Affect Regulation and Addictive Aspects of Repetitive Self-Injury in Hospitalized Adolescents

doi:10.1097/00004583-200211000-00015

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 41, Issue 11, November 2002, Pages 1333-1341

https://doi.org/10.1097/00004583-200211000-00015 Get rights and content

ABSTRACT

Objective:

The incidence of self-injurious behavior (SIB) in adolescent psychiatric inpatients has been reported to be as high as 61%, yet few data exist on the characteristics and functional role of SIB in this population. Because of the repetitive nature of SIB and its potential to increase in severity, features of SIB and its specific reinforcing effects were examined.

Method:

Participants were 42 self-injuring adolescents admitted to a hospital over a 4 month period. Data sources consisted of self-report questionnaires and medical chart review.

Results:

Mean age was 15.7 ± 1.5 years. Reported urges to self-injure were almost daily in 78.6% of the adolescents (n = 33), with acts occurring more than once a week in 83.3% (n = 35). The two primary reasons endorsed for engaging in self-injury were “to cope with feelings of depression” (83.3%, n = 35) and “to release unbearable tension” (73.8%, n = 31). Of the sample, 97.6% (n = 41) endorsed three or more addictive symptoms.

Conclusions:

SIB in hospitalized adolescents serves primarily to regulate dysphoric affect and displays many addictive features. Those with clinically elevated levels of internalized anger appear at risk for more addictive features of this behavior.

Section snippets

Participants

Between March and June 2000, all adolescents (aged 12–18 years) who were admitted or were participating in the inpatient and acute youth partial hospitalization programs at a large urban tertiary-care teaching hospital (Children's Hospital of Eastern Ontario) were screened by staff for recent SIB. The 16-bed inpatient unit includes an acute assessment service and treatment program, accepting admissions primarily through the emergency service. The acute youth partial hospitalization program

Sample Characteristics

Over the 4-month study period, 130 patients were screened and 50 completed the questionnaires. Eight were excluded from further analyses because of the infrequency of their SIB. Two females had not self-injured at all in the past 6 months, and six females had injured only once or twice in the past 6 months. In all, 27 (29.7%) of 91 inpatients and 15 (38.5%) of 39 partial-hospitalization patients, or 84% (n = 42/50) of the injuring sample, met our criteria for repetitive SIB. A cross-tabulation

DISCUSSION

Approximately one third of this inpatient and partial hospitalization sample had a repetitive form of SIB, with more than 80% self-injuring at least once a week during the previous 6 months. The frequency of urges to self-injure indicates a significant preoccupation with the behavior, despite associated feelings of shame, guilt, and disappointment. The predominance of depressive symptoms in our sample is similar to that of Ghaziuddin et al. (1992) and Darche (1990), whereas DiClemente et al.

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Correspondence to Dr. Nixon, Mental Health Patient Service Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1; e-mail: [email protected].

DOI: 10.1097/01.CHI.0000024844.60748.C6

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ARTICLESAffect Regulation and Addictive Aspects of Repetitive Self-Injury in Hospitalized Adolescents

ABSTRACT

Objective:

Method:

Results:

Conclusions:

Section snippets

Participants

Sample Characteristics

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Adolesc

J Psychiatr Res

Peptides

Clin Psychol Rev

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Manual for Beck Depression Inventory-II

Affect Regulation and the Development of Psychopathology

Self-mutilation in clinical and general population samples: prevalence, correlates, and functions

Am J Orthopsychiatry

The medical basis of addictive disorders

Psychological factors differentiating self-mutilating and non–self-mutilating adolescent inpatient females

Psychiatr Hosp

The plight of chronic self-mutilators

Community Ment Health J

Female habitual self-mutilators

Acta Psychiatr Scand

ARTICLES
Affect Regulation and Addictive Aspects of Repetitive Self-Injury in Hospitalized Adolescents