The Harmful Myths about Non-Suicidal Self-Injury
By Nicole, NAMI Dane County Intern
What do you think of when you hear “self-injury?” If you can only think of cutting or suicidality, you are not alone. Self-injury is shrouded in a stigma that causes many to be unaware of its definition, causes, and effects. This lack of understanding can cause those who self-injure to feel hesitant in seeking support from loved ones, or even in disclosing their experience to a mental health professional. We can start breaking through this stigma by addressing common myths about self-injury.
Myth: People who self-injure are always suicidal.
Reality: While some people who are suicidal may engage in self-injury, not all those who self-injure are suicidal. It is important to understand the difference between self-injury and suicidality. Non-suicidal self-injury (NSSI) is purposefully harming oneself without suicidal intent. Instead, the intention of NSSI is related to short-term coping for the individual, such as a release of tension. Those who self-injure without suicidal intent are still at risk of seriously hurting themselves, regardless of their intentions. Harmful behaviors may escalate in severity or can increase the risk of experiencing suicidal thoughts.
Myth: Cutting is the only form of self-injury.
Reality: The most common form of NSSI is cutting, but there are many forms of NSSI. Scratching, burning, preventing wounds from healing, and excessive exercising are some examples. The intention to harm is what draws the line between what is self-injury and what is not. For example, a piercing is not self-injury unless it was created with the intention to cause harm to oneself. Another common belief is that injury is only inflicted onto the wrists. While wrists, hands, stomach, and thighs are often locations where self-injury is inflicted, anywhere on the body may be affected.
Myth: Self-injury affects only a very small proportion of people.
Reality: NSSI affects a large range of people, and is especially prevalent in teenagers and young adults. One study found that 17.2% of adolescents and 13.4% of young adults report having self-injured at some point in their lives. There are multiple reasons why one may believe that self-injury is uncommon. The stigma associated with self-injury causes people to be less likely to disclose their struggles with it, making it appear less common. Additionally, beliefs about what NSSI is can cause a bias in what people expect it to look like. For example, if someone believes that cutting one’s wrists is the only form of self-injury, they may not register other signs of self-harm (such as a burn mark on the stomach).
Myth: People who self-injure do it for attention.
Reality: This myth creates shame and stigma for those who engage in NSSI. There are a vast number of reasons why people may self-injure. Individuals report self-injuring in response to numbness, self-loathing, guilt, dissociation, fear, and helplessness. They may be motivated by the desire to feel something, forget something, regain control, escape from depression, communicate pain, or make their body show what they feel inside. An individual may self-injure in response to a variety of emotional states, and their reasons for doing so may change over time. The myth that people self-injure for attention is victim-blaming. It is true that a person may self-injure as a cry for help, or to soothe the fear that they will not be cared for. These feelings of helplessness are valid and are to be met with empathy and compassion. Believing that someone who self-injures does so for “attention” can further the shame and alienation that leads them to harm themselves in the first place.
Myth: The best way to respond to someone engaging in NSSI is to tell them all of the risks and reasons why they need to stop.
Reality: When someone discloses NSSI, it can be frightening for the person they tell. It is natural to start thinking of all of the ways to stop a loved one from engaging in NSSI. While coming up with alternative solutions to NSSI is key to helping someone who suffers from it, immediately greeting them with reasons why they need to stop may cause them to be wary of opening up. Instead, when someone initially discloses that they self-injure, it is crucial to remain present and unassuming about their experience.
Those who self-injure may feel shame in doing so which causes them to fear reaching out for help. This shame is dangerous, as it decreases the likelihood that the individual will seek support. When responding to someone disclosing their experience with NSSI, it is important to understand how vulnerable of an experience it can be. Letting them know that you are thankful that they trusted you to listen to their story can help decrease potential feelings of shame and fear. Listening to and comforting someone who self-injures, before coming up with potential solutions, is essential for ensuring that they feel heard and understood. Additionally, this will give the individual space to discuss the reasons for why they self-injure, which is essential for creating safe alternative responses to negative thoughts and feelings.
Myth: There aren’t any good ways to prevent someone from engaging in NSSI.
Reality: Therapy, especially dialectical behavioral therapy(DBT) and cognitive-behavioral therapy (CBT), has been proven to be effective in helping those who self-injure. This is important in making long-term positive changes to an individual’s self-worth and coping strategies, the driving factors that affect engagement in NSSI. In terms of short-term coping strategies, it is beneficial to create a plan for engaging in safe alternative activities when experiencing an urge to self-harm. Understanding the specific reason (or reasons) for wanting to self-injure will best guide what to do instead. For example, feelings of numbness may best be addressed by going for a run to reconnect with the body. Feelings of abandonment may be addressed by talking with a trustworthy loved one. Like any other mental health issue, effective interventions for NSSI are not “one-size-fits-all.”
It is true that there has not been extensive research done on NSSI- it was listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders as a condition requiring further research. However, there have been data collections and a couple of promising studies regarding self-injury. A 2014 study conducted by Hooly and Germain gives insight into a potential intervention target for NSSI. The researchers created two groups of participants (those who self-injure and those who don’t) and then tested each group’s pain endurance by seeing how long they could keep their fingers in a pressure device. After the first round of pain endurance testing, both groups received a 5 minute intervention aimed at increasing self-worth. After the intervention, the groups had their pain endurances re-tested. After the self-worth intervention, the NSSI group kept their fingers in the pressure device for only about half the time they originally did, whereas the non-NSSI group did not show any significant change. The researchers suggest that these findings demonstrate how feelings of low-self worth increase the ability to handle pain in those who suffer from NSSI. The effect of the 5 minute intervention is promising- it shows that increasing one’s self-worth is key to preventing self-injury. The bottom line: There are interventions and resources for those who engage in NSSI.
The topic of self-injury should be met with empathy and compassion. The last thing someone who engages in NSSI should feel is shame in seeking support.