Non-suicidal self-injury (NSSI) is the act of deliberately harming one’s own body without the intention of suicide. It is a behavior, not an illness, and commonly involves actions like cutting, scratching, or burning the skin. While the methods can look alarming, the purpose of NSSI is to cope with intense emotional pain or a sense of numbness, not to end one’s life. Understanding this behavior as a harmful coping mechanism is the first step toward a non-judgmental perspective, which helps create a safe space for healing.
The Function of Self-Injury
Self-injury is a coping strategy for overwhelming emotional distress. When a person lacks healthy ways to manage intense feelings, they may turn to physical harm as an outlet. The physical pain can serve as a distraction from emotional pain that feels unbearable, providing temporary relief that reinforces the behavior.
The act of self-injury can also be a way to break through emotional numbness or dissociation. For individuals who feel empty or disconnected, the physical sensation of pain can make them feel real again. It provides a concrete experience during a moment of internal emptiness.
Self-injury can create a feeling of control in a life that feels chaotic. While external circumstances may be unmanageable, a person can control their own body and the pain they inflict. The behavior may also be a form of self-punishment driven by feelings of guilt, shame, or worthlessness. An individual may self-injure for different reasons at different times, or for multiple reasons at once.
The reasons for NSSI are sometimes categorized as either automatic (internal) or social (influencing others). Research shows that automatic functions, like managing negative emotions, are the most commonly reported reason for self-injury. Understanding these functions is necessary for developing healthy alternative coping skills.
Recognizing the Signs
Physical indicators of NSSI include unexplained wounds such as cuts, scratches, burns, or bruises. These injuries appear on the wrists, arms, thighs, or stomach and may be dismissed with implausible excuses. A person might also be found with sharp objects like razors, knives, or glass shards for no apparent reason.
Another physical sign is a persistent effort to cover up parts of the body. An individual may start wearing long sleeves or pants, even in hot weather, to hide injuries and scars. You might also notice blood stains on clothing, towels, or bedding.
Behavioral signs often accompany the physical evidence. An individual might become withdrawn and isolated, pulling away from friends and family. They may exhibit mood swings, irritability, or signs of underlying conditions like depression and anxiety. This emotional instability can make it difficult for them to maintain relationships and function in daily life.
Statements reflecting feelings of hopelessness, worthlessness, or self-hatred can also be indicators of the emotional distress that fuels self-injury. The person may struggle to express their emotions effectively or have difficulty with problem-solving. Recognizing that these behaviors are symptoms of intense pain is important for offering support.
Potential Health Complications
One of the most common complications of NSSI is infection. Using non-sterile tools can introduce bacteria into a wound, leading to localized skin infections like cellulitis or systemic infections such as sepsis.
Permanent physical damage is another concern. Deeper cuts can result in lasting scars, including keloid scars. If a cut is deep enough, it can sever nerves, tendons, or muscles, leading to loss of sensation, weakness, or impaired movement in the affected area.
There is a risk of accidental death from NSSI. An individual might misjudge the depth of a cut or severity of a burn, leading to unintentional life-threatening injuries. For example, a cut that severs an artery can result in rapid and fatal blood loss.
A history of NSSI is a strong predictor of future suicide attempts. By repeatedly engaging in self-harm, a person may become desensitized to pain and the sight of injury. This habituation can lower the barrier to attempting suicide if their emotional distress escalates.
Pathways to Healing and Support
Recovery from self-injury begins with seeking professional help. Therapists, counselors, and psychiatrists can provide a safe environment to address the underlying issues that lead to NSSI and help develop healthier coping strategies.
Dialectical Behavior Therapy (DBT) is an effective approach for treating NSSI. It teaches skills in four areas to provide practical tools for managing painful emotions without resorting to self-harm:
- Mindfulness
- Distress tolerance
- Emotion regulation
- Interpersonal effectiveness
Cognitive Behavioral Therapy (CBT) is another effective treatment. CBT helps individuals identify and challenge the negative thought patterns and beliefs that contribute to their emotional distress and self-injurious behaviors. By changing these cognitive distortions, a person can learn to respond to difficult situations in a more constructive way. Therapy often involves creating a personalized plan to manage triggers and urges.
Learning alternative coping strategies provides a healthy outlet for intense emotions. These can include sensory techniques like holding ice, taking a cold shower, or snapping a rubber band on the wrist. Intense physical exercise, such as running, can also help release tension. Creative expression through journaling, drawing, or music offers another avenue for processing feelings.