Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents

Objective: The incidence of self-injurious behavior (SIB) in adolescent psychiatric inpatients has been reported to be as high as 61 %, yet few data exist on the characteristics and functional role of SIB in this population. Because of the repetitive nature of SIB and its potential to increase in severity, features of SIB and its specific reinforcing effects were examined. Method: Participants were 42 self-injuring adolescents admitted to a hospital over a 4 month period. Data sources consisted of self-report questionnaires and medical chart review. Results: Mean age was 15.7 +/- 1.5 years. Reported urges to self-injure were almost daily in 78.6% of the adolescents (n = 33), with acts occurring more than once a week in 83.3% (n = 35). The two primary reasons endorsed for engaging in self-injury were "to cope with feelings of depression" (83.3%, n = 35) and "to release unbearable tension" (73.8%, n = 31). Of the sample, 97.6% (n = 41) endorsed three or more addictive symptoms. Conclusions: SIB in hospitalized adolescents serves primarily to regulate dysphoric affect and displays many addictive features. Those with clinically elevated levels of internalized anger appear at risk for more addictive features of this behavior.