Like many topics in mental health, discussions of self-harm are often surrounded by a palpable stigma. Self-harm is frequently mentioned in the same breath as suicide, a topic also surrounded by stigma and unease. While both important topics, it is important to note that thoughts and acts of self-harm are often fundamentally different from those of suicide. Self-harm (otherwise known as “Non-Suicidal Self-Injury” or NSSI) is often brought about by a profound desire to live rather than to die.
Those who have experienced self-harm report using it as a way to cope with the painful hardships of life, such as trauma, depression, or other underlying mental health concerns. It is not an uncommon coping mechanism either – an estimated 2-6% of the general public, and 13-35% of adolescents and young adults, have engaged in NSSI, with an even higher percentage of those who have experienced thoughts of NSSI.
The high prevalence of NSSI, in combination with its stigma, warrants a strong need for more public awareness on what causes NSSI. People who engage in NSSI can have a myriad of reasons (or a combination thereof). Common reasons include:
Communication of pain. People who experience strong emotional pain often do not have tangible, externalized evidence of their pain. NSSI can be a way to communicate to themselves or others that their pain is legitimate and real. This is, unfortunately, also due to the larger cultural acceptance of physical pain over emotional pain.
Release of Endorphins. The body naturally responds to pain by releasing endorphins (pain-relieving neurotransmitters that help the body cope with stress). While initially increasing their experience with pain, people who engage in NSSI can feel a sense of relief afterwards.
Self–soothing. Especially once NSSI becomes habitual, people may find comfort in the reliable routine of self-harming as a coping mechanism. Many even develop a repeated “ritual” around NSSI and develop a similar relationship with NSSI as other addictive coping mechanisms, such as substance use or compulsive eating.
In combination with developing empathy for those who use NSSI, the risks need to be taken equally seriously. Risks of NSSI include permanent scarring on the body (such as from cuts or burns), increased risk of infections, as well as an inhibition from using healthier coping styles.
While NSSI is often distinct from a desire to die, it is also important to note that those who engage in NSSI are at higher risk of suicide. This could be from accidentally self-harming more severely than intended, or from when the underlying pain causing the NSSI continues to go unaddressed until the development of suicidal thoughts and behaviors.
Warning signs of NSSI include wearing long sleeves and pants even in warm weather, frequent bruising or bandages, or other attempts to hide the visibility of one’s body. If you are concerned about NSSI in a loved one, some of the steps you can take include:
Provide a safe, nonjudgmental space to talk openly with your loved one about thoughts of suicide and/or self-harm.
Address the conversation with curiosity and empathy.
Gently encourage professional help.
If part of their safety plan, a loved one may ask that you hold onto their self-harming objects (i.e. knives, cigarette lighters) for safekeeping. One protective measure against self-harm is to limit access to self-harming means.
If you are concerned about NSSI in yourself, it is important to know that you are not alone. Therapy can help people learn more about the underlying causes of their self-harm and develop a safety plan, harm-reduction strategies, alternative coping methods, and a social support system. Those in immediate crisis regarding NSSI are encouraged to use crisis resources, such as the national mental health crisis line, 988. You can also learn more about NSSI at the references listed below.
Trauma Warriors – The C.A.R.E.S.S. Technique by Lisa Ferentz
