NonSuicidal Self-Injury

NonSuicidal Self-Injury (NSSI), also known as self-mutilation, self-harm, or cutting, includes any intentional behavior resulting in self-injury.  It is perhaps the most dramatic example of  an emotional problem becoming a physical problem.  Although cutting is the most common method of self-injury, other methods may include burning, puncturing, pinching, biting, hitting and rubbing.

Estimates of the prevalence of  NSSI range from 1% of the general population to as much as 15% of the student population in high schools across the country. Self-injury is slightly less common among Asian Americans, but otherwise equally common across all  other racial, ethnic or socio-economic groups.

Though NSSI is thought to be more common in females, that may be a misconception based solely on the fact that females are more likely than males to seek treatment.  NSSI often starts in the preteen years, when emotions are more volatile and loneliness, peer pressure and conflicts with parents are at their most intense. However, the behavior often persists well into adulthood.

Though it may be more common in people who have a family history of suicide, as the name suggests, NSSI  is not an attempt at suicide, but rather a way to self-regulate intense emotions.

Just as NSSI should not be seen as a suicidal gesture, it also should not be seen as manipulation or attention seeking.  Many who self-injure have a history of not feeling validated and are sensitive to rejection.  As a result, most are secretive about their NSSI behavior and hide evidence of the injuries via clothing or by choice of body locations that are accessible, but not easily visible to others.

Individuals who self-injure tend to have poor problem-solving and interpersonal skills, are self critical, experience intense emotions, have low self-esteem and are impulsive.

For those who self-injure, the self inflicted pain is a solution to some other unexpressed or unresolved problem.  Many of those who utilize NSSI have a history of  childhood sexual abuse or neglect and more than half have a history of emotional abuse as children or adults.

For them, NSSI may be a way to seek relief from the emotional pain, an external way to express internal distress and despair or a form of self-punishment or control in response to a situation in  which they were not in control.

Self-injury can serve as a non-verbal expression of strong feelings of anger or anxiety, or confusion about the experience of pain in a caring relationship.

In addition to being a way to cope with emotions, NSSI can also be a way to impact others: it can serve as a way to punish; test a relationship; communicate boundaries; and trigger comfort and soothing.

For those who feel emotionally numb, NSSI can be a way to affirm their existence by producing the simultaneous experience of emotional and bodily pain.

Self-injury can be addictive and bring with it feelings of shame.  However, the self-injury will not stop until other coping skills are developed.

Therapy must first focus on building trust. Therapy may also address perfectionism, ways to manage changing moods, how to directly express strong feelings, developing healthy relationships, personal boundaries and assertiveness. A therapist must also consider if there are other more subtle ways in which mental health is resulting in behaviors that are self -destructive to one's physical health.