A noted trend in teenage girls from the age of 14-17: Self Harm

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A trend that seems to be developing among teenage girls between the ages of 14 – 17 is an inability to process their emotions, which leads them to use self-harm as a means of emotion regulation. What has been noticed is a distinct inability to digest anger and frustration, which needs a much-required outlet.

Society appears to be more focused on the mindfulness revolution, which aims at pacifying one’s over-thinking and tumultuous emotional states.

We are all for mindfulness practice and we benefit greatly from this practice. However, concern is raised when it seems that every problem we have is referred to a dose of mindfulness as a cure. It is clear that we all have the capacity to sit with uncomfortable feelings and emotions and because mindfulness is a practice, its effectiveness is in the practice. It does take some time before a sure level of tranquility is reached, but one does eventually reach this tranquil state when due diligence is applied.

There is a slight contradiction here, as becoming more mindful does allow us to regain a sense of control in life in general, however few of us have the patience to do so.

Moving off at a tangent, reference is made to the movie “Fight Club”. There is one scene in particular that is intriguing. The protagonist in the movie has had his first fight with Brad Pitt outside a bar. This scene depicts his internal sense of relief and tranquility. Obviously in physical pain from being punched in the face and doing the same to his imaginary friend (Brad Pitt), they sit together to discuss the chain of events just happened. We get an immediate sense that Edward Norton (Protagonist) needed to find an outlet for his anger. Grossly unorthodox in the manner in which it arises, he recognizes the immensity of his internal relief by being able to simply let this anger out in a fashion that general society would not condone.

By no means is this suggesting that young 14 – 17 year old girls go out and create a fight club. However this does suggest that alternate ways of embracing anger towards others needs to be considered before there is the inevitable shift towards self-blame and loathing.

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Due to the process of conditioning through repetition, these young girls find themselves in a difficult cycle to break out of. On one level they have convinced themselves that it is easier to cut and self harm because the effect is almost immediate, in comparison to using traditional psychological tools. You will often hear the phrase that “it is easier to cut than to do a mindfulness exercise or an alternative method of distraction”.

Let me explain the anatomy of this type of belief system. At onset, you have an individual who is trying to make sense of the world. From social conditioning she establishes that it is inappropriate to display anger or to share this with peers and parents due to the inevitable reaction that there is no point in getting angry. So she feels dismissed and the emotions she feels are squashed. The girl therefore begins to internalize her anger instead of finding an external release. This is where the mind/body conflict begins to take a turn for the worse. Due to the immense emotional pressure and buildup she feels, there are two paths in which this can follow.

  1. The use of self-harming techniques, which induce a different yet distracting pain, which deters from her centering her focus on the emotional pain. With a bit of consistency, reinforced by a changing core belief system that she actually deserves this, convinces her to see this as a successful means of processing the underlying rage and emotional pain.
  2. The second path follows a more unconscious process based on the research of Dr Sano. Here the emotional buildup and rage needs to find some type of release but instead imbeds itself into the creation of a bodily ailment eg: lower back pain. The protection mechanism of the unconscious mind forces the body to embody this rage, which causes bodily pain instead of the body having to face emotional pain. This suggests that it is more excruciating to face emotional pain than the physical cutting.

You will find that avoidance and resistance to facing emotional pain is a common human condition, yet a source of great relief and healing. Part of the problem is allowing oneself the luxury of being guided to the site of pain. Secondly, when you are there, having the courage to sit and process and digest the range of pain behind the rage at the self and others.

Coming back to the trend first mentioned. I have identified that part of the problem is the lack of psycho-education in this age range. The harsh reality that they are being placed under more stress and demands from school, which detracts them from actually having a childhood. Moreover, schools teaching them little of value which could be used in the outside world i.e: how to realize one’s full potential and knowing how to achieve it; what is your meaning and purpose and how to instill and cultivate the necessary values to acquire greatness; how to deal with negative thinking and emotions.

Another part of the problem is related to the effects of the media and social contagion. Drawing on social contagion, awareness of self-harm has increased significantly over the years, partly through reference to self-harm in the media and popular culture. Related to the notion of social contagion, the internet is a social and cultural resource which can have a powerful impact on young people, and particularly vulnerable young people at risk of self-harm. For example, research conducted recently indicated that young people at risk of self-harm tended to be online for longer periods of time than other teenagers (Daine et al., 2013).

Although the internet may represent a preferred way of communicating with others for isolated adolescents, and the anonymous e-communication may be particularly appealing for those experiencing psychological difficulties and emotional distress, and for those who do not feel comfortable discussing their experiences of self harm offline, research has indicated there are several risks associated with this particular form of content and communication. For example, a recent review (Daine et al., 2013) indicated that one study reviewed highlighted that young people using internet forums appeared to normalise self-harm, and rather than talking about how to reduce self-harming behaviour, the study indicated the forums were used a way to swap tips on how to hide the problem and did not make the users feel any better. Therefore this suggests that some internet forums may actually reinforce self harming behaviour for some individuals, especially when the material is repeatedly accessed.

In addition, the review also indicated that one study highlighted that some users showed increased distress following a visit to an internet forum. Whilst some studies suggested that young people who went online to find out more about self-harm were exposed to violent imagery and then went on to self-harm themselves. Worryingly, the review concluded that internet use is linked with more violent methods of self-harm. Therefore, is it clearly important for the media to support vulnerable individuals, rather than promote the use of self-harm.

Related to the difficulties surrounding adolescence, identity formation is an extremely important development task during adolescence, and self-harming behaviour has been indicated to be a means of dealing with identity confusion (Claes, Luyckx, & Bijttebier, 2014). Related to the notion of identity and drawing on social identity theory (Brown, Eicher, & Petrie, 1986), a small minority of adolescents have been indicated to self harm in order to reinforce their group identity e.g. feel more like they are a part of the group (Young, Sproeber, Groschwitz, Preiss, & Plener, 2014). Moreover, drawing on the difficulties surrounding adolescence and fitting in with peers, and gaining acceptance from those around us, another part of the problem relates to invalidation or lack of acceptance. For example, a recent study indicated a high degree of peer invalidation predicted engagement in self harming behaviours in girls (Yen et al., 2014). This highlights a clear need to assess adolescents’ feelings of invalidation or lack of acceptance.

Furthermore, in line with the risk factors of other negative coping mechanisms, there are also various other risk factors for self-harm including a history of child abuse or trauma, adverse life events, bullying, family and peer conflict, low self-esteem and a persistent sense of hopelessness and poverty (Hawton & James, 2005). For example, bullying has been linked to a propensity to self harm during adolescence. One study found that children who were exposed to chronic bullying over a number of years at primary school were nearly five times more likely to self harm six to seven years later in adolescence (Lereya et al., 2013). This indicates bullying should also be considered as an important potential risk factor and that children should be provided with support to speak out about bullying and to not suffer in silence.

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TREATMENT

Given that self-harming behaviour is a serious public health concern which is increasing, particularly among younger girls aged 14-18, and since it is a risk factor for suicide attempts, there is a clear need for appropriate assessment and management of self-harm in young girls.

It is important for us to gain a greater understanding into the problems which are contributing to this trend, and to gain a greater understanding of the key risk factors of self-harm in order to inform existing interventions, and to develop new and effective treatment interventions which are both accessible and acceptable for girls engaging in self-harm. In addition, in order to reduce the risk of suicide, there should be good management of the care pathway of vulnerable individuals as they move from child and adolescent to adult services in order to ensure continuity of care.

References

Brown, B. B., Eicher, S. A., & Petrie, S. (1986). The importance of peer group (“crowd”) affiliation in adolescence. Journal of Adolescence, 9 (1), 73-96.

Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents: Prevalence and associations with identity formation above and beyond depression. Personality and Individual Differences, 61-62, 101-104.

Daine, K., Hawton, K., Singaravelu, V., Stewart, A., Simkin, S., & Montgomery, P. (2013). The Power of the Web: A Systematic Review of Studies of the Influence of the Internet on Self-Harm and Suicide in Young People. PloS ONE, 8 (10), 1-6.

Hawton, K., & James, A. (2005). Suicide and deliberate self harm in young people. British Medical Journal, 330 (7496), 891-894

Lereya, S. T., Winsper, C., Heron, J., Lewis, G., Gunnell, D., Fisher, H. L., Wolke, D. (2013). Being bullied during childhood and the prospective pathways to self-harm in late adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 52 (6), 608-618.

Yen, S., Kuehn, K., Tezanos, K., Weinstock, L. M., Solomon, K., & Spirito, A. Perceived family and peer invalidation as predictors of adolescent suicidal behaviors and self-mutilation. [published online ahead of print September, 29, 2014]. Journal of Child and Adolescent Psychopharmacology.

Young, R., Sproeber, N., Groschwitz, R. C., Preiss, M., & Plener, P. L. (2014). Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity. Biomedcentral Psychiatry, 14 (137), 1-14.

 

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