Why do you hurt yourself? An introduction to self-harm

Non-suicidal self-injury (NSI) is the direct and deliberate destruction of one's own body surface, without lethal intent. Therefore, it involves self-inflicted bodily harm, without the intention of causing death.

Currently, self-harm is receiving a lot of interest from families, journalists, scientists, teachers, and educators, partly due to the increased incidence of these behaviors among young people and adolescents, and partly due to the concern and distress that the behavior generates in the people who surround these young people and adolescents.

Although ANS is not a psychiatric disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM), in its fifth version (APA, 2013), has included it as a diagnosis that requires further study.

The DSM defines non-suicidal self-injury based on the following criteria:

1. In the past year, the individual has intentionally caused self-inflicted injuries to the surface of his body for five or more days, likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessively rubbing), with the expectation that the injury will only result in mild or moderate physical damage (i.e., there is no suicidal intent).
2. The individual engages in self-harming behavior with one or more of the following expectations:
   - To obtain relief from a negative feeling or cognitive state.
   - To resolve an interpersonal difficulty.
   - To induce a state of positive feeling.
3. Intentional self-harm is associated with at least one of the following criteria:
   - Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress or self-criticism, that occur in the period immediately preceding the act of self-harm.
   - Before the act begins, there should be a period of concern about the anticipated behavior that is difficult to control.
   - Think about the self-harm that frequently occurs, even if no action is taken.
4. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious ritual) and is not restricted to scratching a scab or biting one's nails.
5. The behavior or its consequences cause clinically significant distress or interference with interpersonal, academic, or other important functioning.
6. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with neurodevelopmental disorders, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual disability, Lesch-Nyhan syndrome, stereotyped movement disorder with self-injury, trichotillomania (hair-pulling disorder), excoriation (skin-picking disorder)).

How many teenagers without any psychiatric disorder self-harm?

Historically considered a rare problem, in recent decades an increase has been observed among young people and adolescents without psychiatric disorders. When the first scientific articles on the subject were published (early 1980s), they reported a prevalence of 0.4% (percentage of cases in a population) (Pattison EM, 1983), but current international studies observe much higher prevalences.

In general, it is estimated that between 13% and 45% of adolescents worldwide have self-harmed at some point in their lives , and in Europe, the lifetime prevalence is reported to be 27.6%. In Spain, very little data is available for those under eighteen, but the figures are similar to those in Europe.

Self-harm in young people

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Therefore, the data from epidemiological research allow us to affirm that it is a phenomenon that has increased in recent years and that transcends barriers of severe mental pathology and extends among adolescents and young people in the general population in all countries and cultures.

Self-harm among adolescents with some type of mental health problem

When studying adolescents with some type of psychiatric or psychological disorder, the incidence of ANS is much higher for several reasons.

Firstly, this behavior may be one more symptom within a mental disorder that presents with other symptoms, in addition to self-harm , but in which self-harm is an inherent symptom and, therefore, very relevant for diagnosis and treatment.

This is the case of personality disorder , which is defined by a pattern of dysfunctional thinking, emotions, and behaviors due to various alterations related to mood instability, impulsivity, problems with one's own identity, and also the propensity to perform ANS.

Secondly, ANS can also be observed in adolescents with other disorders (besides BPD) as an accompanying symptom, which may be associated with this disorder, or may not occur.

In these cases, it has been observed that in adolescents with eating disorders (ED) , depressive or anxiety disorders, self-harm occurs occasionally or on a one-off basis (not always) and takes place in different ways, fulfilling different functions in coping with the difficulties of the boy or girl (as a mechanism to reduce anxiety, to socially express discomfort, etc.).

Finally, another reason that could explain the high incidence of ANS in the clinical population is contagion. An inevitable occurrence among adolescents with any psychiatric condition is admission to specialized care facilities (inpatient units, day hospitals, etc.). This has proven advantages, such as access to specialized treatment and professionals, and the benefits of group therapy with other adolescents who have the same problems, among others.

Students who self-harm

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At what age does the problem begin and what evolution is observed?

Very little data is available on the incidence and prevalence of ANS before the age of twelve, but we do know from recent studies that this behavior usually begins between the ages of eleven and thirteen.

This data is explained by the fact that adolescents are a population highly vulnerable to developing ANS, especially due to the high impulsivity and emotional reactivity that characterizes this life stage.

This is an original article from FAROS. For more information on family communication, see the   12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them."