when they need to feel better. "The last thing we want to do for these kids," she says, "is reinforce the narrative that they're victims and that this behavior isn't something they can choose to stop, and without a lot of help."
However, if the behavior persists, it should be taken seriously, notes Whitlock. "Our studies show that someone with a history of NSSI is nine times more likely to make a suicide attempt than someone without one. Because of this, we suggest that the presence of NSSI history trigger suicide assessment."