Taking Back the Control: Non-Suicidal Self-Injury

In the 1990’s, Great Britain’s Princess Diana was one of the first high profile people to open up about her struggle with self-injury. Awareness about non-suicidal self-injury (NSSI) has since continued to grow. Yet, it is still widely misunderstood and the behavior remains just as prevalent today. In fact, one study found up to 24 percent of youth engage in NSSI behaviors, and the 2016 Missouri Student Survey reported that 15.5 percent of youth cut, scratched or hit themselves on purpose in the past year.

Non-suicidal self-injury is the intentional action a person takes towards one’s body to produce physical injury. Examples include cutting any part of the body, such as arms, legs, stomach and back; bruising oneself through punching, kicking and impacting objects; and burning skin. The purpose of NSSI is not to die; rather, it is a coping method that can become an excruciating habit.

The important thing to remember is that NSSI is a behavior, and behaviors can be changed. By learning alternative techniques and skills to effectively regulate their emotions, people can stop engaging in non-suicidal self-injury and start taking back the control of their life.

Why do People Hurt Themselves?

People who injure themselves are generally seeking a coping strategy for their negative emotions. Non-suicidal self-injury produces a biological effect on the body during and post injury that can become highly reinforcing for some in this situation. The following are desired results, in order from most common to least:

  1. Change the way they feel – move emotional pain to physical pain
  2. Reduce the intensity of emotional pain
  3. Stop unwanted thoughts, images or flashbacks
  4. Punish self
  5. Communicate intense emotional pain to others due to lack of interpersonal skills to communicate directly

There are also common threads that tie together people who injure themselves. The behavior is prevalent among those who have been exposed to traumatic experiences. It is also common among those who, as emotionally vulnerable children, grew up in environments where they failed to learn ways of coping; whether this was due to a breakdown in internal resources or environments failing to know how to teach these children to manage emotions. Regardless of the path, research continues to suggest a common thread of one’s inability to tolerate, cope with or manage intense emotions.

Is Non-Suicidal Self-Injury a Suicide Attempt?

No.

Those who engage in non-suicidal self-injury have a different intent than those who attempt suicide. One action is to stop immediate pain without wanting to die and the other is to stop pain forever. Self-inflicted wounds can be thought of as a “life raft”, helping the person continue to live by enduring emotional pain, changing emotional pain or controlling emotional experiences. Furthermore, NSSI is typically associated with multiple episodes and multiple items (knife, paperclip, tacks), while suicidal behavior is typically ritualized through thinking about the details of the experience over and over again, therefore, they do not tend to switch methods or means.

While the two are different, they are not mutually exclusive. NSSI is a strong risk factor for future suicide attempts – if a person is willing to induce physical harm to feel better, he or she can also acquire the capability of possibly ending life to stop the pain.

Common Misconceptions about Non-Suicidal Self-Injury

  1. Not all forms of self-injury are considered non-suicidal self-injury. It is differentiated due to the immediate, predictable and intentional nature of the behavior. For example, every time you cut yourself it produces a cut. Consuming excessive alcohol doesn’t intentionally produce the outcomes that occur by engaging in NSSI, as they are not predictable each time. Similarly, eating disorders are another form of harm that are not considered NSSI because there is no way to truly predict that harm occurs every time someone engages in a behavior.
  2. Although onset is not typical in adults, anyone who has an emotional vulnerability or has not developed emotion regulation capacity to tolerate emotional pain, is susceptible to NSSI. However, the onset of non-suicidal self-injury typically spikes in adolescents around 12 to 15 years of age. Without intervention, the behavior can increase into young adulthood. The trajectory typically tends to fizzle out as individuals age.
  3. People who engage in NSSI are not just doing it for attention. On the contrary, the behavior typically occurs when someone is alone and they are often silenced by shame. One reason they harm themselves in places such as their legs and stomach is because they are trying to hide the signs of the non-suicidal self-injury.
  4. NSSI is not a mental health disorder. Rather, it is a coping strategy that can be found across many disorders. The only disorder that describes NSSI in the diagnostic criteria is Borderline Personality Disorder. However, it is also frequently common among individuals with post-traumatic stress disorder, depression and bi-polar disorders, as well as individuals with significant anxiety symptoms.

How to Overcome Non-Suicidal Self-Injury Tendencies?

Therapy is an excellent way to overcome self-injury and start taking back the control of one’s experiences. NSSI is a specialty area of practice and not all social workers, counselors or therapists are equipped to address this complicated behavior.

When searching for a trained mental health professional, look for an individual who has experience in treating suicidal and non-suicidal self-injury and who understands emotion regulation difficulties. You can start by asking the professional about his or her experience working with this behavior and how comfortable they feel working with someone who is suicidal.

Ideally, the therapist would also be trained in Dialectical Behavior Therapy (DBT). DBT helps individuals understand their emotional experiencing through a set of specific skills and awareness strategies in order to learn how to observe, describe, tolerate and ultimately modify their emotions without needing to resort to extreme behaviors, such as NSSI. Additionally, the warm therapeutic relationship helps the person feel less isolated and ashamed. This is accomplished by teaching the following skills:

  • Mindfulness – to pay attention to the environment and what goes on inside of us
  • Distress Tolerance – to tolerate really distressing situations without engaging in behaviors that make it worse
  • Emotion Regulation – to identify, label, and problem solve emotions
  • Interpersonal Effectiveness – to communicate needs and wants in ways that help people get what they want, keep their relationships, and maintain self-respect

DBT provides a clear road to recovery for those suffering from NSSI and is the treatment of choice for anyone who has engaged in this behavior more than once. St. Louis Center for Family Development is a mental health facility that provides comprehensive DBT services for individuals engaging in NSSI, as well as a range of services for those suffering from PTSD, Borderline Personality Disorder, Anxiety and Depression. STLCFD established the first post graduate training fellowship for DBT in the St. Louis area, and several of our clinicians are DBT-Linehan Board Certified. If you are ready to take back the control, contact us today.