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People have been hurting themselves for centuries. By "hurting oneself," I am referring to what psychologists call, Nonsuicidal Self Injury, or NSSI. NSSI is defined as the direct and deliberate destruction of one's own body tissue without a desire to die. For most, NSSI includes cutting oneself, although there are many other creative ways that adolescents and adults engage in NSSI.
Despite evidence that people have engaged in NSSI for centuries, it recently has been suggested that NSSI may be more popular now than ever, particularly among adolescents. It has become so prevalent in fact, that the upcoming diagnostic manual of psychiatric disorders (i.e., the DSM-V) proposes NSSI has a disorder unto itself. Is NSSI more popular now, and if so, why?
One reason may have to do with adolescents' peers. Research suggests that the most consistent and powerful predictor of adolescents' decisions to engage in a risky behavior is their belief that their peers (i.e., either their best friend, or an admired nonfriend peer) engage in a similar behavior. In other words, if an adolescent's best friend smokes, the risk that the adolescent will smoke increases dramatically. The same effect has been shown for adolescents' use of alcohol, drugs, aggressive behavior, sexual risk behavior, engagement in illegal activity, and even adolescents' depressive symptoms. Criminologists have demonstrated that peer influence occurs between prison cellmates. And some research has suggested that some attitudes and behaviors are "contagious" within large communities of peers.
But do peers influence adolescents' decisions to engage in NSSI?
We recently conducted a study to examine this exact question. We asked preadolescent youth to report whether they had engaged in NSSI, and to identify their very best friends. We then asked these best friends to tell us whether they had engaged in NSSI. One year later, we went back to these same youth and asked the same questions again. We very surprised to learn that preadolescents with a best friend who engaged in NSSI were more likely than others to pick up the same habit within the following year. We tested the same hypothesis in a sample of youth who were admitted to a psychiatric inpatient unit for severe clinical distress. Our findings were very similar. Adolescents' friendships with others who engaged in NSSI were related to increases in adolescents' own engagement in NSSI over time. In fact, our research findings revealed support for two basic tenets of peer influence research, referred to as selection and socialization effects. Socialization effects suggest that friendships can lead to a "contagion" of attitudes and behaviors between adolescents. Selection effects suggest that adolescents who engage in NSSI are more likely to develop new friendships with others who engage in NSSI. Clearly, selection and socialization effects can lead to a dangerous cycle of influence.
Why?
When we try to explain why adolescents may emulate their peers' use of alcohol or cigarettes, it is easy to imagine why peer influence is so powerful. Unfortunately, for many decades, some substance use is considered "cool" among some adolescents. If an adolescents' friend, or their admired peer drinks, they may be tempted to do the same with hopes that engaging in these behaviors will raise their status among their peers more generally. In addition, mild engagement in some substance use produces sensations that many consider to be pleasurable.
But NSSI causes pain. And most adolescents do not think that NSSI is "cool." What gives?
This is an ongoing question among psychologists and clinical scientists. Several preliminary answers are available. First, it appears that there is a subset of adolescents among whom NSSI is indeed "cool." These adolescents may be experiencing some psychological distress (e.g., depression, anger), and may even bond with one another over the expression of this distress. In recent years, some of these teens have been referred to as "Emos," although not all distressed teens are Emos, not all Emos are distressed. Nevertheless, it has been suggested that among distressed teens, NSSI may be discussed among adolescents as a strategy to alleviate emotional distress. NSSI may even be considered "cool," or at least "normal" among these subgroups of teens.
Second, NSSI may not feel good per se, but may produce a feeling of relief that is rewarding for those who have engaged in NSSI for some time. Although NSSI is a very dangerous and maladaptive way to relieve distress, research has demonstrated that adults with a history of NSSI report lower emotional arousal immediately following NSSI as compared to immediately before.
If this is true, then what can we do about it?
Combating peer influence has never been easy. Policy makers interested in reducing dozens of health risk behaviors all have tried to mitigate the effects of peer influence (e.g., on smoking, on drinking and driving, on sexual risk behaviors) with varying effects. We know with certainty that adolescents are quite resistant to reducing their contact with a risky peer, perhaps especially if an adult asks them to do so. Thus, peer influence cannot be remedied by attempting to limit adolescents' exposure to specific peers.
Instead, our challenge will be to help adolescents recognize when they feel distress and practice alternate coping strategies that are more adaptive. This is a challenge, indeed, since those who have engaged in NSSI often report that few alternatives are as quick and effective. But most all are less dangerous, nonetheless. And then perhaps one day, being able to manage one's emotions in an adaptive way will be considered the coolest thing of all.
Copyright © Mitch Prinstein, 2011. All rights reserved.
