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Self-Injury in Adolescents and Adults

Edward A. SelbyPresenter: Edward A. Selby, Ph.D.
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Dr. Selby described the behavioral presentation, associated features, and clinical outcomes of nonsuicidal self-injurious behavior in both adolescents and adults. He distinguished self-injurious behavior from suicidal behavior as well as covered the basics of assessing, understanding, and treating self-injury.

Comments(10)

  1. NJCTS says

    Do you recommend medication for patients who self injure?

    • DrSelby says

      The research on whether medication helps reduce self-injury is mixed, and unfortunately there is no clear medication guideline specifically for self injury. However, if an individual who self injures also has co-occuring problems like depression or anxiety, treating those conditions with medication is likely to help the individual with the anxiety or depression, but it may also help reduce self injury. However, even in such cases where medication helps with another problem, it is unlikely that medication alone would completely cease self injury.

  2. NJCTS says

    What kind treatment approach would be best for an adolescent who is self-injuring but doesn’t want to stop this behavior?

    • DrSelby says

      Cases where an individual who is self injuring does not wish to stop are important. Such individuals often state “my self injury isn’t hurting anyone else, and it’s my body, so what’s the problem?” However, even if someone views self injury as not harmful, there is clear research evidence to suggest that there are numerous negative consequences to self injury. In a case like this, I would recommend the individual undergo treatment focused on motivation, often referred to as Motivational Interviewing. This approach takes a neutral and supportive stance toward the behavior, and focuses on barriers in motivation to change and potential positive effects that the individual receives from the self injury. Typically, with successful focus on motivation, many patients come to the personal conclusion that it’s better to work on stopping self injury.

  3. NJCTS says

    Do those who self injure have other problems as well, such as with using alcohol, drugs, or eating disorders?

    • DrSelby says

      Yes, it is very common for those who self injure to have problems with a number of other impulsive behaviors, including substance use, binge eating and purging, aggressive behavior, and reckless driving, for example. Often times these kind of behavior have a similar function as self injury, in that they are harmful but effective ways for coping with stress and negative emotion. In the treatment of self injury, careful attention should also be paid to other impulsive behaviors.

  4. NJCTS says

    I work in a school, is self injury something that requires me to break confidentiality with my client, the student and report to a parent ?

    • DrSelby says

      This is indeed a challenging question for any professional working with self injury. First, the most important issue is whether suicidal intent is present, and in cases where there is intent or preparation to engage in a suicide attempt (including in cases where self injury is present) – then the adolescent is at risk from harm and confidentiality must be broken. However, if suicidal ideation is absent, then the issue gets more tricky. As to whether confidentiality should be broken in the case of discovering self injury there are likely a variety of policies across different educational settings. Typically parents have to wave the right to have updates about an adolescent’s treatment, and if a parent does not wave such a right then a professional would likely disclose the behavior. However, if the parent waves updates about an adolescents treatment – often in times to facilitate the treatment and increase disclosure to the professional – then the issue becomes tricker. In this case (when a parent has waved the right to treatment updates for his or her child) I treat self injury the same way I would any other problematic behavior (e.g. substance use, risky sexual behavior) in that I respect the confidentiality wishes of the child and parent. Though these are all indeed harmful behaviors, they do not reflect imminent risk of harm (like in a suicide attempt), and I might wish I could alert the parent, but to do so would unethically break confidentiality with the adolescent. So treatment of self injury is indeed a complicated and gray area for ethical respect of confidentiality and required disclosure.

  5. NJCTS says

    If a 16 year old autistic child mentions he wants to kill himself because he wants to be with his grandfather who just recently passed away, is it something to worry about?

    • DrSelby says

      This is definitely a situation that would warrant further investigation about the teen’s thoughts about suicide and why he’s thinking this way. Depending on the severity of the child’s autism spectrum disorder, such a suggestion could simply be a presentation of grief and missing his grandfather. However, if the teen reported serious consideration of suicide (represented by frequent and intense suicidal thoughts, planning of ways to attempt suicide, and/or making preparations for a suicide plan), then that would indeed be a serious scenario that would justify reaching out to a mental health professional or emergency health services. The only way to know what the best approach to take is to ask questions and get the information you can without being afraid to do so, and usually with this approach the severity of the suicide ideation (if any) will become clear.

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