Skip to main content

Military Health System

Understanding Non-Suicidal Self-Injury, Support for Military Children

Image of Non-suicidal self-injury by adolescents vary based on studies — from 1 in 6 to as high as 1 in 4 — rates have increased over the past 20 years. Given this prevalence and the associated health risks, it’s crucial for anyone treating adolescents to be aware of NSSI. Frequency of non-suicidal self-injury by adolescents have increased over the past 20 years. Given this prevalence and the associated health risks, it’s crucial for anyone treating adolescents to be aware of NSSI.

Recommended Content:

Total Force Fitness | Public Health

Medical staff who work with adolescents will likely meet patients who intentionally hurt themselves. Non-suicidal self-injury (NSSI) involves deliberate harm to one's own body without the intention to die. Girls are more likely to cut or pierce themselves, while boys are more likely to hit walls or themselves.

While estimates from the National Institutes of Health of NSSI by adolescents vary based on studies — from 1 in 6 to as high as 1 in 4 — rates have increased over the past 20 years. Given this prevalence and the associated health risks, it's crucial for anyone treating adolescents to be aware of NSSI, its risk factors, primary assessment considerations, and related resources.

Risk Factors

Adverse interpersonal experiences are the most common risk factors for NSSI.

In the past, professionals often believed traumatic childhood events like sexual abuse were associated with higher rates of NSSI. However, recent research shared by Current Psychiatry Reports has shown that emotional abuse is more common. Specifically, being bullied, parental critique or apathy, and indirect abuse (e.g., witnessing domestic violence), all strongly correlate with NSSI.

Military children may be at an elevated risk for trying NSSI. Bullying is likely a common risk factor for military kids as military-connected children report "higher rates of discrimination based on race/ethnicity, religion, gender, sexual orientation, and physical/mental disability than non-military connected children," according to a study published in Military Behavioral Health journal. Additionally, military families face unique emotional stressors due to deployments, relocations, and concern for the safety of deployed family members. For example, while a parent may not intend to be apathetic if they are deployed or worried about a deployed partner, the child may experience decreased emotional availability as apathy.

Assessment

Adolescents who self-injure frequently go to great lengths to hide their injuries. Many report a sense of shame or fear around adults discovering their behavior. Teenagers may self-injure for months or years before an adult knows.

As a result, NSSI may be discovered through indirect means.

"At times, parents have observed changes in behavior, such as declining school grades or difficulty regulating emotions, and are seeking services without being aware that their child is engaging in NSSI," explained Dr. Lisha Morris, a psychologist at Naval Medical Center Portsmouth's Child Mental Health Clinic in Virginia.

"Other families are informed by the parent of their child's friend, following viewing a text message or the child confiding in their friend."

Primary care providers can serve an essential role in helping adolescents get appropriate treatment.

"Children and adolescents engaging in NSSI are typically referred to mental health at our clinic through their PCM," continued Morris. "I would encourage PCMs to screen for NSSI, especially as children enter adolescence as we know that there is an increase in the prevalence of NSSI during adolescence."

Even if a patient is not currently self-injuring, it is still important to determine if they have a history of the behavior. Ceasing NSSI is associated with an increase in other risky behaviors, especially substance abuse.

Understand the Function

Adolescents primarily use NSSI as a form of emotional regulation. Studies have consistently shown that the experience of physical pain decreases negative affect. The act of self-harm can reduce negative feelings, thoughts, or internal experiences (e.g., anger, racing thoughts, or loneliness). It can also decrease the overall intensity of emotions, which helps if an adolescent feels overwhelmed.

Researchers, clinicians, and adolescent clients agree that a non-judgmental stance is an important first step in assessing NSSI, according to a report in the Journal of Marital and Family Therapy. Many adolescents who self-injure feel shame and do not want adults to discover the behavior. Approaching the assessment with a desire to understand how self-injury helps the patient can decrease the sense of being judged.

Questions that begin with "why" naturally evoke a defensive reaction, as they can be interpreted as accusatory. Instead of "why do you self-injure," providers should consider asking, "What does self-injury help you with?"

Assess for Risk

During the assessment, it is vital to explore the overall risk associated with the NSSI. Possible risks include:

  • The self-harm itself (e.g., method, frequency, intensity, location on body)
  • Potential medical complications (e.g., infection, required medical attention)
  • Other dangerous behaviors

NSSI can be associated with other high-risk behaviors like substance abuse, eating disorders, and unsafe sex.

It can be helpful to normalize the connection between NSSI and these other risky behaviors as a method of trying to feel better. For example, providers can ask, "Is there anything else you do to feel better, which others might consider risky?"

NSSI is also associated with an increased risk for suicide. A standard suicide assessment should be used by a provider according to their clinic's policy.

While the NSSI itself may not require urgent attention, these associated risks may increase the need for an urgent referral or close follow-up.

Identify Strengths

NSSI is often associated with feeling overwhelmed, so evaluating the patient's strengths is also key. It can help to ask the patient who they can go to for support, what comforts them, or what is going well for them.

Identifying these strengths can build rapport and highlight existing coping resources. If the patient cannot identify strengths, this can also inform the urgency of a provider's referral.

Accessing Resources

Therapy is frequently recommended as the most effective treatment for NSSI. A referral to a behavioral health specialist in a military medical treatment facility or a community provider will likely be necessary.

For military kids especially, it can be helpful to increase their overall social support.

"Friends play such an important role when one is struggling. It can be hard for military youth when they don't have a support network just after PCSing," said Dr. Kelly Blasko, program lead for the Defense Health Agency's Military Kids Connect program. "The Military Kids Connect website now has information to help military youth build healthy relationships that can be a support when difficulties arise."

Military OneSource also provides comprehensive services to increase family resilience and readiness through the Military Family Readiness System.

You also may be interested in...

Toxicologists Hold Vital Role in Protecting DOD Workforce

Article Around MHS
1/20/2023
Toxicologist working in laboratory

Among the DOD's priorities, protecting warfighters from enemy combatants and weapons is critical. But there are other scenarios, when undetected, that pose threat to the health of our military. Find out why that makes the job of a DOD toxicologists so important.

Recommended Content:

Public Health

Public Health Nutritionist Shares Strategies, Resources for Meeting New Year Weight Loss Goals

Article Around MHS
1/12/2023
healthy food infographic

Don't give up on your 2023 resolution to lose weight! We've gathered some unique tips, tools, and strategies to help you stay the course and meet your goals.

Recommended Content:

Public Health | Nutritional Fitness

Public Health Nurses: Heroes for Health

Article Around MHS
12/14/2022
U.S. Navy Cmdr. Tracy R. Kraus head shot

In a world where public health is constantly being challenged, the need for front-line contenders in the fight against threats is rapidly increasing. The work of the Public Health Nurse is nothing short of heroic. Learn more about the extraordinary dedication and arduous work it takes for Public Health Nurses to keep the warfighter population healthy and fit to fight and win.

Recommended Content:

Public Health

Big Hearts from Small, Small Places

Article Around MHS
12/13/2022
Military personnel demonstrating CPR

Sailors stand in a red and white metal space filled with folded wheelchairs and various medical equipment, each paired with a plastic torso and dummy infant at their feet. All eyes are fixed on the only voice in the room. The voice, carefully but clearly asking questions and giving out instructions, comes from a woman adorned in blue coveralls with her dark hair pulled back in a neat bun. U.S. Navy Hospital Corpsman 2nd class Johana Chi, from a small town in El Salvador, teaches CPR.

Recommended Content:

Public Health

Two Public Health Command Europe Soldiers Receive Highly Sought-After Expert Medical Field Badge

Article Around MHS
11/30/2022
U.S. Army Sgt. Stephanie Hardin taking the M4 proficiency test

One officer and one enlisted soldier assigned to Public Health Command Europe earned the coveted Expert Field Medical Badge on their first try during a grueling three-week testing event conducted by the 173rd Infantry Brigade at Caserma Del Din.

Recommended Content:

Total Force Fitness

How the U.S. Military Acclimates Units to High-Altitude Operations

Article
11/28/2022
Service members on a mountain

The Military Health System takes measures to prevent and mitigate altitude sickness in service members operating at high altitudes. For best results, it’s key to acclimate units gradually and progressively.

Recommended Content:

Total Force Fitness | Health Readiness & Combat Support

Enhancing Public Health Interoperability for the Joint Force

Article Around MHS
11/10/2022
Army Lt. Cmdr. Matthew Hall teaches a class

Members of Army Public Health Command Europe strengthened their partnership with sister services in a U.S. Air Force led Public Health Emergency Management training exercise held at Ramstein Air Base in Germany.

Recommended Content:

Building Partner Capacity and Interoperability | Humanitarian Assistance and Disaster Relief | Public Health

Lifestyle Changes Could Add 10-15 Years to Your Life

Article
11/8/2022
A female Navy physical therapist works with a senior citizen lying on a table holding a ball.

You're never too old to start being more physically active and eating healthier, which can add years to your life.

Recommended Content:

Preventive Health | Total Force Fitness

Navy and Marine Corps Public Health Center Holds Town Hall in Advance of DHA Transition

Article Around MHS
10/24/2022
Military personnel speaks at NMCPHS town hall event

The Navy and Marine Corps Public Health Center held a town hall meeting on Oct. 12 at their Portsmouth, Virginia, headquarters, in advance of their transition to the Defense Health Agency (DHA) Public Health directorate.

Recommended Content:

Public Health | Military Health System Transformation

DHA Turns 9: 'Now Fully Responsible for Health Care Delivery' in DOD

Article
10/6/2022
Four DHA personnel, including DHA Director Place, center, cut a birthday cake with a sword to celebrate DHA's ninth birthday. Oct. 1, 2022.

Defense Health Agency celebrates its 9th year; continues to grow military medical mission.

Recommended Content:

Defense Health Agency | Military Health System Transformation | Public Health

Get Your Flu Shot

Video
10/4/2022
Get Your Flu Shot

Rear Adm. Brandon L. Taylor, Director of DHA Public Health, discusses how vaccines greatly reduce the risk of severe disease, hospitalization, and death. "An ounce of prevention is better than a pound of cure." Lets us join Rear Adm. Taylor this year to get informed on how vaccines can minimize the dangers of flu.

Recommended Content:

Public Health | Immunizations | Immunization Healthcare Division | Seasonal Influenza Vaccine Toolkit

MSMR Vol. 29 No. 10 - October 2022

Report
10/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

MSMR Vol. 29 No. 09 - September 2022

Report
9/1/2022

A monthly publication of the Armed Forces Health Surveillance Division. This issue of the peer-reviewed journal contains the following articles: Surveillance trends for SARS-CoV-2 and other respiratory pathogens among U.S. Military Health System Beneficiaries, Sept. 27, 2020 – Oct. 2,2021; Establishment of SARS-CoV-2 genomic surveillance within the MHS during March 1 – Dec. 31 2020; Suicide behavior among heterosexual, lesbian/gay, and bisexual active component service members in the U.S. Armed Forces; Brief report: Phase I results using the Virtual Pooled Registry Cancer Linkage system (VPR-CLS) for military cancer surveillance.

Recommended Content:

Health Readiness & Combat Support | Public Health | Medical Surveillance Monthly Report

NAMI Recompression Chamber Supports Area Training Missions, Operations

Article Around MHS
8/29/2022
Military personnel demos compression chamber

Scuba diving can be extremely dangerous, and it’s possible for divers to develop adverse medical conditions and injuries while performing underwater operations. A common diving injury is decompression sickness (DCS), also referred to as the “bends”.

Recommended Content:

Public Health

Battalion Hosts Critical Medical Training

Article Around MHS
8/24/2022
Military personnel in combat training exercise

Allied Forces North Battalion conducted a week-long Combat Lifesaver Course July 25-29.

Recommended Content:

Total Force Fitness | Education & Training | Building Partner Capacity and Interoperability | Global Health Security Agenda
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 33
Refine your search
Last Updated: September 02, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery