Nonsuicidal Self-Injury

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Nonsuicidal self-injury can manifest in various physical and behavioral signs. Recognizing signs of injurious behaviors can be crucial for timely intervention and support. Even if a person didn’t mean to engage in an act of attempted suicide, life threat can be serious depending on the type of injury.

Physical signs

Below are potential physical signs that someone has hurt themselves: 

• Fresh cuts, bruises, burns, or other self-inflicted wounds, often located on the wrists, arms, thighs, or chest
• Scars from previous self-injury
• Concealing skin with long sleeves or pants, even in hot weather
• Frequent unexplained injuries with vague or inconsistent explanations for their cause

Behavioral and emotional signs

Behavioral and emotional signs may include the following: 

• Evidence of self-harming tools, like razors, knives, or lighters, hidden in one’s room or carried with them 
• Isolation from friends and family or withdrawal from social activities
• Expressions of being overwhelmed or thoughts of hopelessness and helplessness 
• Difficulties in interpersonal relationships marked by high emotional volatility
• Negative self-talk, intense self-criticism, or pervasive feelings of guilt or shame

Patterns of behavior

Patterns of behavior that may be connected to self-harm include the following: 

• Engaging in risky behaviors with a high potential for harm, even if not explicitly self-injurious
• A routine or ritualistic aspect of self-harming, such as always doing it at a particular time or in a specific setting
• An increased frequency or severity of self-harm during stress or emotional upheaval

The emotional aftermath of NSSI

After an individual partakes in non-suicidal self-injury, they might experience the following: 

• Temporary relief or calmness immediately following the act of self-harm
• Feeling guilty, ashamed, or overwhelmed 
• Defensive or secretive behavior when questioned or confronted about the self-injury

Recognizing the signs and symptoms of NSSI can be the first step in providing help. If someone is suspected of self-harming, approach the subject with sensitivity, understanding, and a genuine desire to help. Do not tell someone who has self-harmed that they are “seeking attention” or “following a trend.” 

The causes and risk factors of nonsuicidal self-injury are multifaceted, often stemming from personal, environmental, and psychological factors. While these factors might increase the likelihood of NSSI, they do not guarantee that an individual will engage in deliberate self-harm.

Psychological and emotional causes

Below are a few psychological causes of nonsuicidal self-injury: 

• Emotional regulation: For some, NSSI serves as a way to cope with overwhelming emotions or intense psychological pain. The act of self-harming might provide temporary relief or distraction from distressing feelings.
• Self-punishment: Some individuals may self-harm as a form of self-punishment, driven by guilt, shame, or self-hatred.
• Expression: NSSI might be a means to express internal turmoil or emotional pain outwardly when verbal articulation seems impossible or insufficient.
• Numbness: For some, NSSI is a way to remind people that they are alive when their emotions are dulled. 

Risk factors

Risk factors for non-suicidal self-harm might include: 

• Mental health conditions: Disorders like depression, anxiety, borderline personality disorder (BPD),² bipolar disorder, conduct disorder, and eating disorders can elevate the risk of engaging in NSSI.
• History of trauma: Individuals with a history of physical or sexual abuse, neglect, or other traumatic experiences may have a heightened risk of self-harming. They may also experience symptoms of post-traumatic stress disorder.
• Peer influence: Knowing friends or peers who self-harm can increase the likelihood of an individual adopting similar behaviors.

Triggers related to trauma

For those with a traumatic history, specific triggers³ may prompt an episode of NSSI. These trauma triggers might include:

• Encounters with individuals or locations associated with past trauma
• Specific dates or anniversaries linked to traumatic events
• Sensory experiences (like certain smells, sounds, or physical sensations) that are reminiscent of trauma
• Other stressors or situations that evoke powerlessness or vulnerability akin to the traumatic experience

Understanding the causes, risk factors, and potential triggers of NSSI can aid in developing effective prevention strategies and therapeutic interventions.

Nonsuicidal self-injury treatment often aims to help individuals develop healthier coping mechanisms, address underlying emotional or psychological challenges, and reduce or eliminate self-harming behaviors. The treatment approach often involves a combination of therapy, medication, and self-care strategies.

Medication

While no medication is specifically approved for treating NSSI, certain medications may treat underlying or co-occuring mental health conditions that could contribute to self-harming behaviors, such as the following: 

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) may help individuals with mood disorders like depression and generalized anxiety disorder.
• Atypical Antipsychotic medications: Some antipsychotic medications might be used to reduce NSSI.
• Naltrexone: Low dose naltrexone is being studied as a potential treatment for NSSI. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options

In some cases, additional treatments or interventions might be recommended, such as the following: 

• Group therapy: Connecting with others who have similar struggles can offer support, understanding, and shared coping strategies.
• Hospitalization: In severe cases or when there's a risk of escalating self-harm or suicidal thoughts, short-term hospitalization may be necessary to ensure safety.

Self-care

Self-care strategies can be vital components in managing and overcoming NSSI tendencies. These strategies aim to promote healthier emotional regulation and reduce the frequency and intensity of urges to self-harm.

• Mindfulness and meditation: Mindfulness practices can help individuals become more aware of their emotional states, potentially making managing and redirecting negative impulses easier.
• Physical activity: Regular exercise can be a healthy outlet for emotional release and may stabilize mood.
• Journaling: Writing can offer a means to process emotions, recognize what causes one to want to self-harm, and reflect on progress.
• Avoiding alcohol and drugs: Substance use may reduce inhibitions and escalate emotional volatility, increasing the risk of self-harm.

Engaging in treatment and adopting self-care practices can substantially improve the prognosis for those struggling with NSSI. As with many mental health challenges, early intervention, ongoing support, and a commitment to recovery are crucial for optimal outcomes.

Therapy is a pivotal resource for those struggling with nonsuicidal self-injury. A licensed therapist can provide the tools and insights needed to understand the underlying causes of self-harm, develop healthier coping mechanisms, and guide individuals toward long-term recovery. 

Online platforms have emerged as a convenient and supportive avenue for therapy. Platforms like BetterHelp connect individuals with licensed therapists based on their specific needs, and they can meet with them from home via phone, video, or live chat sessions. Other resources include the following: 

• The National Institute of Mental Health (NIMH) provides information on NSSI, including signs, symptoms, treatments, and ongoing research.
• The Self Injury Foundation provides information and resources for self-injurers, their loved ones, and professionals. Their mission is to promote healing and reduce the stigma associated with NSSI.
• Safe Alternatives is a nationally recognized program offering guidance and support for self-injury patients. Their website provides resources, including books and therapeutic interventions, to help individuals and their families.
• The American Psychiatric Association has information on the rise in self-harm during the pandemic.

Accessing and utilizing these resources may be crucial in the recovery journey. Whether through therapy, education, or community support, individuals with NSSI have multiple avenues to seek help and find hope.

If you have experienced physical, emotional, or sexual abuse, contact the National Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Emerging research on nonsuicidal self-injury (NSSI) has provided valuable insights into its prevalence, demographics, and underlying causes. Research published in the Canadian Journal of Psychiatry highlights that NSSI is most prevalent among adolescents and young adults, with lifetime rates among these populations ranging from 15% to 20%. 

While some may assume that NSSI is more prevalent in women, general population studies have found equivalent rates between men and women. However, the methods of NSSI differ, with women more likely to cut while men are more inclined toward hitting or burning.

The reasons behind NSSI have also been explored in depth. Historically, the primary reasons for self-injury were theoretical. However, recent empirical studies have shown that the most common function of NSSI is to temporarily alleviate overwhelming negative emotions. Intense negative emotions often precede NSSI, and the act itself often results in reduced negative emotions, calm, and relief. Additionally, more than 50% of the individuals reported self-injuring as self-directed anger or self-punishment. 

Other causes of self-injury include a desire to influence others or to manifest a physical sign of emotional distress. These findings are consistent with the information provided by the Cornell Research Program on Self-Injury and Recovery, which emphasizes the importance of understanding the intention behind the act rather than the act itself.

Further research in the form of a systematic review or longitudinal study of a large community sample of adolescents, young adults, and people of other age groups may reveal more about why people engage in NSSI.

Below are several critical statistics on nonsuicidal self-injury (NSSI) among adolescents:

• The lifetime prevalence of NSSI in community samples of adolescents is approximately 17%. 
• In high school students in Sweden, the prevalence of NSSI was nearly identical in two separate assessments, with rates of 17.2% and 17.7%, respectively. 
• A significant increase in NSSI prevalence among these students during the COVID-19 pandemic, rising to 27.6%.
• The rise in NSSI underscores the importance of timely interventions and therapy to address the mental health needs of adolescents.