According to a recent JAMA study,1 emergency room visits for nonfatal self-inflicted injury among boys ages 10-14 increased by 93 percent between 2001 and 2015. For girls, this rate increased by 261 percent. Substantial increases were also seen in teens ages 15-19, especially for girls.
The trends are truly alarming, according to Kristy Champignon, LPC, LMHC, ACS, Adolescent and Child Clinical Manager at Princeton House’s Hamilton site.
“Some instances of NSSI are a call for help or a desire to generate a feeling when someone feels numb,” she says. “In other cases, young people are replacing intense emotional pain—which is difficult to understand and manage—with a physical pain that they can control.”
“Tweens and teens are more frequently seeing NSSI as a viable option via peers, social media, television, and music,” she adds. “It can quickly become a vicious cycle if they experiment with NSSI and then begin to rely on it for relief.”
A Biological Component
The brain registers both emotional and physical pain in the same two areas: the anterior insula and the anterior cingulate cortex, according to Champignon. The onset of physical pain brings discomfort, but the removal of the pain stimulus provides the more pleasant experience of relief.
Due to some degree of neural overlap, this relief is sensed for both physical and emotional pain. Through NSSI, a child may inflict pain to find relief from an array of confusing, self-questioning emotions or from comorbid conditions like depression or anxiety.
Supportive Strategies
Champignon recommends that behavioral health providers be vigilant given the increasing incidence of NSSI among young people. If a child or teen is self-harming, it’s critical to involve parents in educational strategies. This includes tactics for creating a safe environment for communication, validating painful emotions, supporting the use of coping skills, and fostering self-compassion.
Dialectical behavior therapy (DBT) is an excellent treatment modality in this population, because it focuses on the main needs of a patient who is self-harming:
NEED
|
DBT STRATEGY |
Invalidating thoughts or feelings that may lead to NSSI |
Mindfulness |
Intense emotion or emotional vulnerability |
Emotion Regulation |
Ineffective communication of needs |
Interpersonal effectiveness |
Low threshold for stress; lack of skills in the moment |
Distress tolerance |
“At Princeton House, we teach DBT skills ranging from cope-ahead plans and communication skills to building a toolbox of options that young people can use in moments of distress. We help them understand that no matter how difficult things may seem, there are safe, healthy ways to address emotional pain and find relief.” — Kristy Champignon, Adolescent and Child Clinical Manager
1. Mercado, M, Holland, K, and Leemis, R. Trends in emergency department visits for nonfatal self-inflicted injuries among youth aged 10 to 24 years in the United States, 2001- 2015. JAMA 2017; 318(19):1931-1933.
For more information about child and adolescent programs at Princeton House, visit princetonhouse.org or call 888.437.1610.
Article as seen in the Winter 2019 issue of Princeton House Behavioral Health Today.
