Self-harm and adolescence
Self-harm, which includes self-injury as well as self-poisoning, refers to the intentional administration of bodily injuries, mainly without any suicidal intentions. Morris (2011) defines self-harm as a portrayal of personal distress, which usually takes place in private when a person injures him/herself. The most popular form of self-harm includes skin-cutting although the term can refer to a broader range of behaviors such as hair pulling, burning, scratching, hitting oneself of a hard service as well as swallowing of toxic substances. This indicates that self-harm is solely behavioral and only constitute of a wide spectrum of risky behaviors. Such risky behaviors may range from smoking, substance misuse, tattooing, restraining from food as well as promiscuity (Kim, 2011). Self-harm is common and rapidly increasing among adolescents and has thus raised concern especially among processionals. This is because they perceive it as an expression of mental disturbance that require serious professional attention. This paper evaluates current knowledge on self-harm among adolescents aged between 13 and 18 years old. It also reviews the various challenges that the at-risk population faces as a result of their life situation as well as the various interventions needed to help them out of these challenges.
Self-harm among adolescents aged between 13 and 18 years old
Adolescents aged between thirteen and eighteen years constitute to the primary at-risk population in regard to self-harm. This has raised significant public concern despite the fact that most self-harming cases perceived to be a behavioral aspect do not attract professional attention. However, self-harm as an expression of mental illness and a sign of medical phenomenon has attracted significant attention both in the professional and public domain. For instance, Alain (2015) discovered that over 70% of adolescents aged between 13 and 18 years were admitted to hospital for engaging in conducts such as self-poisoning, which are mainly associated with self-harm. Subsequently, Morris (2011) conducted an in-depth analysis among adolescents within the same age bracket to investigate how prevalent the problem was at the community level. Findings of the in-depth analysis showed that over 13.2% of the participants had attempted to harm themselves at a certain point in their lives while 6.9% of these participants reported to have attempted self-harm within the previous year. Over 15% of participants in the survey reported to have encountered suicidal thoughts. Further findings indicated that 54% of adolescents reporting to have attempted or undertaken self-harm actions reported more than one incident. Those admitted in hospitals only represented 12.6% of adolescent reporting self-harm incidents.
Further statistical evidence was compiled by Kim (2011), and it shows that self-harm is more prevalent to adolescents with developmental disabilities as well as various types of eating disorders than those without. It is also more prevalent among female adolescents exhibiting various developmental disabilities than male adolescents with similar disabilities. Further scholarly evidence shows that most adolescents engage in self-harm as a quick liberation from emotional distress. For instance, adolescents engaging in this action believe that the experience would numb away undesirable thoughts as well as feelings. Such feelings include emotional separation by parents, the desire to fit in a certain peer group and emotional disorientation (Freedenthal, 2010).
Adolescents aged between thirteen to eighteen years that are vulnerable to self-injury face a significant range of challenges as they go through the adolescent stage. The challenges take the biological, psychological and social aspects, which primarily depend on the manner in which their tendency to self-injure impacts them. A major biological challenge that adolescents aged between thirteen and eighteen years dealing with self-injury face is that they rely on endogenous opioids induced through injuring oneself to avoid life stressors. As explained by Alain (2015), most adolescents that resolve to self-injury often have a wide range of stressful situations emanating from school, home and the wider community to deal with. Research indicates that self-injury has widely been used among adolescents to regulate the generation of endogenous opioids, which play an important role in relieving innate pain.
Most adolescents experiencing negative emotions as a result of trauma, neglect or any other form of stressful situation tend to have a significantly low level of endogenous opioids. They thus experience a growing challenge dealing with stressful situations that they might face during their adolescent stage (Michael, 2012). As such, they tend to rely on repeated self-injury cases in attempt to bring endogenous opioids to normal level, which would in return stabilize the prevailing negative emotions. This is however not the case with adolescents going through a normative biological hallmark of the adolescent stage. This is because such adolescents often have endogenous opioids at normal levels and hence do not have to resolve to self-injury to deal with life stressors. As such, they seek for alternative ways, such as counseling, improving relationships, focusing on positive energy and sharing with friends, to deal with life stressors that emanate through the adolescent stage (Morris, 2011).
Another challenge that adolescents face when dealing with self-harm is psychological in nature and it entails a growing inability to deal with psychological distress, which is common during the adolescent stage. According to Kim (2011), adolescents dealing with self-injury experience certain aspects of psychological distress, including depression, anxiety, feelings of worthlessness as well as inability to cope. As such, they find it hard to seek for a more positive way to deal with their life situation and hence resolve to self-injury to address this challenge.
While such psychological experiences are common during the adolescent stage, they constantly resolve to self-injury to address them, which in return make the practice repetitive throughout the stage. As a result, adolescents find it challenging to adopt a more positive coping strategy and only perceive self-injury to be the only means through which they can deal with psychological distress (Freedenthal, 2010). This is however not the case with adolescents going through a normative psychological hallmark of the adolescent stage. This is because such adolescents adopt more positive means to deal with any psychologically distressing situation rather than resolving to self-injury. As such, they find it easier going through the adolescent stage by dealing with life circumstances emanating during this stage, unlike their counterpart adolescents that do not address the life circumstances but only resolve to self-injury to escape the reality (Alain, 2015).
An additional challenge that an adolescent dealing with self-injury face takes a social aspect and it entails an increasing inability to regulate emotions, including those that are interpersonal and intrapersonal. According to Morris (2011), adolescents dealing with self-injury find it challenging to regulate emotions emanating from interpersonal relationships, self-perception, affectivity as well as impulsivity. This is especially because such individuals prevail in an environment where emotions ranging from facial expressions as well as facial mimicry, are usually invalidated. As such, the adolescents do not respond to interpersonal and intrapersonal emotional experiences in an appropriate manner. Instead of employing more adaptive ways to regulate strong emotions by perceiving interpersonal and intrapersonal experiences as being real, they resolve to short-term impulsive approaches to restore their emotions to a bearable level.
This experience is however distinct from that encountered by adolescents undergoing a normative social hallmark during the adolescent stage (Freedenthal, 2010). This is because adolescents that are not dealing with self-injury are able to regulate social emotions resulting from intrapersonal and interpersonal relationships. This is therefore the reason that such adolescents are able to perceive the various emotional experiences resulting from other people’s facial expressions and facial mimicry as well as the intrapersonal emotions that result from affectivity and impulsivity as normal and real. Thus, they find it easy going through the adolescent stage unlike the adolescents relying on self-injury to regulate emotions (Kim, 2011).
Given the severity that challenges linked self-injury can render to adolescents as they go through this developmental stage, it is important to employ certain protective factors that can mediate for their vulnerability. Individual-level problem solving is an important protective factor that can be employed to mediate for various challenges that adolescents dealing with self-injury might face. According to Alain (2015), most adolescents that resolve to self-injury usually face significant challenges resulting from stressful life events, which in return render them hopeless. Instead of such individuals focusing on their life situations, they resolve to short-term impulsive strategies that would alleviate their stressful experiences rather than addressing problems perpetuating such experiences. However, such individuals can be equipped with certain problem solving strategies that would help restore hope and curb challenges linked to self-injury. For instance, adolescents can be taught how to focus on their problems, perceive them as part of life and address them rather escaping the reality as well as employing short-term impulsive methods. This would ensure that the adolescents are able to cope with each problem as it emerges thereby avoiding feeling hopeless and subsequently resolving to self-injury (Kim, 2011).
Promoting self-control of conduct, thoughts and feelings is another protective factor that can be employed to mediate for the various challenges that adolescents dealing with self-injury might face. According to Sarkar (2015), most adolescents dealing with self-injury resolve to injurious actions for being unable to control their conducts, thoughts and feelings and hence lack resilience to cope with stressful life situations. Nurturing self-control among such individuals however promote resilience by enhancing positive thinking as pertains to life issues, purposeful actions intended to transform life situations and willingness to face challenging situations. This would ensure that adolescents facing stressful life situations take the right approaches to address them rather than resolving to self-harm.
Encouraging positive thoughts about health as well as participation in sporting activities can further be employed to mediate for the challenges that adolescents dealing with self-harm might face. According to Morris (2011), adolescents resolve to injurious actions because they spend most of their time in an environment that tend to invalidate their emotions hence being unable to regulate experiences resulting from various life situations. Promoting positive thoughts pertaining to the need of being in good health as well as participating in sports can help to overcome vulnerability that renders individuals to resolve in self-harm. Similarly, helping adolescents to perceive themselves as being healthier than others can help overcome negative thoughts that see most of them resolving to self-injury.
In addition to the various protective factors outlined, micro, mezzo as well as macro interventions can be employed from a social work perspective to help address various challenges linked to self-harm and eventually help vulnerable adolescents through their development stage. At micro level, social workers can focus on personal interactions with the affected clients so as to help establish sources and types of problems that expose them to injurious actions as well as how they can get out of their situation (Kim, 2011). These can either include clinical social workers interacting with clients at health facilities or community social workers that interact with clients at the community level. At this level, social workers develop a rapport with their clients in order to build trust, which in return enables them to extract information on problems and challenges that expose them to acts of self-harm. They then help the clients develop problem solving skills that would bear lasting solutions to their situations rather than resolving to short-term impulsive solutions (Morris, 2011).
Social work interventions can also be offered at mezzo level, which includes bringing together people that may closely be related to the clients as well as who may ultimately benefit from participating in the intervention network. Such people may include school mates, family or community members requiring skill on how they can deal with as well as help the affected victim (Michael, 2012). Interventions at this level, mainly intends to transform the system affecting the wellbeing of the client either at home, school or in the neighborhood. Social workers can thus engage targeted participants in group counseling, community associations as well as self-help groups. Through such groups, participants can obtain information on issues related to self-harm as well as how they can help vulnerable individuals get out of their situation (Alain, 2015).
Further interventions can be offered at macro level, which mainly focus of creating a reliable system of service providers to enhance a wide variety of care. Interventions at this stage can integrate with the political realm to enhance significant policy changes. Further intervention can be promoted through planning as well as implementation of social programs that would enhance macro level practice. Coordinating these interventions creates an opportunity for reliable social service providers to address various intersecting problems that expose most people to self-harm (Kim, 2011).
Self-harm is a common injurious practice among various categories of individuals experiencing mental problems. Adolescents aged between thirteen and eighteen years are most affected by this problem and they often resolve to injure themselves as a way of relieving the pain resulting from various social problems. Research shows that male adolescents exhibit a greater preference than females with most cases failing to reach professional attention. Individuals dealing with self-harm experience biological, psychological and social challenges that affect their ability to deal with certain life situations during the adolescent stage. Such challenges including reliance on endogenous opioids to address innate pain, inability to deal with psychological distress as well as the growing challenge to regulate emotions. To address these situations, certain protective factors, including promoting problem solving skills, self-control on thoughts, feelings and perceptions as well change in thoughts and feelings towards good health and participation in sports, can help protect adolescents vulnerable to self-harm. Interventions can further be issued from a social work perspective at micro, mezzo and macro levels.
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Freedenthal, P. (2010). Adolescents who Self-Harm: How to Protect them from Themselves: Strengthen Coping Skills, Develop a Safety Plan and Treat Comorbid Disorder, Current Psychiatry, 9(8): 891-1010.
Kim, M. (2011). Temporary Tottoos: Alternative to Adolescent Self-Harm, Current Psychiatry, 10(4):712-911.
Michael, S. (2012). Adolescents in Crisis: When to Admit for Self-Harm or Aggressive Behavior: Assess Suicide Risk, Family Support, Other Factors when Considering Hospitalization, Current Psychiatry, 9(1):1011-1233.
Morris, K. (2011). Intense Suicidal Thoughts and Self-Harm Following Escitalopram, Indian Journal of Psychological Medicine, 33(1):691-811.
Sarkar, G. (2015). Intentional Self-Harm IN Children and Adolescents: A Study from Psychiatry Consultation Liaison Services of a Tertiary Care Hospital, Indian Journal of Psychological Medicine, 37(1):561-798.