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Risky Behavior

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Phenomenon of risky behavior: NSSI

•Health behavior models and theories for understanding risky behavior
Human behavior is complex and describing and predicting it continues to be a challenge in social science. Social influence, such as drugs, family, peers, media, has a great impact on development of negative behavior that would require intervention or prevention to make changes in health and behavioral habits by examining the behaviors of findings based on current research and theories /models of behavioral change. Per Heilbron et al. (2008) many current research focused on prevalent and risky group of self –harm behaviors that are growing mostly due to social, peer influence engaging in NSSI. Nonsuicidal self-injury (NSSI) is one of prevalent health behavior risks in pre-adolescence and adolescence, and many fields have offered theories and models that can be important applications for research on peer influence and change of behavior in NSSI groups for behavioral change (Heilbron et al. 2008). Behavioral theories of peer influence are one application to determine NSSI based on Social Cognitive Theory (SCT, originally social learning theory) (Ragin, 2011). Social cognitive theory (SCT) is the psychological model of behavior developed by the work of Albert Bandura (1977; 1986). SCT (Ragin (2011) suggests that cognitive processes are serious to the acquisition and regulation of behaviors, and individuals learn through modeling, direct operant reinforcement with methods of rewarding or punishing, and /or observational learning, . Per Ragin (2011) SCT emphasize that learning occurs in a social context: learned and influenced through observation, from consequences that are “respond information” that indicates one of four approaches: direct experience, vicarious experience, persuasory learning and inferred learning. Per results of research, “high levels of deviant talk and low levels of entropy in adolescent dyads predicted significant increases in deviant behavior in young adulthood” (Heilbron et al. 2008). Per Heilbron et al (2008) these behavioral theories of peer influence outline issues that could encourage and maintain involvement in NSSI. Unfortunately, there is limited data on understanding how NSSI characteristics naturally develop in children.

•A definition and description of emerging adulthood
NSSI-non-suicidal self-injury-defined by Muehlenkampa et al. (2012) is a destruction of the skin with no premeditated suicidal self-injury in adolescents associated with psychological, behavioral emotional instability. Per Muehlenkampa (2012) studies were conducted to identify and explain emotional dysregulation and self –inflicted injuries linking to how the adolescences experience the body: body image that is the “multidimensional set of thoughts and feelings related to the physical experience, appraisal of, and satisfaction of one’s body” (p. 1). Body image and the emotional thought ease the settings of negative effects and NSSI. A feeling of detachment, dissociation is an effect of body dissatisfaction leading to anhedonia, pain tolerance and low or negative body image. However, physically harming the body they show the specific attitude or feeling towards their body (Muehlenkampa, 2012). Body image is a multidimensional mechanism including cognitive, behavioral and perceptual effects (Dyer, et al., 2013). Per Dyer et al. (2013) cognitive-affective mechanism includes the evaluation of one’s own appearance and the importance of the weight and body shape. However, dissatisfaction leads to disturbance of behavior of avoidance where they start covering themselves with wide clothing, constant self-weighting, etc. Finally, the perceptual effect is the mental image of one’s own body that may lead to eating disorders as self-harm (Dyer, 2013). Studies indicated that more suicidal adolescents described negative body image issues, body dissatisfaction leading to depressive and hopeless feeling with higher level s of dissociation and pain tolerance (Muehlenkampa, 2012). However, a person facing low or negative body image views self’s own body disconnected from self and may have high tolerance for pain, and so ability to harm the body when facing stress (Muehlenkampa, 2012).
Nonsuicidal self-injury (NSSI) is identified as deliberate injury or harm to the body without a conscious suicidal intention or a desire to die or kill the self (Schatten et al. 2013). Nonsuicidal self-injury (NSSI) is a behavior that is associated with borderline personality and depression and is growing among children and adolescents (Schatten et al. 2013). NSSI is described as self-injury, self-mutilating, and deliberate self –harm. Per Kelly, et al. (2008) pinching, scratching the skin, punching, hitting something until bleeding, carving something into the skin, burning, branding the skin, cutting are the types of NSSI. Several studies reviewed and addressed the psychiatric symptoms of NSSI in children and adolescents who are experiencing depression, eating disorders, substance use, impulsivity and suicide. Self-harm is used as a mechanism to deal with the stress and dissociation from self and is more effective in youth population (Moskowitz et al. 2013). Per Moskowitz et al. (2013) self-harm is not intended to take one’s own life, but it is a way of handling the internal stress, dissatisfaction and psychological pain, but they are in greater risk of killing themselves unintentionally. However, the self-harm may transform from low fatality methods, like cutting, burning, to high fatality methods, like hanging themselves. Per Moskowitz et al. (2013) a present study indicated that 70 % of teens 70 % who were involved in one type of elf-harm behavior, have attempted at least one suicide. Suicide is third leading cause of death and is common in adolescence and homeless (CDC, 2009). Runaway and homeless adolescence have pattern of behavioral, emotional and family related issues that lead to stress and negative behavior which can contribute to self-harm and suicide. NSSI is a dangerous behavior for it increases the level of the threat and mortality over time (Schatten, et al. 2013).
•An analysis of the theory and research on emerging adults and why risky behavior is a common correlate among this age group
Through research, it has become obvious that NSSI and suicidal behavior is more common in adolescents, and almost 70% of youth reported of NSSI, have become suicidal (Schatten, et al. 2013). However it is important to observe this behavior among school age children and youth. Per Manca et al. (2013) NSSI begins in early adolescence, between the ages of 12-14, and rates about 13% to 41.5 % of sample of mostly high schoolers. NSSI is developing among teenagers due to “pop” culture dominance (Schatten et al. 2013). NSSI was portrait in films (Girl, Interrupted and Thirteen) it was scandalous in the media with Princess Diana, Angelina Jolie, Marilyn Manson, etc., who are role models for many teenager, publicly mentioned of experimenting self-injury on their body (Schatten et al. 2013).
The diagnosis of NSSI condition is applied by the Diagnostic and Statistical Manual of Mental Disorder (DMS-5, American Psychiatric Association, 2010) (Manca et al. 2013). MDS-5 has three principles characterizing NSSI: A-repetition of NSSI behaviors, B-the emotional, motivational and perceptual aspects of a NSSI, and C-the consequences of a NSSI act (Manca et al. 2013). In a research (Muehlenkampa, 2012) a group sample was selected from a high school from Midwest of US, where 578 letters were send home for parents endorsement, of which, 334 were received back. 241 of those had parental consent to participate. Five of the participants did not compete the study, some were absent, however, the final sample was 290 students (90 of them were male, 140 females). They were given a packet of questionnaire to complete. After completion, each questionnaire was examined for signs of suicidal risk and depressive symptoms, then if needed, referred to school psychologist.
Another test was conducted with a clinical sample from a Midwest US hospital, from an inpatient unit. There was an admission process; guardians were asked for permission for the research participation (Muehlenkampa, 2012). Of 56 admitted adolescents, 54 completed the questionnaire. In conclusion, there was no important difference between two samples on age gender or ethnicity, however, due to the test results, the impatient adolescent’s reports indicated engaging in at least one act of NSSI. Results conclude that in adolescents, from young age, negative body image is a link to of negative affect and NSSI that may conclude with a n attempt to suicide (Muehlenkampa, 2012). However, the results of the study indicated that negative body image may become a critical reason leading to NSSI and that body image should be considered a potential risk factor with many other risk factors.

•Research that relates health behavior at this time of life to later life
NSSI is constantly associated to childhood maltreatment (Gomez, 2014). There are many identified child maltreatment: physical abuse/neglect, emotional and psychological abuse/neglect, and sexual abuse. According to the American Child Abuse Prevention and Treatment Act, child maltreatment is “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” Per Gomez (2014) 1 in 7 children aged 2-17 have experienced at least one type or combination of physical and or sexual abuse. A study presented by Gomez (2014) was to define the relationship between childhood maltreatment and NSSI. The hypothesis of the research was: Individuals with abusive experience and engagement self-injury, self-criticism, NSSI, depressive symptoms and anxiety are different from ones who have experienced abuse but not engaged in self-injury, self-criticism, NSSI, Depressive symptoms and anxiety. However, participant sample was taken from Child and Parent Resource Institute (CPRI) that is a center for troubled children and youth aged 4-18. Of 265 146 participants were chosen based on existing data responded to self-injury and history of trauma. Of 146 participants, 107 were male, 39 females. Risk factors were based on previous research and impulsivity, self-criticism, depression, anxiety were defined and scored on scale based on childhood abuse ratings. The results indicate that individuals with abuse and neglect experienced and reported NSSI were different from those who experienced abuse and neglect but no NSSI. Also, individuals with engaged in NSSI scored high in depression and anxiety. However, based on the results, not all abused and neglected individuals engage in NSSI indicated that not necessarily childhood maltreatment may be an association for NSSI. However, this research speaks on connection between maltreatment and NSSI in clinical population based on the report of Maltreatment past, NSSI engagement and distress. However, the results of this research indicated that individuals who have experienced childhood maltreatment, abuse and neglect, and have higher depressive and anxiety symptoms are at risk for NSSI (Gomez, 2014).

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