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Last Updated on : 06th Mar, 2015
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Self-injurious Thoughts and Behaviors

Self-injurious thoughts and behaviors are relatively rare in childhood but increase dramatically during the transition to adolescence. It is estimated that each year approximately 16% of adolescents will seriously consider killing themselves and 8% will attempt suicide. Nonsuicidal self-injury is even more common among youth: around 18% of adolescents report engaging in these behaviors. Given that self-injurious behaviors typically begin and increase dramatically during adolescence, and cause significant impairment in social, familial, and academic contexts, the field is in urgent need of treatments that specifically target self-injurious behaviors in youth.

Self-injurious thoughts and behaviors refers to thinking about intentionally hurting oneself or engaging in actions that are directly harmful to the self. This broad class is divided into two subcategories.

Suicidal self-injury (or suicidal behavior) refers to intentional, self-inflicted injuries where an individual has at least some intent to die (e.g., suicide attempts). Suicide ideation (or suicidal thoughts) are thoughts about killing onself.

Nonsuicidal self-injury refers to self-inflicted injuries where an individual has NO intent to die. The most common forms are skin-cutting, burning, scratching, and banging/hitting onself. These nonsuicidal forms of self-injury are most often used to reduce unpleasant emotional experiences such as sadness, anxiety, and anger.

As can be seen in the table, no treatments are known to be well-established for this complex class of problems. However, several treatments appear to work, including cognitive-behavioral therapy (CBT) for the youth and her/his family, psychodynamic therapy for the youth and her/his family, interpersonal therapy for the youth, as well as two different family-based treatments (attachment-based and parent training).  A third family-based therapy (ecological) is in the “might work” category. Several treatments remain inadequately tested at this point and a group approach involving CBT, dialectical behavior therapy, and psychodynamic skills training has some evidence that it does not work when compared to other treatments.

Although there is no clear-cut first-line intervention for self-injurious thoughts or behaviors, the following common therapy components may enhance treatment for this population: fostering familial and other interpersonal relationships, improving parent education and training (e.g., parental monitoring), and strengthening adolescents’ coping skills (e.g., emotion regulation).

Treatments for self-injurious thoughts and behaviors

Works Well
What does this mean?
  • None
What does this mean?
  • CBT-Individual + CBT-Family + Parent Training
  • Family-based therapy-Attachment
  • Family-based therapy-Parent training
  • Psychodynamic therapy-individual + Psychodynamic therapy-family
Might Work
What does this mean?
  • Family-based therapy-Ecological
What does this mean?
  • CBT-Individual
  • CBT-Individual + CBT-Family
  • Dialectical behavior therapy
  • Family-based therapy-Emergency
  • Family-based therapy-Problem-focused
  • Resources interventions-Individual
  • Support-based interventions-Individual
Not Effective
What does this mean?
  • CBT-Skills + DBT skills + psychodynamic therapy skills-Group

Source: Glenn, C. R., Franklin, J. C., & Nock, M. K. (2014). Evidence-Based Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth. Journal of Clinical Child & Adolescent Psychology, 44(1), 1-29.

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