Special guest speaker Dr. Tyler Black, psychiatrist at BC Children's Hospital in Vancouver, started his public lecture at The Royal by illustrating the high prevalence of self injury. This is clear when we consider where most self-injury pictures, text and videos are these days: online. Specifically, they are on a social network primarily used to sharephotos, called Tumblr. Before his talk, Dr.Black searched the word “cutting” on Tumblr and only fifteen minutes later, pages and pages full of graphic images and text appeared in real time:a clear example of how self-injury is on the rise.
In order to reduce self-injury, it’s important to learn the different types. Dr. Black shared the five different types:
Unintentional Self-Injury Accidents and traumas with no intention of self-injury
Injuries may even result in death. Includes risk-taking behaviours:
- accidental alcohol overdose
- accidental firearm discharge
- choking out
Self-Injurious Behaviours (SIB)
Usually the terminology used for persons with intellectual disabilities:
- hair pulling
- skin picking
- head banging
- self-biting
Non-Suicidal Self Injury (NSSI)
The preferred nomenclature for any intentional self-injury which has a motivation other than death, formerly “parasuicide." It consists of:
- therapeutic cutting
- burning
- purging
- strangulation
- non-lethal overdoses
- running away unsafely
Suicide Attempt
Any self-directed behaviour with the intent of death of self. Lethality of the behaviour must be present, unless the person is impaired by age of intellectual disability. The behaviour must have been undertaken.
Suicide
An intentional self-directed behaviour that results in death of self.
Dr. Black says non-suicidal self-injury is very rare in adults, only about 4-6%. However, among adolescents it’s much more common with studies varying between 35-50% in any given year. The average age of onset of self injury is 12-14 years old.Females are more likely to perform NSSI than males.
Risk factors include depressive symptoms, family loneliness, victimization, and abuse. Self-injury can also be biological. Most repetitive self-injurers have impulsive problems. Impulsivity is a highly genetic trait that relates to the frontal lobe, a known brain region that is still in development during adolescent years. Teens with impulsive tendencies are more likely to shoplift, abuse drugs and alcohol, develop eating disorders and become sexually promiscuous.
Another factor in understanding why someone self-injures is their cortisol levels. A study showed that people who self-injure don't have the cortisol levels to help them handle stressful events. Those who have a history of suicidality and self harm have less endorphins in their spinal fluid than those who only have a history of suicidality. Endorphins also trigger the dopamine reward pathway, suggesting a biological cause for “addictive patterns”.
Dr. Black believes the rise in self-injury results from it being more widely discussed: “There’s been a social acceptance which I think is a generational thing. In my generation and in older generations, we viewed cutting as abnormal. It’s become a bit more accepted so I think that plays a lot into it. We know children are under a lot of distress and stress and those are the roots of it, I’d be worried about the situations that cause distress. By getting to the root of the problem, we can reduce self harm.”
To help understand why a person self-injures, Dr. Black explained the emotional process of self-harm. Before performing NSSI, a person usually feels anxiety, sadness, and/or hostility followed by feelings of relief, guilt, and disappointment.
Regardless of the reasoning, Dr. Black says “Every child wants to succeed. We don't need to say ‘stop cutting’, we need to say ‘how can we find better ways to cope?’” “We need to be reaching out to our kids, asking them how they're doing, and making sure they can get help if they need it,” says Dr. Black. By simply checking in, they’ll feel comforted to know someone cares and they’re more inclined to come to that person if they need help. One of the reasons parents and teachers are sometimes hesitant to ask a teen about suicide is they’re afraid of creating the contagion affect. However, most studies show that directly asking about suicide will not harm the individual or induce suicidal actions. Rather, they will feel more comfortable talking about their state of mind and seeking help.
Youth will be better able to use healthier coping methods if they are able to identify their triggers and practice self-monitoring. By focusing on ways to cope with stress rather than focusing on the self injury itself, Dr. Black says, we can effectively reduce self injury in youth. It’s important to focus on the underlying distress, difficulty, motions or events that led to self-injury, not the act itself.
For more information, visit the Self-Injury Outreach and Support website, an online resource for learning more and seeking help for self injury.