Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: March 2012

Non-Suicidal Self Injury

Rachel Bender, MA

 

Introduction to non-suicidal self injury: What it is, and why people do it

What is non-suicidal self-injury?

Non-suicidal self-injury (NSSI) is defined as deliberately injuring oneself without suicidal intent. The most common form of NSSI is self-cutting, but other forms include burning, scratching, hitting, intentionally preventing wounds from healing, and other similar behaviors. Tattoos and body piercings are not considered NSSI, unless they are created with the specific intention to self-harm. NSSI is often inflicted on the hands, wrists, stomach, or thighs, but it can occur anywhere on the body.

 

Rates of NSSI are highest among adolescents and young adults. Although estimates vary, approximately 12%-24% of adolescents and young adults have self-injured, and 6%-8% report current, chronic self-injury. Some individuals continue to engage in these behaviors well into adulthood, especially when they do not receive treatment.

 

Why do people engage in non-suicidal self-injury?

Unlike suicidal behaviors, people who engage in NSSI report that they do not intend to kill themselves. Instead, NSSI is considered to be a maladaptive or unhealthy attempt to regulate emotions. Individuals who engage in deliberate self-harm report that they do so in response to two types of emotional states: 1) intense negative emotions, such as anger, guilt, shame, self-loathing, or fear of abandonment; or 2) a sense of emotional numbness. Individuals report that deliberate self-harm allows them to express pain, release tension, calm themselves, or feel something rather than nothing at all. To those who engage in NSSI, the behavior can feel effective in the very short term. After NSSI, people often report experiencing some relief from pain or numbness. Interestingly, research has suggested that pain cues the body to release certain endorphins, which have temporary mood-enhancing qualities. This immediate feeling of relief reinforces the behavior, so people are likely to continue hurting themselves in the future.

 

However, it is extremely important to understand that deliberate self-harm is an ineffective emotion regulation strategy in the long run. The sensation of relief tends to wear off very quickly. Soon after NSSI, people feel more guilty, ashamed, or angry with themselves. Ironically, these are some of the very emotions they were trying to escape in the first place! Additionally, people usually feel that they need to keep their NSSI behaviors a secret from friends and loved ones. Carrying this secret can make people feel more lonely and isolated. After repeated NSSI, individuals may also feel as though they are “addicted” to deliberate self-harm. They want to stop hurting themselves, but they have difficulty breaking the cycle. This sense of lost control over one’s own behavior can be distressing. Finally, self-harming behaviors can lead to infections, permanent scars, or accidental death. In the end, NSSI does not truly help people deal with the issues that led them to self-harm in the first place.

 

What are the risk factors for NSSI?

Clinicians and researchers are still learning about what causes people to begin engaging in NSSI. However, several risk factors are associated with a higher likelihood of these behaviors. One of the strongest predictors of NSSI is a childhood history of abuse or sexual trauma. NSSI is also more common among individuals with eating disorders, borderline personality disorder, post-traumatic stress disorder, substance use disorders, depression, and anxiety disorders. In general, people are at heightened risk for NSSI when they have extreme difficulty regulating emotions, and when they tend to behave impulsively.

 

Is NSSI dangerous?

Some individuals report that after trying NSSI once or twice, they do not engage in it again. Others find themselves caught in a vicious and almost addictive cycle from which they cannot escape. The severity of NSSI ranges from superficial injuries to those that require medical attention, cause lasting disfigurement, or are life-threatening. In some cases, people accidentally inflict more harm upon themselves than they may have intended. Whatever the physical severity, repeated NSSI indicates that the individual is experiencing a great deal of emotional pain. This should be taken very seriously. Also, although there are important differences between suicide attempts and NSSI, the practice of NSSI is associated with a higher risk of thinking about or attempting suicide.

 

What is the treatment for NSSI?

If you or a loved one is engaging in deliberate self-harm, it is important to seek help from a mental health professional as soon as possible. A therapist can help you begin to understand how this unhealthy pattern developed, the function of the behaviors, your specific triggers, and how to break the cycle. Ultimately, the goal will be learning to better identify and tolerate your thoughts and emotions, and developing healthier coping strategies. For example, instead of self-cutting to express anger, you may learn to notice when your anger is rising and journal about it instead. Or, you may learn healthy ways to talk to others about how you are feeling. The most effective healthy coping strategies for you will depend on the particular function served by your NSSI behaviors. In addition to talk therapy, a psychiatrist may recommend medication to help with your emotional distress. With the proper support from treatment providers, you can learn to overcome the cycle of non-suicidal self-injury.

 

For more information about non-suicidal self-injury, go to:

http://www.mayoclinic.org/diseases-conditions/self-injury/basics/definition/CON-20025897

http://www.mentalhealthamerica.net/self-injury

http://helpguide.org/mental/self_injury.htm

http://www.selfinjury.bctr.cornell.edu/

 

If you or someone you know is in extreme emotional distress, you can call the National Suicide Prevention Hotline 24-hour Crisis Line at 800-273-8255.

 

 

 

 

 

 

 

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