Discovering that someone you love is self-injuring can be both upsetting and confusing.  People find themselves wondering, “Why in the world would she do this to herself? Is she trying to take her life? Can I trust her? Do I need to remove all dangerous objects from our home?” It can be scary to explore these questions with your loved one for fear of triggering this behavior, but it is okay and even necessary to talk about it.

Pain is a sensory indication that something is wrong and action is needed. Both physical and emotional pain cause discomfort and cue us to respond with acts of self-preservation. Physical pain is typically observable and often has a clear causal explanation, which makes it easier for others to recognize and understand. Most people can relate to a child crying after a fall, someone quickly withdrawing their hand from a hot surface or limping after a stubbed toe. It is also clear when the physical pain is severe enough to require medical attention. The higher visibility of physical pain often warrants more acceptance and understanding from others, it is when the pain remains unseen that people have difficulty understanding and responding. This is often the case with emotional pain. Even when this type of pain is made visible, it is met with fear, uncertainty and judgment, as many do not know how to respond.

Nonsuicidal Self-Injury (NSSI) is nothing new, but in recent years has become more visible to the public eye as a representation of emotional pain. Parents, teachers and friends are noticing more scars on adolescents and do not know how to respond. Questions surface as to why this is happening and how to make it stop. To gain a better understanding of NSSI it is important to know the basics:

What is NSSI?

NSSI is when an individual intentionally harms their body, damaging skin or tissue without suicidal intent (Whitlock, Exner-Cortens, & Purington, 2014). It can take a variety of forms including, but not limited to, skin-cutting, burning, punching or hitting oneself, scratching, hindering the healing of wounds, ingesting harmful substances, etc. NSSI can be achieved by using a wide array of objects commonly found within a household. Often the individual can be fairly inventive in this pursuit, which means the confiscation of one or more of these items does not guarantee discontinuation of the behavior.

Who Self-Injures?

According to Klonsky, Victor and Saffer (2014), self-injury is most likely to occur in the adolescent to young adult population, with an average onset around age 13. Both men and women are equally susceptible to this behavior, but the methods chosen varies- women are more prone to cut whereas men are more prone to hit or burn themselves.Those vulnerable to NSSI often have a history of depression, anxiety and emotional dysregulation. (Klonsky et al., 2014)

Why Self-Injury?

Self-injury is described as providing an element of relief from an overwhelming internal experience, a coping mechanism to deal with emotional pain. Common reasons to engage in this behavior include expressing difficult emotions, releasing internal tension or pain, regulating anger, exercising control, punishing oneself, and reducing numbness (Smith & Segal, 2014).  There is not a simple explanation as to why this behavior is used and reasons can vary from person to person. However, we do know that self-injury is an impulsive response, providing immediate, yet temporary, relief to what seems unbearable at the time. It is thought that self-injury becomes habitual due to feel-good chemicals called endorphins and dopamine released in the brain (similar to when one exercises) that provide a rush of relief or a soothing sensation (Duckworth, 2012).

What is Social Media’s Role?

In recent years, social media has contributed to camaraderies formed amongst those struggling with NSSI by allowing easy depictions through pictures and comments on Twitter, Instagram, Tumbler, and Snapchat. People have mixed reactions to the accessibility of NSSI over social media; for some, it can be comforting to know they are not alone, for others, it can exasperate the problem and lead to further temptation, and for those who have not yet engaged in this behavior, it can spark curiosity. This accessibility may be the reason for increased awareness within the school and amongst peer groups. While the higher visibility raises the question of trendiness, most people desire to keep their NSSI hidden- choosing places on their body such as wrists, sides, stomach, thighs, lower legs, etc. that can easily be covered up.

How Can You Respond?

It can be difficult to prevent someone from self-injury if they are regularly involved in NSSI behaviors. Self-injury serves a purpose for these individuals–it meets a need. Understanding the function of their behavior is critical to successfully ending NSSI, so the need can be met in other healthier ways. Some questions to ask yourself or a loved one:

• What events precipitate NSSI?
• What is the main emotion experienced at this time (e.g., anger, sadness, fear)?
• Are there common circumstances that lead to this behavior?
• What am I communicating through this behavior?
• What does engaging in this behavior do (e.g., alleviate distress)?

These individuals’ bodies have become hidden canvases of pain. Many do not know how to interpret or interact with the idea of someone they love expressing pain through NSSI. Responses to this “emotional pain made visible” can vary between fear, sadness and anger. It is crucial to remember that feelings of shame and guilt are strongly linked to this behavior, so those helping the individual should approach them with love and acceptance. Try to gain a better understanding of their emotional pain, while being careful to not add to the shame already experienced. It is okay to ask questions, especially open-ended ones, to begin learning about the function of this behavior. In addition to open communication, the individual involved in NSSI will likely require professional care in order to stop the self-harm. Please don’t hesitate to contact us if we can support you or a loved one struggling with self-injury.

Sources:

Duckworth, K. (Ed.). (2012). Self-Injury.

Klonsky, D. E., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal Self-injury: What we know, and what we need to know. Canadian Journal of Psychiatry, 59(11), 565-568.

Smith, M., & Segal, J. (2014). Understanding Cutting and Self-Harm.

Whitlock, J., Exner-Cortens, D., & Purington, A. (2014). Assessment of nonsuicidal self-injury: Development and initial validation of the non-suicidal self-injury–assessment tool (NSSI-AT). Psychological Assessment, 26(3), 935-946