What Happens When You Tell Someone You Self-injure? The Effects of Disclosing NSSI to Adults and Peers

Penelope Hasking; Clare S. Rees; Graham Martin; Jessie Quigley

Disclosures

BMC Public Health. 2015;15(1039) 

In This Article

Background

Non-suicidal self-injury (NSSI) is a challenging, yet prevalent, behaviour which typically begins during adolescence[1] and is related to difficulties with emotion regulation.[2] Although distinct from suicidal behaviour, a prolonged history of NSSI is a salient risk factor for later suicidal thoughts and behaviour.[3] For the 18 % of young people who engage in NSSI, the importance of seeking help to address psycho-social concerns is clear.[1,4] Early help-seeking for emotional difficulties is central to developing resilience among adolescents, reducing subsequent NSSI and suicide. Unfortunately, young people who self-injure avoid help, a phenomenon known as help negation.[5] Help negation manifests in the behavioural refusal or avoidance of obtaining and engaging in available help services, as well as the cognitive relationship between reported symptoms and intention to seek help, from either formal or informal sources of support.[6]

Help negation is influenced by a number of factors that work to facilitate or deter people from engaging in help seeking. Possibly one of the most important barriers to help seeking is one's comfort with self-disclosure, with evidence implicating low comfort with self-disclosure in help negation.[7] Despite increasing visibility, NSSI is still highly stigmatised and met with fear and confusion by parents e.g.,[8] school staff[9,10] and medical professionals.[11] Adolescents report that NSSI is often misinterpreted as a suicide attempt,[12] further deterring disclosure of the behaviour. While there is an assumed benefit in disclosing NSSI to adults, fearful or negative reactions from parents and family members may exacerbate psychological distress among youth, increase secrecy and limit help-seeking. Such reactions would also have deleterious effects on the level of perceived support available to the young person, further increasing a sense of isolation. Finally, the way family and friends react significantly impacts the family and social relationships.[8,13]

Not surprisingly, young people prefer to disclose NSSI to friends rather than adults.[14] Seeking help from informal sources, including peers and family, facilitates formal help-seeking[15] and could result in improved psychosocial functioning and coping over time. Yet, there is concern that discussing NSSI within peer groups may increase contagion,[14] with evidence that knowing a peer who self-injures increases the likelihood that a young person will self-injure.[16] As such, disclosing to parents and other adults might offer a more positive avenue for future help-seeking.

In summary, while there are likely benefits in disclosing NSSI to parents and other adults, how they react is paramount to future help-seeking.[17] Similarly, while disclosure to peers might facilitate help-seeking it may also exacerbate or encourage NSSI within the peer group. Facilitating help-seeking for NSSI, and assisting parents and families to effectively respond to disclosures, requires a better understanding of the effects of disclosure on the young person. Previous work has confirmed preferential help-seeking from friends, however no studies have explicitly explored disclosure of NSSI or the impact this may have on the young person. In this study we: 1) examined differences between youth who disclosed NSSI and those who did not with regard to help-seeking behaviour, coping strategies, social support, reasons for living (a proxy of suicidality) and severity of NSSI; 2) explored the effect of disclosure on changes in help-seeking behaviour, coping strategies, social support, reasons for living and severity of NSSI over a two year period; and 3) explored whether these effects were different according to whether the confidante was a peer or an adult. Although this study is largely exploratory, we expected that youth who disclosed their NSSI would report better psychosocial functioning and that disclosure to adults would be more beneficial than disclosure to peers. Finally, given that longer histories of NSSI,[3] and help-negation,[6] are each related to suicidal behaviour we propose that failure to disclose NSSI might relate to later suicidality.

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