School Counselors' Role in Advocating for Students Who Self-Injure

Introduction

Nonsuicidal self-injury (hereafter referred to simply as self-injury or SI) is defined as the deliberate damage of body tissue without intention to die (Berger et al., 2014). Self-injury can take a variety of forms such as cutting, burning, scratching, biting, and hitting. Self-injury is a common behavior among adolescents, with prevalence rates in a nationwide sample of over 60,000 youth at approximately 6%-14% in males and 17%-30% in females (Monto et al., 2018). Because of the risks and pervasiveness of this behavior, professional counselors play a significant role in prevention and intervention. Professional school counselors are especially well-situated to support students who self-injure. However, there are relatively few school policies in place that address self-injury and many school staff report a lack of knowledge, training, and self-efficacy with addressing self-injury (Berger et al., 2014). This lack of knowledge and training, in combination with negative beliefs and stigmatizing views about self-injury, can lead to significant challenges in quality care.

Competently addressing SI may take on a variety of forms including evidenced-based intervention, education and collaboration among school staff, and appropriate referrals. Professional school counselors should take advantage of opportunities to increase their knowledge and self-efficacy regarding SI, while also gaining awareness and challenging their biases and negative assumptions (Berger et al., 2014). In this chapter, the functions and purpose of SI will be explored, along with the relationship between SI and suicidality, and potential complications of SI. Ethical and legal issues associated with SI, including special considerations from the American School Counselor Association (ASCA), will also be addressed. Next, warning signs and risk factors for SI will be presented, and common myths will be discussed. Finally, the importance of collaborating with school personnel is highlighted, and best practices for school counselors working with students who engage in SI are provided.

Background

Self-injury can serve multiple, evolving functions. Emotion regulation tends to be the most common reason for self-injury, which involves responding to negative emotional states and reducing emotional arousal (Nock & Prinstein, 2004). Other possible reasons for self-injury include the following: coping with dissociation (i.e., the pain reconnects an individual with their body), physically communicating emotional distress, interpersonal reasons such as peer bonding and social influence, revenge, autonomy, sensation-seeking, feeling strong/building mental toughness, and gaining a sense of control (Muehlenkamp et al., 2019).

Biological factors may also contribute to an increased likelihood of self-injuring. For example, some people may have a genetic predisposition for decreased serotonin levels or dopamine levels, which might increase their use of SI as this can result in a temporary rush of neurotransmitters (Halicka-Maslowska et al., 2020). This temporary rush of neurotransmitters is positively reinforcing, which can encourage individuals to continue to self-injure in order to experience more positive emotions. Additionally, neurobiological factors, such as emotional intelligence, which is considered a collection of social skills and emotion regulation skills, may also be correlated with self-injury. Individuals with greater emotional intelligence and emotion regulation are at a lesser risk for engaging in SI (Halicka-Maslowska et al., 2020). Individuals who engage in SI often experience more than one reinforcer that promotes or encourages their use of this means of emotion regulation.

Because self-injury typically serves more than one function, a combination of these techniques may be particularly helpful. Additionally, it is important for school counselors to consider that individuals with a history of trauma have greater difficulties with emotion regulation. Therefore, those who have experienced adverse childhood experiences or other traumatic experiences, such as racial trauma and poverty, are at a greater need for processing their traumatic experiences, rather than simply being taught emotion regulation skills.