Part 2: Understanding Self-Harm in Students (Treatment and Prevention)

By Didi Dunin, CEI Intern

An understanding of the warning signs and appropriate means of intervention for non-suicidal self-injury (NSSI) can help reduce the incidence of this increasingly widespread behavior. Thankfully, more schools are recognizing this problem and taking action to reach students using NSSI to regulate their emotions. While intervention is essential, we know that prevention can be an even more powerful tool to help students better understand what to do with troubling thoughts and feelings.

NSSI, which you can read more about in Part 1 of this series, is defined as deliberately injuring oneself without suicidal intent. The most common types of self-injury behaviors are cutting and burning the skin. Since youth often hide these injuries, being aware of the warning signs are critical to helping these individuals.

Warning Signs

Warning signs for students who might be engaging in NSSI behaviors include:

1. Unexplained cuts, burns, or bruises

2. Possession of any sharp objects that may be used to injure (e.g., razors, glass, lighters, knives, thumb tacks, paper clips, ends of pencils)

3. Continually wearing clothing that is inappropriate for the weather or the situation (e.g., long sleeves in hot weather or gym class)

4. References made to self-injury in a student’s creative writing, journals, or art projects

Unfortunately, many school personnel unintentionally express negative initial reactions when first encountering youth engaging in NSSI and do not know how to help (Riggi, Moumne, Heath, & Lewis, 2016).

Thus, it is important for educators to learn to manage their reactions to warning signs and address the student in a non-accusatory manner. According to Walsh (2012), the best way to respond to potential self-injury is with a “low-key, dispassionate demeanor and respectful curiosity” (p. 134).  

Once the educator has confirmed that the warning signs are indicative of NSSI, educators can refer said student to mental health personnel that have specialized training in intervention to help that student get the individualized care and guidance they need. Educators can also do their own part in prevention by fostering open communication, teaching coping mechanisms and media literacy, and promoting a safe and positive school climate.

Types of Treatment and Prevention Strategies

Social Support and Media Literacy

Since most students who self-injure report first learning about self-harming behavior from friends, family, and the media (Whitlock, Purington, & Gershkovich, 2009), providing students with appropriate role models and support groups can serve as protective factors. Teaching media literacy can also help students resist harmful media influences.

Positive School Climate

Students who report being bullied and threatened and who have less trust in school staff are more likely to engage in NSSI (Noble et al., 2011). Alternatively, students who feel supported by their teachers and who are exposed to a positive peer climate are less likely to engage in NSSI (Madjar et al., 2017).

Mindfulness and Cognitive Reappraisal

Research provides promising insight into potential prevention and intervention initiatives that target rumination and distress tolerance to reduce the likelihood and frequency of self-injury (Slabbert, Hasking, & Boyes, 2018). For example, Mindfulness-Based Cognitive Therapy, Cognitive-Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT) can help address emotion dysregulation in adolescence. This is accomplished by teaching them acceptance and mindfulness skills as a way of coping with stressful experiences (peer pressure, exams) and internal distress (depression, identity confusion).

Developing a School Protocol

Key issues to be addressed in school protocols include (Riggi, Moumne, Heath, & Lewis, 2016):

1. Having a designated school mental health professional (MHP)

2. Clarification of the roles of each school personnel involved in the management of the student who is engaging in NSSI

3. Policies regarding confidentiality and parental notification

4. The use of validated risk assessment tools

Overall, it is important for school staff working with youth who self-injure to be aware of the warning signs and self-regulate their own reactions to students dealing with these difficulties. Educators can teach students alternative coping mechanisms and media literacy skills as preventative procedures, as well as provide a positive classroom climate. Each school can also develop their own protocol to help facilitate appropriate treatment and intervention. Taking these steps will not only reduce the number of students who turn to self-harm to relieve their stress, it will also improve the culture of the school, thus benefiting all students.

References Madjar, N., Shabat, S. B., Elia, R., Fellner, N., Rehavi, M., Rubin, S., Segal, N., & Shoval, G. (2017). Non-suicidal self-injury within the school context: Multilevel analysis of teachers’ support and peer climate. European Psychiatry, 41, 95-101.

Noble, R. N., Sornberger, M. J., Toste, J. R., Heath, N. L., & Mclouth, R. (2011). Safety first: The role of trust and school safety in non-suicidal self-injury. McGill Journal of Education, 46(3), 423. Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2016). Non-suicidal self-injury in our schools: A review and research-informed guidelines for school mental health professionals. Canadian Journal of School Psychology, 32(2), 122-143. Slabbert, A., Hasking, P., & Boyes, M. (2018). Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury. Psychiatry Research, 269, 309-315. Walsh, B. W. (2012). Treating self-injury: A practical guide (2nd ed.). New York: The Guilford Press. Whitlock, J.L., Purington, A., Gershkovich, M. (2009). Influence of the media on self-injurious behavior. In Understanding non-suicidal self-injury: Current science and practice, edited by M. Nock. American Psychological Association Press. 139-156.