Don’t Hurt Yourself: Patterns of Self-Injury in Adolescence

Deliberately harming oneself, for example, by cutting, burning, biting, or hitting, is known as non-suicidal self-injury (NSSI) and is a pressing health concern for adolescents. NSSI affects about 17% of US adolescents, with similar rates internationally. Although NSSI affects a minority of adolescents, it is associated with serious mental health problems and attempted suicide. Biyao Wang and colleagues examined patterns of NSSI in a sample of nearly 3,400 Chinese secondary school students aged 13 to 17 (56% female) over 3 6-month intervals. Their goals were to examine patterns of NSSI, specifically, to identify subgroups of adolescents with distinct NSSI trajectories, and to examine the developmental course of NSSI.


At Time 1 adolescents completed measures examining impulsivity, depression, anxiety, self-criticism, unstable relationships, and perceived parental criticism. At all 3 time points, spaced 6 months apart, participants reported the frequency with which they engaged in 7 NSSI behaviors within the previous 6 months: self-cutting, burning, biting, punching, scratching skin, inserting objects into the nail or skin, and banging the head or other parts of the body against the wall.

Reports of NSSI behaviors declined at each time point, with 18% of adolescents reporting engaging in NSSI within the last 6 months at Time 1 to 9% at Time 3. Cutting was the most prevalent method followed by biting, and scratching; burning was the least common method. Four distinct patterns of NSSI were identified. Three-quarters of the adolescents comprised the Negligible group, demonstrating no or trivial engagement in NSSI. A second group, the Experimental group (13%), engaged in low levels of NSSI that decreased over time to nearly no NSSI behaviors. The Moderate Decreasing group (11%) showed moderate NSSI behavior that decreased to low levels. The final group, High Fluctuating (2%), showed the most severe and chronic NSSI, with a declining trajectory, but still persistently high levels. Girls were overrepresented in the three NSSI groups.

Adolescents who engaged in self-injury reported higher levels of depression, more unstable relationships, and greater parental criticism than did adolescents who reported engaging in no NSSI behaviors. Negative emotions likely accompany poor relationships with parents and NSSI is thought to play a role in emotional regulation. In addition, impulsivity distinguished the three levels of self-injury; as impulsivity increased, so did self-reported self-injury. While most adolescents who engage in self-injury do so experimentally, a small proportion engage in severe and persistent NSSI with potential long term consequences. Screening for NSSI behaviors and the risk factors for NSSI, such as depression and poor relationships with parents, can identify adolescents most at risk for NSSI. Training in interpersonal skills, emotion regulation, and impulse control can aid adolescents who self-injure.


By Tara Kuther

Image by reewungjunerr


Read the full article:

Wang, B., You, J., Lin, M. P., Xu, S., & Leung, F. (2016). Developmental trajectories of nonsuicidal self‐injury in adolescence and intrapersonal/interpersonal risk factors. Journal of Research on Adolescence. DOI: 10.1111/jora.12273


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