In this disorder, the rate of causing physical harm to the body is higher compared to adolescents in the normal developmental period who do not have oppositional defiant disorder. One out of every three adolescents with oppositional defiant disorder exhibits self-harm behavior (Wessely et al., 1996). In such adolescents, aggressive behaviors and the risk of these behaviors turning into suicide attempts have been found to be very high. The rate of suicide attempts following acts of physical self-harm is also high, and behaviors such as cutting or burning themselves serve almost as a signal of a potential suicide attempt.
Although these behaviors may appear to be modeled after others, the modeled act itself contains elements that express the adolescent’s internal situation. When looking at the histories of these adolescents aged 13 to 18, some form of self-harm behavior is observed at a very high rate. When listed from most to least common, these include: cutting the body—especially the arms, burning or extinguishing cigarettes on the arms and legs, scratching the body, pulling out hair or eyebrows, and in rarer cases, intentionally breaking bones.
A portion of adolescents with oppositional defiant disorder also display substance use and alcohol misuse, and it has been observed that such adolescents often develop antisocial personality disorder or borderline personality disorder in later years. Psychiatric history is also commonly found among the parents of these adolescents, along with alcohol or drug use.
Feldman and Wilson, in their 1997 study, found a close relationship between suicide attempts and oppositional defiant disorder. Later researchers reached similar findings based on their work. These adolescents show very low affect regulation, poor anger control, and exaggerated, uncontrolled emotional responses. However, some of these suicidal behaviors were not associated with depression, and in certain adolescents, suicidal behavior was found to be independent of depressive states. Examination of the family structures of adolescents who are at high risk for self-harm shows that parental separation or living apart may be a significant factor. It is often observed that adolescents who engage in cutting and have oppositional defiant disorder come from single-parent families. Their childhood histories frequently reveal serious relational problems with their mothers, and it has been found that mothers often become aware of their children's self-harm behaviors only long after they began.
Self-harm behavior and oppositional defiant disorder in adolescents must be taken seriously, not minimized, and not dismissed with simplistic explanations such as adolescent turmoil, imitation, attention-seeking, or a “bad peer group.”
