Non-Suicidal Self-Injury

Trigger Warning: This article contains mentions of self-harm and suicide. Please proceed with caution.

Self-harm, especially in the form of cutting or burning, has been romanticised as well as stigmatised. A plethora of myths surrounds Deliberate Self-harm (DSH) or Non-suicidal Self Injury (NSSI). According to the American Psychological Association, DSH is the intentional, direct destruction of body tissue without conscious suicidal intent but resulting in injury severe enough for tissue damage to occur. Non-suicidal self-injury serves as a coping mechanism during times of severe depression or stress and may be a cry for help among those who display such behaviours. By controlling one’s emotional pain with physical pain, NSSI acts as an effect regulator.

Self-harm vs Suicide

Self-harm is usually an attempt at a momentary escape from overwhelming emotional pain which should not be confused with a suicide attempt. Intent differentiates self-harm from suicide. Suicide attempts usually come from a place of despair, hopelessness, and worthlessness that causes individuals to end their lives. On the contrary, NSSI functions as a coping mechanism. Suicide and self-harm might be related but are not the same.

Non-suicidal self-injury in the DSM

According to the Diagnostic and Statistical Manual V, the essential feature of nonsuicidal self-injury is that

• The individual repeatedly inflicts shallow, yet painful injuries to the surface of his or her body to reduce negative emotions, such as tension, anxiety, and self-reproach, and/or to resolve an interpersonal difficulty.
• In some cases, the injury is conceived of as a deserved self-punishment.

A sensation of immediate relief is often reported during the process. The inflicted wounds can become deeper and more numerous.

Why People Engage In Self-Harm?

It might serve different purposes for different people. The following are some reasons reported by individuals:

• When they feel out of control over other aspects of their lives, this is a way to regain control over their bodies.
• A means through which the individual punishes themself for a perceived wrong.
• A temporary fix for feelings of loneliness, worthlessness or emptiness.
• A response to overwhelming responsibilities
• A cry for help.

It can be a response to present or past experiences. However, sometimes the reason might be unknown. It persists because of its reinforcements. Self-injury can restore someone’s sense of aliveness if they feel numb and disconnected. When the human body is injured, there is a rapid burst of endorphins and other natural painkillers beginning a sense of calm and releasing physical and emotional tension. But this lasts for a split second, and feelings of guilt and shame quickly take over along with the return of the distressed emotional state. This can become a vicious and addictive cycle.

Notice the Signs

Several behavioural and physical signs can point out that someone is engaging in self-harm. The following signs can indicate that someone is regularly cutting or burning themself:

• Scars, often in patterns.
• Rapidly changing emotions
• Isolating from friends and family.
• Wearing full-sleeves or long pants, even in summer.
• Talk of helplessness, hopelessness or worthlessness.
• Fresh cuts, scratches, bruises, bite marks or other wounds.
• Possessing sharp objects or other items used for self-injury on hand.

Prevalence

NSSI is one of the most common maladaptive behaviours reported during adolescence, with prevalence rates around 18-22% in community samples around the world. Early and middle adolescence is typically the time when NSSI first appears, with a peak occurring between 14-15 years and a subsequent decline through late adolescence. Further subgroup analyses showed that females; smokers; people who drink; people who have siblings; and belong to a single-parent family have a high prevalence of NSSI.

However one should not conclude that only teenage girls engage in self-harm, as posed in popular culture. While the onset of NSSI usually occurs during early and middle adolescence, studies have found that 5.5% of adults engage in self-harm too. Females who self-harm mostly cut, while males are likely to hit themselves. However, kids of all genders engage in NSSI.

Myths surrounding self-harm

Myth: Self-harm is an attention-seeking behaviour.

• Fact: Usually individuals who self-harm experience shame which sometimes leads them to go to extreme lengths to hide their cuts and scars.

Myth: People self-harm to manipulate others.

• Fact: Self-harm may serve the purpose of a distress call for some people, but in no way is it done to manipulate others.

Myth: The only way people self-harm is by cutting themselves.

• Fact: While it is the most common form, it is far from being the only one. In addition to cutting, some self-harm by burning themselves, pulling their hair, scratching themselves, and banging their heads.

How you can help?

In order to help a loved one struggling with self-harm, keep the following tips in mind:

• Educate yourself regarding their condition as much as possible.
• Be non-judgmental and accepting and don’t ridicule or dismiss their emotions
• Remind them of coping strategies: Following coping mechanisms might stave off the urge:
  • Engaging in a hobby
  • Rubbing ice cubes on the skin
  • Drawing with a red marker on a piece of paper or on the skin
• Don’t ask for promises: It is a common tendency of people to ask the affected person to promise that they would refrain from such behaviours. However, such promises can add undue pressure and can worsen their emotional distress.
• Encourage them to seek professional help: Making sure someone receives professional help at the earliest in cases of self-injury can minimise risks and aid in recovery.