Extreme 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 non-suicidal 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 self-injurious 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 self-injurious 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 self-injurious behaviour and/or exhibiting signs of suicidality, please contact a mental health professional.
— Ginelle Nelson
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.