The number of teenagers deliberately hurting themselves is on the increase. For example, the latest data for England show that over 13,000 15- to 19-year-old girls and 4,000 boys were admitted to hospital for this reason in the 12-month period up to June this year, an increase of 10 per cent compared with the previous 12-month period. More than ever we need to understand why so many young people are resorting to this behaviour.
A common motivation teenagers give is that non-suicidal self-harm provides a way to escape unpleasant thoughts and emotions. Another motive, little explored before now, is that self-harm is a way to deliberately provoke a particular desired feeling or sensation. A new paper from US researchers has explored this aspect of self-harm, known as “automatic positive reinforcement” (APR).
Edward Selby and his colleagues gave 30 teenagers who self-harm (average age 17; 87 per cent were female) a digital device to carry around for two weeks. Twice a day, the device beeped and the teens were asked to record their recent thoughts of self-harm, any episodes of self-harm, their motives, their actual experiences of what it felt like, as well as answering other questions.
Just over half the sample reported engaging in at least one instance of self-harm that was motivated by wanting to experience a particular sensation (and 35 per cent of all self-harm behaviours had this motive). The most common sensation the teenagers sought was “satisfaction” (45 per cent of them), followed by “stimulation” (31 per cent) and “pain” (24 per cent). Those were the hoped for sensations. In fact, pain was experienced more often than it was sought; stimulation was experienced as often as it was sought; and satisfaction was experienced less often than the teenagers wanted.
There were differences between the teenagers who self-harmed in order to produce a particular feeling and those who didn’t have this motive. The former group self-harmed more often during the study (and in the past) and they thought about self-harm more often and for longer. Those seeking a particular feeling from self-harm also engaged in more other risky behaviours including using alcohol, binge eating and impulsive spending. Zooming in on the different sensation motives, those teens seeking pain and stimulation tended to self harm more than those who sought satisfaction.
This study has made an important contribution to an under-researched aspect of self-harm, although it leaves many questions unanswered. For instance, one explanation for the more frequent self-harming observed among those who say they self-harm because they want to experience pain, is that the act triggers pain-relief mechanisms in the brain – a form of euphoria. And yet, self-harming was less frequent among those who said they self-harmed for satisfaction. This potential contradiction could be due to vagueness in the meanings of the words used – is the pursuit of euphoria (via pain) different from the pursuit of satisfaction? Such ambiguities will have to be addressed by future research.
Despite this, and the small sample size, Selby and his team said their novel findings already have clinical implications. “If alternative healthy behaviours can be identified that might induce a similar reinforcing sensation, then those healthy behaviours may be able to be harnessed as a more effective alternative to non-suicidal self-injury (NSSI),” they concluded. “For example if one purpose of NSSI is to derive pain, then exercise might function as an effective alternative as moderate levels of exercise might have a similarly painful or distracting effect that can help cope with upsetting emotions.”
Edward A. Selby, Matthew K. Nock, and Amy Kranzler (2013). How Does Self-Injury Feel? Examining Automatic Positive Reinforcement in Adolescent Self-Injurers with Experience Sampling. Psychiatry Research DOI: 10.1016/j.psychres.2013.12.005