Are you struggling to understand non-suicidal self-injury? Is someone you know self-injuring? Here is a comprehensive guide to non-suicidal self-injury. Read along for information and resources about NSSI.

What Are Non-Suicidal Self-Injuries (NSSI)

According to the International Society for the Study of Self-Injury, non-suicidal self-injury is deliberate, self-inflicted damage to body tissue. These sorts of injuries are neither culturally nor socially acceptable. These sorts of behaviors are often done in an attempt to cull ongoing emotional or psychological distress. Non-suicidal self-injury is a prevalent concern of therapists and mental health experts. After all, these behaviors are often associated with an increased risk of suicide.

People self-injure for several different reasons. However, the majority of people self-injure after experiencing negative emotions. For other individuals, these short-lived and destructive self-injury rituals offer a sense of calmness and relief. Others consider self-injury of form of self-punishment. Some people may even self-injure because of a lack of self or peer, and parental-approval. Other individuals may struggle to regulate their emotions. NSSI behaviors may help them feel a sense of temporary regulation or relief.

Non-suicidal self-injury is sometimes considered a social behavior. These destructive behaviors often provide individuals with the attention or companionship they crave. NSSI habits may even lead to alliances or relationships. As a matter of fact, online self-injury communities have played a part in normalizing these self-destructive behaviors.

Common Methods of NSSI

There are several different methods of non-suicidal self-injury. However, the most common methods include:

  • Cutting
  • Scratching (typically to the point of drawing blood)
  • Carving
  • Scraping
  • Hitting
  • Bruising
  • Burning
  • Inserting objects into the body
  • Intentional poisoning

Destructive Behaviors That Are Not Considered Self-Injury

Not all destructive behaviors fall into the category of non-suicidal self-injury. While the following behaviors may be self-destructive and may even result in body tissue damage, they are considered non-suicidal self-injuries.

  • Drinking
  • Smoking
  • Drug Use
  • Piercing
  • Tattooing

Of course, these are just some of the types of non-suicidal self-injuries observed by clinicians. According to the experts at Mental Health National, skin cutting makes up 70% to 90% of the nation’s self-injury cases. Meanwhile, headbanging and hitting make up 21% to 44% of cases. Finally, burning makes up 15% to 35% of recorded NSSI cases. It is important to note that most people who engage in non-suicidal self-injury use multiple methods of self-harm.

How Clinicians Recognize Non-Suicidal Self-Injuries

Studies show that non-suicidal self-injuries are typically a reaction to:

  • Negative emotions
  • Depression
  • Anxiety
  • Emotional dysregulation

Many self-injuring individuals do not seek help. So, clinicians must learn to recognize and intervene when they witness non-suicidal self-injuries.

Doctors can look toward statistics when looking for non-suicidal self-injuries. Studies show that there are some significant gender differences between self-injury subjects. Clinicians may notice that their female patients have more cuts than their male NSSI patients. Female NSSI patients are more likely to have abrasions on their thighs and wrists. Meanwhile, male NSSI patients are more likely to hit or burn themselves. Also, male NSSI patients are more likely to injure their hands and head.

Risk Factors

Here are a few factors that put individuals at a higher risk for non-suicidal self-injury:

  • Forced criticism and invalidation
  • Difficulty communicating emotions
  • Mental illnesses
  • Unresolved relationship issues
  • Self-hatred, perfectionism, and poor body image
  • Peer or social influence

The Internet and NSSI

Researchers have found that the internet and social media have an impact on individuals with self-injury habits. Individuals may share their self-injuries with others. They may also receive tips on how to self-injure or conceal self-injuries. Images, videos, and discussions about self-injury can be very triggering. They can even lead recovering individuals to relapse. Therefore, all parents and caregivers need to monitor their children’s online activities.

Beneficial Intervention

NSSI is a sensitive matter. Doctors and mental health professionals must be compassionate and relatable when dealing with NSSI patients. Many patients do not feel comfortable talking about their NSSI habits. When it comes to cases of adolescent NSSI, peer and parental disclosure is much more common than self-confession.

Once a patient opens up about their NSSI habits, a therapist can work to access the following:

  • The patient’s history of non-suicidal self-injury behaviors
  • The age at which the patient started self-injuring
  • How often and recent are the the patient self-injures?
  • How likely a patient is to hurt themself again
  • The method in which the patient self-injures
  • The location and severity of the patient’s NSSI wounds
  • The triggers or motivations for the patient’s self-injury habit
  • The patient’s risk for develop becoming suicidal
  • Potential therapies and coping strategies

The Cornell Research Program on Self-Injury and Recovery offers an online NSSI assessment tool. This assessment tool can be filled out by someone who self-injures or someone who suspects someone of self-injuring. It helps doctors to develop a meaningful treatment experience.

Non-Suicidal Self-Injury Statistics

While statistics show that non-suicidal self-injury is common in adolescence and adulthood, many individuals (roughly 25%) will develop these destructive tendencies before the age of 12. Meanwhile, 30% of self-injury cases start after the age of 17. With that said, non-suicidal self-injury may commence at any age.

According to the most recent statistics, 14% to 28% of youths have participated in self-injury. Meanwhile, 25% of adolescence have self-injured more than two times. Finally, 40% to 65% of individuals self-injure for a lifetime.

Non-suicidal self-injury is not a rare occurrence. Both males, females, youth, and adults self-injure.

Help Individuals Recover From Non-Suicidal Self-Injuries

Researchers have found that individuals who self-injure are at a higher risk of developing suicidal tendencies. Therefore, most health experts are focused on providing their patients with early and meaningful intervention.

It is essential to recognize that many people will try to escalate or extend their NSSI behaviors. These behaviors can lead them to engage in more severe self-injury methods or even attempt suicide. People who engage in NSSI are far more likely to attempt suicide. Every person with a history of self-injury should be assessed for suicidal tendencies.

A Few Ways to Approach NSSI

Here are a few of the most common therapies used to treat patients with NSSI.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is one of the most effective forms of NSSI therapy. It is a type of talk therapy that allows patients to discuss their NSSI behaviors in a safe and meaningful environment. Cognitive-behavioral therapy patients learn to recognize and respond to negative thinking patterns and other triggers.

Individuals may learn to recognize and restructure their thoughts to avoid the trappings of NSSI. They may discover that they are not the only ones battling these sorts of thinking patterns. However, they need to create realistic expectations for themselves, develop mental resilience, and build healthy alliances. Therapy should continue even after a person has recovered.

Dialectical Behavior Therapy

Dialectical behavior therapy is a specialized form of cognitive-behavioral therapy. It is used to teach patients that are suffering from NSSI healthy strategies for coping with and regulating emotions. It is a popular therapy for borderline personality disorders, eating disorders, and PTSD.

Personalized Coping Strategies

Since non-suicidal self-injury is typically a coping strategy, individuals must learn to replace these destructive habits with healthy coping alternatives.

NSSI Recovery Resources for Families

While non-suicidal self-injury is not fatal, it should never go ignored. These behaviors are highly destructive. Moreover, they can even lead to suicidal thoughts and actions. Here are a few resources that may be helpful for families.

According to the latest statistics, roughly 35% of hospitalized adolescents are suffering from some form of NSSI. Meanwhile, suicide is the second leading cause of death for individuals between the ages of 15 and 29. It is particularly alarming when you consider the fact that:

70% of adolescents with a history of NSSI have attempted suicide once
55% of adolescents with a history of NSSI have attempted suicide more than once

SiOS

Self-injury Outreach & Support is an international outreach organization formed through a collaboration between McGill University and the University of Guelph. This organization offers resources to those that self-injure and those that have recovered from self-injury illnesses. It’s also a great place for caregivers, healthcare professionals, friends, and teachers of those that self-injure to find help.

The organization’s co-founder, Dr. Stephen Lewis, is a recovered self-injurer. He talks about his personal NSSI experience in this TEDx presentation.

Live Through This Project

The Live Through This Project shares the stories and portraits of suicide survivors. It helps those that are self-injuring understand that there is a road to recovery.

Crisis Text Line

The Crisis Text Line provides self-harming individuals with free 24/7 support. Individuals from the United States and Canada can text 741741 to connect with a qualified crisis counselor. This organization specializes in helping those with NSSI disorders.

Mental Health America

Mental Health America is yet another organization that offers comprehensive self-injury resources to individuals in need.

Further Concerns

There are several reasons that individuals fail to recover from NSSI disorders. Sometimes treatment plans do not work as planned. A person’s urge to self-injury may be too great. Furthermore, lasting scars and stigmas may continue to weigh on a recovering individual. A successful intervention or recovery process does not eliminate the possibility of temporary or even permanent relapse. It is essential that all individuals that are recovering from NSSI develop a coping plan.

Kanefield, K. (2020, October 8). Non-suicidal self-injury: Essentials for clinicians. Lecture presented at Non-suicidal self-injury: Essentials for clinicians.