Back to Top Skip to main content Skip to sub-navigation

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. Click to open a larger version of the image. 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 | Conditions and Treatments

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...

Infectious Disease Screening

Infographic
8/3/2021
Infectious Disease Screening

TRICARE covers the following screenings and vaccinations as part of the annual Health Promotion and Disease Prevention exams: Blood Pressure Chlamydia and Gonorrhea Cholesetrol Diabetes Mellitus (Type II) Hepatitis B Hepatitis C Human Immunodeficiency Virus (HIV) Testing Immunizations Rubella Antibody Testing Syphilis Tuberculosis (TB)

Recommended Content:

About TRICARE | Conditions and Treatments

Total Force Fitness Physical

Infographic
7/21/2021
Total Force Fitness Physical

Total Force Fitness - Total Body Preventive Health and Physical Fitness - Ability to physically accomplish all tasks while remaining mission capable and avoiding injury

Recommended Content:

Preventive Health Toolkit | Total Body Preventive Health and Total Force Fitness | Total Force Fitness | Physical Fitness | Medical and Dental Preventive Care Fitness

TFF cogs Physical 1200x675

Infographic
5/19/2021
TFF cogs Physical 1200x675

“Vision and Hearing and Physical Fitness. Ability to physically accomplish all tasks while remaining mission capable and avoiding injury.”

Recommended Content:

Total Force Fitness Toolkit | Total Force Fitness | Physical Fitness | Vision and Hearing Loss Prevention

TFF cogs Environmental 1200x675

Infographic
5/19/2021
TFF cogs Environmental 1200x675

“Vision and Hearing and Environmental Fitness Ability to perform tasks in any environment"

Recommended Content:

Total Force Fitness Toolkit | Total Force Fitness | Environmental Fitness | Vision and Hearing Loss Prevention

Total Force Fitness COGS Psychological

Infographic
4/26/2021
Total Force Fitness COGS Psychological

Total Force Fitness Mental Health and Psychological Fitness Ability to integrate and improve cognitive, emotional, and behavioral capabilities to optimize performance and ensure mission readiness

Recommended Content:

Mental Health Toolkit | Total Force Fitness | Psychological Fitness

Total Force Fitness Circle Logo

Infographic
4/26/2021
Total Force Fitness Circle Logo

"Total Force Fitness”

Recommended Content:

Mental Health Toolkit | Total Force Fitness | Mental Health and Total Force Fitness

Total Force Fitness COGS Environmental

Infographic
4/26/2021
Total Force Fitness COGS Environmental

“Total Force Fitness Mental Health and Environmental Fitness Ability to perform tasks in any environment”

Recommended Content:

Mental Health Toolkit | Total Force Fitness | Environmental Fitness | Mental Health and Total Force Fitness

TFFcogs Nutritional 1200x675

Infographic
3/23/2021
TFFcogs Nutritional 1200x675

Total Force Fitness for Kids social media graphic showing an orange military kids logo, a multi-colored Total Force Fitness logo, and a blue circle with a star in the center and plate with a fork and a knife emanating from the center

Recommended Content:

Total Force Fitness and Military Kids | Total Force Fitness | Nutritional Fitness

TFFcogs Financial 1200x675

Infographic
3/23/2021
TFFcogs Financial 1200x675

Total Force Fitness for Kids social media graphic showing an orange military kids log, a multi-colored Total Force Fitness logo, and a blue circle with a star and a dollar sign emanating from the center

Recommended Content:

Total Force Fitness and Military Kids | Total Force Fitness | Financial Fitness

Holiday Food Safety Tip: Cook Food Thoroughly

Infographic
10/16/2019
Holiday Food Safety Tip: Cook Food Thoroughly

Use a thermometer to ensure your food is cooked to the right minimum internal temperature.

Recommended Content:

Total Force Fitness | Nutritional Fitness

Holiday Food Safety Tip: Keep Cold Food Cold

Infographic
10/16/2019
Holiday Food Safety Tip: Keep Cold Food Cold

Don't let your cold dishes sit out on a counter for more than 2 hours. Keep it chilled at 40 degrees or less.

Recommended Content:

Total Force Fitness | Nutritional Fitness

Holiday Food Safety Tip: Marinate Meat Safely

Infographic
10/16/2019
Holiday Food Safety Tip: Marinate Meat Safely

Marinate your food in the refrigerator, and keep it there until you're ready to cook it.

Recommended Content:

Total Force Fitness | Nutritional Fitness

Holiday Food Safety Tip: Wash Your Hands

Infographic
10/16/2019
Holiday Food Safety Tip: Wash Your Hands

Washing your hands often is one of the best ways to prevent the spread of bacteria.

Recommended Content:

Nutritional Fitness | Total Force Fitness

Medical encounters, by condition, U.S. Armed Forces 2016

Infographic
5/25/2017
Medical encounters, by condition, U.S. Armed Forces 2016

This infographic documents the three burden of disease related conditions that accounted for the most medical encounters among the active component of the U.S. Armed Forces in 2016.

Recommended Content:

Armed Forces Health Surveillance Division | Conditions and Treatments

Diabetes Mellitus

Infographic
3/17/2017
Diabetes Mellitus

Diabetes Mellitus (DM) is a group of chronic metabolic conditions characterized by high blood glucose levels resulting from a decreased ability to produce and or use insulin. DM-related metabolic abnormalities are associated with damage to various organs and tissues. From 2008 - 2015, a total of 9,092 incident cases of DM were reported among active duty service members. This infographic provides details on the overall incidence rates of type 1 and 2 DM cases per 100,000 person-years. It also provides information about service members at higher risk of diabetes.

Recommended Content:

Conditions and Treatments | Armed Forces Health Surveillance Division
<< < 1 2 > >> 
Showing results 1 - 15 Page 1 of 2

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.