Despite what many people believe, the majority of individuals who self-harm do not harm themselves to commit suicide. However, self-harm is often practiced while under significant emotional duress. While in this state, it is possible to severely injure yourself unintentionally. Nonsuicidal, self-injury can lead to hospitalization and death. 

Historically, NSSI was determined to be a symptom of borderline personality disorder. Over the last 10-15 years, research has determined that the majority of non-suicidal, self-injuries occur independent of a diagnosis of BPD. Due to this research, NSSI is independently listed as a diagnosis in the DSM-5, (Klonsky et al., 2014). 

Non-Suicidal Self Injury

Nonsuicidal, self-injury, (NSSI), is the act of intentionally harming yourself without the consideration of suicide. It is an unhealthy coping mechanism often utilized to bring the individual a temporary sense of relief from emotional pain, stress, anger, or tension, (Mayo Foundation for Medical Education and Research).

Individuals that self-harm often attempt to hide the behavior from their families. They may wear conspicuous clothing, harm themselves in difficult-to-see places, or come up with stories to cover the reason for new injuries. If you suspect that a friend or loved one is self-harming, suggest that they speak with their GP or a mental healthcare provider. 

Common Types of Self-Harm 

While self-injury can be inflicted anywhere on the body, the most common locations are wrists, stomachs, and thighs (PAH Newsletter, 2023). In previous years, the presence of tattoos and piercings has been assumed to indicate SIB. Mental health professionals do not consider a tattoo or piercing to be a circumstance of self-harm. 

Cutting 

Cutting is the predominant form of self-harm. It is one of the quickest and most convenient forms of self-harm. Knives, paper clips, and razors are easy to obtain and effectively break the skin to cause immediate pain. This pain serves as a distraction or punishment for experiencing negative emotions, such as; sadness and anger. Young women are most likely to participate in this form of SIB.

Burning 

Burning is another common form of self-injury. Adolescents are the most common demographic to practice SIB. Due to their age, matches, cigarettes, and lighters are more difficult to obtain. Burning as a form of self-injury requires more effort and planning, but once done becomes a preferred form of NSSI. Self-burning as an independent form of self-injury rarely correlates to the presence of suicide ideation and suicide attempts. 

Scratching

Scratching is a form of NSSI when it is intentionally done to harm the body or cause pain. This form of self-injury is performed through the use of erasers and other tools to rub the skin raw or intentionally scratching with the nails or another tool. Scratching is an easier-to-hide form of SIB. 

Starving 

Eating disorders and self-image issues are linked to NSSI. Starving the body and intentionally vomiting are two symptoms of eating disorders, but they are also considered to be forms of self-harm. This is an indirect and direct form of self-harming behavior, (Fox et al., 2019). The classification is largely dependent on the thoughts and feelings experienced during the episode. 

Hitting

Similar to scratching- hitting, headbanging, punching, and slapping is another easy-to-hide form of self-injury. This form of self-injury is among the most common SIB of individuals on the autism spectrum with self-injuring tendencies and young men. The behavior is often attributed to frustration, anger, and anxiety. 

Who Self-Harms? 

Anyone could self-harm. The behavior is not directly related to any single mental illness, the occurrence of abuse, or demographic. The thoughts, behaviors, and emotions that determine the psychological reasoning of SIB are complex and multifaceted. There are, however, a few demographics that engage in SIB more frequently than others. Take a look at the demographics below, cited from a research study outlined by the American Psychological Association, (APA).

Teens/Adolescents 

When psychologist Jennifer Muehlenkamp, Ph.D., performed an analysis of 52 distinct studies, she found that 17% of adolescents performed NSSI. The Journal of American College Health found that 15% of college students had demonstrated at least one instance of NSSI, (Who Self-Injures?, APA).

Eating Disorders 

Jennifer Muehlenkamp, Ph.D., also found that as many as 55% of individuals who self-injured were diagnosed or met the diagnosis criteria for an eating disorder. She claims, “Body objectification, body devaluation and lack of internal bodily awareness are prevalent in this population,” (Who Self-Injures?, APA).

LGBTQ 

An Eight-College Review conducted in 2011 determined that 47% of bisexual females participated in self-injury. Additional research on SIB and demographics has found that young individuals with a sexual minority status have an increased risk of developing self-injuring behaviors. These behaviors are especially prevalent among gay and bisexual men, (Who Self-Injures?, APA).

Reasons for Self-Injury 

It is widely believed that NSSI is a strong indicator of suicidal ideation. In most cases, NSSI occurs without the intent of death. Individuals that participate in non-suicidal, self-injury typically do not struggle with suicidal ideation (Klonsky et al., 2014). Despite these findings, NSSI strongly correlates to future suicide attempts. 

It is natural for humans and other living creatures to fear pain. Pain is essentially our body’s warning sign of danger and other physical problems, such as; illness, injury, and death. One of the most common fears that accompany suicide ideation is the fear of pain. If an individual with a history of self-harm experiences suicidal tendencies and behavior later in life, that fear of self-inflicted pain is largely diminished. Thus, alleviating the fear of pain that accompanies death and injury.

There are several other misconceptions regarding the reason individuals self-injure. The three following misconceptions are among the most commonly noted (Klonsky et al., 2014).   

Misconception 1: NSSI Primarily Occurs with BPD 

As stated above, NSSI was historically associated with borderline personality disorder. Mental health issues and mental illness often occur alongside SIB or self-injuring behaviors, though NSSI does not directly relate specifically to BPD. NSSI is a symptom of BPD. Although, it is far from the most common symptom and occurs independently of MI. 

Misconception 2: NSSI Occurs as a Result of CSA 

Another historically held belief is that NSSI occurs as a result, coping mechanism, and re-enactment or punishment for child sexual abuse. Despite this long-held, frequently used trope, the correlation between CSA and NSSI is modest at best, (Klonsky et al., 2014).

Misconception 3: Attention-Seeking is the Primary Motive for NSSI

Human nature is to fear pain. Due to this, many find it difficult to understand why individuals would inflict pain upon themselves unless they are seeking attention. The misconception that attention-seeking is the primary motive for NSSI is still widely believed and used to shame individuals that participate in NSSI. 

NSSI is often done in private and individuals who demonstrate self-injuring behavior attempt to hide the injuries and occurrence of the behavior. They often go as far as creating stories to explain their injuries. The most common reason individuals perform SIB is to alleviate or distract themselves from emotional pain and negative emotions, (Klonsky et al., 2014).

NSSI as a Pattern

The emotional turmoil and psychological distress that prompts self-injuring acts create a behavioral pattern. The negative emotions become so intense that an individual feels the need to hurt themselves and escape from their thoughts and feelings, even if the escape is brief. The act of self-injury is often accompanied by feelings of shame, guilt, and self-contempt. These negative self-thoughts often prompt additional occurrences of self-harm. 

The National Institute of Health recommends DBT, emotional regulation therapy, cognitive behavioral training, antipsychotics, and SSRIs as treatment options for NSSI, (Turner et al., 2014). The key to addressing non-suicidal, self-injury is to create more healthy thought patterns and learn to recognize and halt negative thought patterns before they become too intense. 

References:

American Psychological Association. (n.d.). Who self-injures? Monitor on Psychology. Retrieved March 5, 2023, from https://www.apa.org/monitor/2015/07-08/who-self-injures 

Fox, K. R., Wang, S. B., Boccagno, C., Haynos, A. F., Kleiman, E., & Hooley, J. M. (2019, May). Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed. The International journal of eating disorders. Retrieved March 5, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611160/ 

Klonsky, D. E., Victor, S. E., & Saffer, B. Y. (2014, November). Nonsuicidal self-injury: What we know, and what we need to know. Canadian journal of psychiatry. Revue canadienne de psychiatrie. Retrieved March 5, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244874/ 

Mayo Foundation for Medical Education and Research. (2022, November 10). Self-injury/cutting. Mayo Clinic. Retrieved March 1, 2023, from https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/syc-20350950 

Newsletter. Newsletter | PAH Outpatient Behavioral Health Clinic | Perelman School of Medicine at the University of Pennsylvania. (n.d.). Retrieved March 5, 2023, from https://www.med.upenn.edu/psychotherapy/newsletter_selfinjury.html#:~:text=The%20most%20common%20form%20of,specific%20intention%20to%20self%2Dharm. 

Turner, B. J., Austin, S. B., & Chapman, A. L. (2014, November). Treating nonsuicidal self-injury: A systematic review of psychological and pharmacological interventions. Canadian journal of psychiatry. Revue canadienne de psychiatrie. Retrieved March 5, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244876/#:~:text=Several%20interventions%20appear%20to%20hold,serotonin%20reuptake%20inhibitors%20(with%20or