Sui­cide ver­sus Self In­jury among Ado­les­cents

The Star (St. Lucia) - - COMMENT - By

EGinelle Nel­son xtreme stress among chil­dren and ado­les­cents is of­ten over­looked and dis­par­aged. Ad­di­tion­ally, ado­les­cents are of­ten la­belled as ‘sui­ci­dal’ when­ever they en­gage in any act of self-in­jury. Care must be taken though in as­sess­ing self-in­ju­ri­ous be­hav­iour among ado­les­cents since not all self-harm­ing acts are sui­ci­dal at­tempts. An in­ac­cu­rate pro­nounce­ment of such be­hav­iour leads to su­per­flu­ous la­belling and un­in­ten­tional ac­cep­tance of a mis­di­ag­no­sis on the part of the teenager. Spe­cific iden­ti­fi­ca­tion of de­lib­er­ate acts of harm against one­self is crit­i­cal for pre­cise clin­i­cal treat­ment but firstly re­quires an un­der­stand­ing of the dif­fer­ent be­havioural clas­si­fi­ca­tions of self harm.

As pre­vi­ously men­tioned, not all acts of self-in­jury, es­pe­cially among ado­les­cents, can be cat­e­gorised as sui­ci­dal at­tempts. Self-in­ju­ri­ous be­hav­iour refers to a broad class of be­hav­iours in which an in­di­vid­ual di­rectly and de­lib­er­ately causes harm to her/him­self. Th­ese be­hav­iours, how­ever, may not all be sui­ci­dal, since sui­cide at­tempts are di­rect ef­forts to in­ten­tion­ally end one’s life. Non-sui­ci­dal self-in­jury (NSSI), on the other hand, refers to di­rect, de­lib­er­ate de­struc­tion of one’s body tis­sue in the ab­sence of the in­tent to die. There­fore, as I have en­coun­tered in my ca­pac­ity as a psy­chol­o­gist, it is quite pos­si­ble for an ado­les­cent to en­gage in self-in­jury, for ex­am­ple cut­ting of the arm, with­out the in­tent to die. This be­hav­iour is not sui­ci­dal, but rather a non­sui­ci­dal self-in­ju­ri­ous act and is of­ten an in­di­ca­tion of the de­sire to es­cape or protest against a cur­rent sit­u­a­tion.

Although NSSI and sui­cide at­tempts are dis­tinct be­havioural phe­nom­ena, they both can co-oc­cur within in­di­vid­u­als. In other words, it is not un­com­mon for an ado­les­cent who fre­quently en­gages in NSSI to, at some point, en­gage in the act of self-harm with the in­ten­tion to die. In fact, sev­eral stud­ies have shown that ado­les­cents who en­gage in NSSI are at an el­e­vated risk for sui­cide at­tempt. Thomas E. Joiner (2005) pos­tu­lated that many per­sons lack the abil­ity to at­tempt sui­cide ow­ing to the fright­en­ing and ex­treme na­ture of the act. How­ever, “in­di­vid­u­als be­come more coura­geous, com­pe­tent, and will­ing to make sui­cide at­tempts with re­peated en­gage­ment in NSSI and may even ex­pe­ri­ence in­creas­ing re­in­force­ment in the process”. The ‘re­in­force­ment’ re­ferred to here speaks of the sooth­ing ef­fect of self-in­jury re­ported by many pa­tients. This sooth­ing ef­fect abates the fear and phys­i­cal pain as­so­ci­ated with self-in­jury, giv­ing in­di­vid­u­als the con­fi­dence and ca­pa­bil­ity to at­tempt sui­cide. Re­search on pain anal­ge­sia has also re­vealed that many per­sons who en­gage in self-in­ju­ri­ous be­hav­iour ex­pe­ri­ence lit­tle or no phys­i­cal pain dur­ing repet­i­tive NSSI. As a re­sult, th­ese in­di­vid­u­als de­velop a higher pain thresh­old and tol­er­ance to pain, thereby in­creas­ing their en­durance for at­tempt­ing sui­cide. Suc­cinctly put, in­di­vid­u­als who en­gage in con­tin­u­ous non-sui­ci­dal self­in­ju­ri­ous acts are at a greater risk for at­tempt­ing sui­cide than in­di­vid­u­als who do not.

Sev­eral warn­ing signs may be present in in­di­vid­u­als with sui­ci­dal ideations. Th­ese in­clude, but are not limited to, with­drawal, self-de­struc­tive be­hav­iour, say­ing good­bye to friends/rel­a­tives us­ing notes and a sud­den ac­cep­tance of fate. Ad­di­tion­ally, most in­di­vid­u­als with sui­ci­dal thoughts speak of death and their in­ten­tion to com­mit sui­cide. This should in no way be met with threats of aban­don­ment, phys­i­cal vi­o­lence or any form of abuse. Though this may seem ridicu­lous to men­tion, it has been my ex­pe­ri­ence that the fear of loss pro­pels ir­ra­tional be­hav­iour. Note that flog­ging a dead corpse is as pro­duc­tive as Caribbean pol­i­tics: its fu­til­ity is in­ef­fa­ble.

Re­gard­less of the na­ture or in­tent of the self-in­ju­ri­ous be­hav­iour, in­ter­ven­tion is ab­so­lutely nec­es­sary. The ini­tial phase of in­ter­ven­tion most of­ten com­mences with close friends and rel­a­tives who have de­tected and as­sessed be­havioural pat­terns. Open dis­cus­sion is rec­om­mended to as­cer­tain the de­gree of risk which should be fol­lowed by in­sti­tu­tional sup­port.

The preva­lence of self­in­ju­ri­ous be­hav­iour, sui­cide and sui­ci­dal­ity in any so­ci­ety, and given any eco­nomic and/ or po­lit­i­cal cli­mate, is a di­rect re­flec­tion of men­tal volatil­ity at a so­ci­etal level and hence calls for na­tional ad­vo­cacy. Hot­lines open to the public may just mit­i­gate the per­va­sive feel­ing of hope­less­ness ex­pe­ri­enced by many. If you or some­one you know is en­gag­ing in self­in­ju­ri­ous be­hav­iour and/or ex­hibit­ing signs of sui­ci­dal­ity, please con­tact a men­tal health pro­fes­sional.

Ginelle Nel­son is a Con­sul­tant Clin­i­cal Psy­chol­o­gist and Man­ag­ing Direc­tor PsyDA Con­sul­tancy Ltd.

PsyDA Con­sul­tancy (pro­nounced ‘Cider’) pro­vides psy­cho­log­i­cal ser­vices in­clud­ing in­di­vid­ual and fam­ily psy­chother­apy, psy­cho­log­i­cal eval­u­a­tions and as­sess­ments, coun­selling and foren­sic con­sul­ta­tions. Con­tact 727-1490 for week­end ap­point­ments.

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