Destigmatizing Self-Injury: What to Know and How to Help
Author: Steven Topper, LCPC – Young Adult Group Therapist
While so much of mental illness is stigmatized through movies, television, and news, few topics are as divisive as non-suicidal self-injury (NSSI). In critically acclaimed movies such as Black Swan and The Wrestler, depictions of NSSI often come from wounded protagonists who clearly suffer from profound mental health issues. Clinical definitions of nonsuicidal self-injury describe the behavior as: Direct and self-inflicted destruction or alteration of body tissue occurring without suicidal intent or developmental disorder. The most common forms of NSSI are cutting with sharp objects or knives, burning skin, or hitting/punching themselves. Most of our culture believes this to be a very small problem that only impacts a tiny minority of the population. However, a growing body of research indicates that NSSI is far more prevalent than those media sources would have us suggest. While it can be terrifying and isolating to learn that someone you love is struggling with NSSI, knowing more about the functions that lead to NSSI as well as appropriate actions to take can lead our communities toward increased access to care and destigmatization.
Studies investigating how many adolescents and young adults engage in NSSI show that this is an ever-growing issue for our society. While lifetime prevalence for any American to self-injure is approximately 15%, studies have found that in upper middle-class, highly educated communities approximately one third of adolescents had engaged in NSSI within the past year, and roughly 75% of those endorsed recurrent NSSI (Yates). These numbers are certainly staggering and, for many of us, surprising. With populations in highly educated and driven communities, a few key factors influence the likelihood of someone engaging in self-injury. Specifically, research suggests that feeling alienated toward parents is a key pathway in leading young people toward NSSI. Another major factor is perceived criticism from parents. Across broader socioeconomic statuses, all college aged kids who struggle with regulating their emotions are far more likely to engage in NSSI.
Roughly 25% of people who report NSSI say that no one knows they are engaging in self-injury. So often this behavior is extremely private and people go to great lengths to hide it from family and friends. The more we can open lines of communication, the less dangerous these behaviors become. Because so many people keep it hidden due to the perceptions and stigmas, being mindful of how we talk about this challenging topic can make a world of difference.
There are important gender differences when looking at NSSI. Specifically, males are more likely to report engaging in NSSI when feeling angry, when intoxicated, and as a sensation-seeking activity. Females are more likely to engage in NSSI as a way to regulate emotion, as self-punishment, and due to experiencing a very strong urge. Females are also typically twice as likely to report NSSI, though that does not mean they are more likely to be engaging in NSSI. In fact, males and females engage in self-injury at very similar rates across ages, ethnicities, and educational levels.
Helpful tips for discussing NSSI with children, friends, or any other loved ones include:
- Avoid making any assumptions. Just because someone is engaging in self-injury does not mean they are doing it as a way to get attention. It also does not necessarily mean the person is having suicidal thoughts (though people engaging in NSSI are more likely to have suicidal thoughts).
- Be as nonjudgmental as possible. We all have beliefs and judgments about the actions of others, especially loved ones. However, bringing judgment to a conversation about NSSI often leads to more feelings of alienation, isolation, and not feeling heard or understood. Any time criticism or shame-based approaches are taken; open communication is far less likely.
- Express support and care over fear and anger. Often we feel like adding pressure or making demands can lead them to change. Instead, if we express to our loved ones that we are worried for how much they are going through and ask how we can best support them while keeping them safe, then the lines of communication begin to open.
- Listen. Listen to what the person has to say about their experience. Once again this facilitates an open and honest conversation where the loved one feels like talking about self-injury is a safe topic.
- Avoid asking: Why did you do this to yourself? Don’t you know people will see that? What did I do to make you do this? Don’t you know how this affects me?
- Instead ask: When do you most feel like engaging in self-injury? How long has this been going on, and how often do you have urges? How can I be a helpful support during times when you have the urge? What is helpful for you about NSSI?
- Avoid blaming. Whether that is blaming the family, the person who is self-harming, or anything else. Often people self-injure for complicated, multifaceted reasons and sometimes seeking to “figure out” why they self-injured can lead to feelings of invalidation.
- Reach out to treatment providers. Therapists, psychiatrists, and primary care physicians can act as helpful supports and liaisons toward the best treatment. The earlier those who struggle with NSSI can seek and attain treatment, the better off they are. Seeking treatment for a family member or friend demonstrates that you take their self-injury seriously and want to be supportive. Don’t try to sweep this under the rug. Taking steps toward helping the person shows you care.
NSSI has been studied for many years and treatments have become increasingly more effective for those suffering from self-injury. When treating NSSI, therapists often utilize Cognitive Behavioral techniques to challenge distorted thinking patters and increase awareness of urges. Further, Dialectical Behavioral Therapy (DBT) works to increase tolerance of distress and learn emotion regulation and interpersonal effectiveness skills and has been shown to decrease severity and frequency of NSSI across populations. Group therapy focused on emotion regulation also has been shown to reduce self-injury, especially when coupled with mindfulness and acceptance-based practices. In short, there are many places to turn for help and support for this scary and often misunderstood behavior.
While stigma will continue to exist within our society and communities, bringing light to self-injury and opening up dialogue with our friends and loved ones will only give us more understanding and awareness of NSSI. It is far more prevalent than most of us realize, and by expressing care, support, compassion, and nonjudgment, as well as facilitating access to treatment, we allow those who are struggling with NSSI to reach out and get the help they need.
Bentley K, Nock M, Sauer-Zavala S, Gorman B, Barlow D. A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury. Journal Of Consulting And Clinical Psychology [serial online]. June 2017;85(6):632-646.
Yates T, Tracy A, Luthar S. Nonsuicidal self-injury among ‘privileged’ youths: Longitudinal and cross-sectional approaches to developmental process. Journal Of Consulting And Clinical Psychology[serial online]. February 2008;76(1):52-62.
Heath N, Toste J, Nedecheva T, Charlebois A. An examination of nonsuicidal self-injury among college students. Journal Of Mental Health Counseling [serial online]. April 2008;30(2):137-156.