Predisposition and precipitation factors of non-suicidal self-injury behaviors among adolescents

Adolescents face various transitions from hormonal, cognitive, and psychosocial aspects, causing adolescents to become a vulnerable population with mental health problems. Non-suicidal self-injury (NSSI) becomes one of the mental health problems fought by adolescents. NSSI is defined as a behavior to overcome emotional stress or emotional pain by self-hurting and self-harming without intending to commit suicide.¹

The demographic data on NSSI behaviors is difficult to identify¹ because NSSI is considered a private issue, so many cases are not detected by health workers, except for those being treated for their mental health condition.² However, previous studies consistently show that NSSI is more common in women.^3–6 NSSI behaviors can also occur in both normal populations and individuals who are diagnosed with mental health disorders, such as borderline personality disorder, depressive disorders, bipolar disorder, and schizophrenia.⁷ NSSI was reported often occurring in individuals aged 12-19 years.⁸ Meanwhile, the previous study explained several NSSI methods, including cutting, biting, carving, pinching, hair pulling, scratching, hitting, disrupting wound healing, piercing, and swallowing dangerous substances.⁸

The most common factors causing NSSI behaviors are the inability to regulate emotions, conflicts with peers, and inharmoniousness in the family.⁶ Meanwhile, NSSI behaviors create a broad spectrum of deprivation, both physical, psychological, economic, social, and academic aspects.⁸ Research shows that even though NSSI is carried out without any intention of committing suicide, significant cases of NSSI result in death. Individuals who experience NSSI have a 1.68 times higher risk of committing suicide. Furthermore, individuals who experience NSSI damage their body tissue can result in medical complications and even death.⁹

NSSI cannot be considered an insignificant phenomenon, especially in vulnerable populations such as adolescents. Therefore, this study aimed to identify the predisposition and precipitation factors associated with the dynamics of NSSI behaviors among adolescents.

The majority of adolescents in this study were at risk of NSSI. Adolescents more often engage in NSSI behaviors because adolescence is a period where various transitions occur.¹¹ Previous research explains that adolescents are associated with NSSI behaviors due to their self-identity development and awareness of their “fit place.” The social acceptance is one of the critical factors for them. On the contrary, adolescents may not yet have the skills to identify the appropriate judgment.¹² NSSI behaviors are often used as maladaptive coping to deal with negative feelings associated with depression and anxiety (e.g., sadness, nervousness, and worthlessness), and women are at higher risk of engaging in NSSI behaviors because they experience these symptoms to a greater degree than men.¹³ Several previous studies suggest that the prevalence of women may be more common in clinical populations due to differences in treatment-seeking behaviors, where there is a stigma for men in seeking mental health treatment.¹⁴ This study’s results show that most respondents are at risk of NSSI. This aligns with a previous study, which indicates that the percentages of individuals with NSSI in clinical populations tend to be higher than in the general population.¹⁵

The results of this study indicate that the most significant predisposition factors of NSSI behaviors experienced by respondents in this study are introverted personality and the environment that supports NSSI behaviors. An introverted personality is connected to low self-esteem and becomes a risk factor for depression, which later becomes a potent factor of NSSI behaviors.^16,17 Furthermore, media exposure is the possible environmental factor that supports NSSI behaviors in the current era. The development of various media on the internet has caused more and more teenagers to be exposed to more complex and diverse information about NSSI behaviors on the internet, making them compare and discuss their own experiences, making it easier to try new ways in NSSI behaviors.⁵ Other environmental factors possibly include exposure to emotional or psychological abuse, physical abuse, sexual abuse, parental intimate partner violence, living with a substance-abusing, mentally ill, or criminal household member, and parental separation or divorce.¹⁷

However, the analysis in this study shows that both introverted personality and environment that support NSSI behaviors are not related to the dynamics of NSSI behaviors. Otherwise, the maladaptive coping mechanism has become a predisposition factor related to the dynamics of NSSI behaviors. Coping is a deliberate effort to deal with a threatening emotion or situation.¹⁸ The maladaptive coping strategies may appear in front of adversities, for example, anxious behaviors, avoidance behaviors, rationalization cognitions, and dissociation of their own emotions and cognitions.¹⁹ SSI becomes a maladaptive coping strategy that adolescents use as a coping style when faced with adverse events in their lives.²⁰ The previous study shows maladaptive coping mechanisms, e.g., poor emotional expression, were positively associated with NSSI in adolescents.¹⁸ Studies also suggest that positive coping mechanisms need to be taught to adolescents to reduce NSSI behavior rates, such as support seeking.^15,18

Moreover, the most significant precipitating factors for NSSI behaviors experienced by respondents in this study are bullying and deep disappointment. This is consistent with other research that indicates that the best predictor of the occurrence of NSSI behaviors in adolescents is their bullying experience, including cyberbullying.²¹ Adolescents who have been bullied may engage in NSSI as a solution to express their need for help or as a kind of self-punishment because they feel unable to speak out against or stop the bad behavior they witness.²¹ Another research revealed that adolescents who suffered from childhood trauma, such as abuse and neglect, may be more vulnerable to bullying victimization, as well as using NSSI as a coping strategy.²² Furthermore, the deep disappointment associated with self-blame behaviors significantly moderates the relationship between stressors, depression, and NSSI behaviors.²³ Self-blaming behaviors also partially mediate the relationship between poor self-concept and NSSI behaviors.²⁴

Moreover, the analysis of this study indicates bullying and deep disappointment as precipitating factors related to the dynamics of NSSI behaviors. Bullying is any form of violence intentionally perpetrated by one person or group of people toward another person with the intent to cause harm to that other person.²⁵ The form of bullying varies from ridiculing, spreading gossip, giving inappropriate nicknames, and hurting verbally or in writing, isolating, slandering, intimidating, physically attacking, and embarrassing in public.²⁵ With the rapidly growing population of internet users, cyberbullying is becoming a “new” bullying strategy among adolescents. Cyberbullying refers to one individual or group of individuals who repeatedly communicate aggressive messages intended to inflict harm or discomfort on others by a set of behaviors performed through the network of connections, e.g., smartphone.²⁶ Several previous studies have suggested that exposure to bullying and cyberbullying is a significant risk factor for developing NSSI behaviors in adolescents.^26–29 In fact, previous research suggests that both victims and perpetrators of bullying are likely to engage in NSSI behaviors, with victims at a higher rate.²⁷ Victims of bullying may use NSSI behaviors as a way to seek help, cope with stress, or even as a means of self-punishment.²⁹

Furthermore, deep disappointment becomes another precipitating factor associated with self-critical behaviors. Previous studies indicate that self-criticism in the face of the negative consequences of stressful life events promotes NSSI behaviors. In contrast, self-compassion buffers the effects of stressful life events on NSSI.²³ Another study indicates that self-criticism partially mediates the risk relationship between lack of self-concept clarity. In contrast, a lack of self-concept clarity is associated with more remarkable NSSI behaviors. Self-critical behaviors will increase an individual’s desire to punish themselves, reduce a positive view of themselves, and motivate individuals to choose NSSI over other coping behaviors.²³

The key results of this study indicate that the most significant predisposition factors of NSSI behaviors experienced by respondents in this study are introverted personality and the environment that supports NSSI behaviors. In contrast, the precipitation factors are bullying and deep disappointment. Otherwise, based on the data analysis, the maladaptive coping mechanism has become a predisposition factor related to the dynamics of NSSI behaviors, while bullying and deep disappointment still become precipitation factors related to the dynamics of NSSI behaviors among State High School and Vocational School students in Central Java Province. The results of this research can be evidence-based for stakeholders to provide interventions, especially for NSSI behavior’s vulnerable population.