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

Discussion

Overall, we found that disclosure of NSSI facilitated further help-seeking from peers, improved coping and reduced suicidality. However, disclosure to peers may reduce perceived social support and encourage NSSI in others. Conversely, confiding in an adult may be an important protective factor, increasing both adaptive coping skills and the belief in the ability to employ alternative coping skills to avoid death by suicide, and possibly reducing the severity of NSSI.

Among young self-injurers, most had disclosed their NSSI to another person, primarily to peers (friends). Preference to disclose to peers is consistent with findings from other studies.[13] When adults were the chosen confidantes, parents were more common than any other adult. We also found young people who disclosed NSSI (to either adults or peers) were more likely to have friends who are self-injurers. Arguably, knowing others who self-injure reduces stigma and facilitates disclosure of NSSI. It is also possible that young people who disclosed to adults had better pre-existing relationships with the adults in their lives, including better home environment. Anticipation of support and non-judgemental attitudes would facilitate disclosure to adults.[33] A more supportive family environment, open communication between parents and their children and modelling of adaptive coping might also explain why youth who disclosed to adults reported better psychosocial functioning over time.

That over 40 % of young people had not disclosed their NSSI to anyone highlights the secretive nature of NSSI and the need to encourage disclosure of the behaviour. Little work has explored the relationship between exposure to NSSI and stigma or attitudes towards people who self-injure. Among school staff, having experience with students who self-injured is associated with more positive attitudes towards those students,[9] but among psychologists no relationship exists between years of experience working with self-injuring clients and attitudes towards NSSI.[34] Further work is required to explore the relationship between exposure to NSSI and stigma, with a view to reducing stigma and facilitating help-seeking.

It is concerning that disclosure to others was associated with acquiring new friends who self-injured. There is ongoing concern that discussion of NSSI among peer groups risks an increase in the incidence of NSSI. While there is evidence of contagion in psychiatric settings e.g.,[35] less is known about the impact of discussion of NSSI among community-based samples. Previous work suggests that when an adolescent experiences an accumulation of negative life events (e.g. bullying), knowing a friend who self-injures is related to later NSSI,[15] a 'learned coping strategy'. Alternative explanations include the notion that an individual may change friendship groups after beginning to self-injure. This might arise as a result of stigma or disapproval expressed by friends (see discussion below), and a seeking out of like-minded friends who also self-injure. Disclosure to friends might also prompt those friends to disclose their own NSSI, thus increasing the awareness of the number of friends who self-injure. However, the increase in new friends who self-injure was not limited to disclosure to peers, but also observed when youth disclosed to adults. A plausible explanation for this relationship might be that disclosing to an adult could result in being placed into a therapy group with others who self-injure, increasing the number of self-injuring friends. Unfortunately, with the data collected we are not able to ascertain the reason for this effect.

Young people who disclosed to peers as opposed to adults were more likely to seek help by the end of the study period. While this is encouraging, peers remained the primary source of support. Although seeking help from informal sources facilitates formal help-seeking,[14] more effort is required to determine how best to support young people to seek help from adults and formal supports (e.g. school psychologist), and reduce help-negation. Turning to peers may stem from fear of stigma, a perception that parents and other adults lack understanding, and may not be able to help.[33] In hindsight, disclosure of NSSI can be viewed favourably by young people who receive help.[17] Capitalising on this through peer support programs may warrant consideration.

There was a general deterioration in level of perceived social support over time among those who disclosed their NSSI, particularly for those who disclosed their NSSI to friends. Although friends are generally supportive, learning of NSSI may make them react negatively (i.e. due to stigma, lack of understanding) and distance themselves. This negative reaction is then reflected over time in a reduction in perceived social support. Even young people who self-harm (broadly defined) express difficulty understanding self-harm in others.[17] However, despite this, help-seeking continued to increase suggesting that perhaps whilst the reactions of peers may not always be positive, overall it did not discourage further help-seeking.

Limitations and Suggestions for Future Research

First, we explored differences in whether the confidante was a peer or adult, but people who told peers may also have confided in adults; confidantes were not mutually exclusive. Consequently we cannot draw definitive conclusions about the effect of disclosure specifically to adults or peers on later psycho-social functioning. Arguably, the first person that comes to mind when asked about disclosure is likely to be most significant in the disclosure/recovery process, but further work is required to tease apart the differential effects of confiding in peers and adults. Second, although we collected data at three time points over a two year period, our design cannot detect nuances in family or social dynamics that may impact on, or result from, disclosure of NSSI. More detailed examination of the relationships explored here is required. Third, we did not explore the impact of disclosing NSSI on the confidantes, or the way in which confidantes reacted to the disclosure that someone they know self-injured. The reaction of family and friends will impact the young person and their future help-seeking behaviour. Fourth, the measures of disclosure and help-seeking may be confounded, as disclosure of NSSI may be perceived as a form of help-seeking. However, only three participants explicitly stated seeking help for NSSI when asked about the problem they were seeking help for. Fifth, participants included in this study are not representative of the general population of Australian adolescents, limiting generalizability of the findings. Finally, the internal consistency of the 'reference to others' subscale of our coping measure was poor, potentially explaining the null results observed with this scale.

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