Academic journal article Journal of Mental Health Counseling

Minimizing Social Contagion in Adolescents Who Self-Injure: Considerations for Group Work, Residential Treatment, and the Internet

Academic journal article Journal of Mental Health Counseling

Minimizing Social Contagion in Adolescents Who Self-Injure: Considerations for Group Work, Residential Treatment, and the Internet

Article excerpt

Social contagion among adolescents is a growing concern as the numbers of youth who selfinjure increases. Mental health counselors face challenges in treating self-injurers in settings that are prone to social contagion. This article describes social contagion as one factor motivating self-harm in group settings, residential facilities, and audiences for social and electronic media. It reviews possible benefits and pitfalls of self-injury treatment in these environments and presents approaches to minimize social contagion. Responses to self-injury and social contagion are explored.


The prevalence of nonsuicidal self-injury (NSSI) among adolescents and young adults has been rising rapidly and significantly (Kerr, Muehlenkamp, & Turner, 2010; Prinstein, Guerry, Browne, & Rancourt, 2009); it has even been described as epidemic (e.g., Plante, 2007; Whitlock, Purington, & Gershkovich, 2009). In one recent study of a community adolescent population, at least 27% had engaged in one or more types of NSSI (Baetens, Claes, Willem, Muehlenkamp, & Bijttebier, 2011). In studying adolescent clinical populations, Jacobson, Muehlenkamp, Miller, and Turner (2008) found that only 52% of patients reported not having engaged in any form of self-injury, and in a different population Nock & Prinstein (2004) found that 82.4% had engaged in at least one NSSI incident. These statistics suggest the importance mental health professionals must place on helping prevent self-injury. It is imperative that counselors working with youth recognize the prevalence of NSSI and understand how certain environments present higher risks.

By definition, intent to die is not a factor in NSSI (Wilkinson & Goodyear, 2011; Yaryura-Tobias, Neziroglu, & Kaplan, 1995). Researchers describe it as a deliberate, adaptive strategy to manage physiological stimulation and emotional distress, without the intention of ending life (Deiter-Sands & Pearlman, 2009; Hyldabl & Richardson, 2011; Plante 2007; Walsh 2006). Most often individuals engage in NSSI to regulate or express affect, relieve tensions, manage dissociative and depersonalization symptoms, gain a sense of control, and influence others (Klonsky, 2009). Consequently, NSSI can become a repetitive, addictive coping strategy that may result in significant scarring, infection, life-threatening injury, and accidental death (Nafisi & Stanley, 2007; Plante, 2007). Understanding the unintended consequences of NSSI is important to preventing it.

With a significant proportion of teens engaging in NSSI, there is growing evidence that self-injury "is a behavior subject to peer influence, perhaps particularly among adolescents ... [which] presents a large public health concern" (Prinstein et al., 2009, p. 89). Self-injury contagion has been defined as when (a) acts of self-injury occur in two or more persons within the same group within 24 hours, or (b) acts of self-injury occur within a group of statistically significant clusters (Walsh & Rosen, 1985). The primary focus of this article is to identify environments that present a high risk of contagion and suggest ways counselors working with adolescents can minimize and prevent it.


Many programs designed to treat adolescents who self-injure consider group therapy to be an essential treatment ingredient. Self Abuse Finally Ends (SAFE), founded in 1985 by Karen Conterio and Wendy Lader, was the first treatment facility designed specifically for people who self-injure. Since its inception, clinicians at SAFE have used group therapy as a central feature of their treatment programs (Conterio, Lader, & Bloom, 1998). Dialectical behavior therapy (DBT), which combines individual therapy, group skills training, and family education, has emerged as one of the most effective treatments for adolescents who are suicidal or self-injurers (Katz, Cox, Gunasekara, & Miller, 2004; Muehlenkamp, 2006; Rathus & Miller, 2002). …

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