The Science Behind Non-Suicidal Self-Injury

By Wasim Kakroo

NSSI is an increasing concern among teenagers and young adults, and it can be an indication of sadness, loneliness, despair, low self-esteem, or a sense of being unwanted.

Non-Suicidal Self-Injury is one of the growing health problems among adolescents and young adults. The International Society for the Study of Self-Injury defines Non-Suicidal Self-Injury as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. Self-harm is a symptom, not a diagnosis, of mental illness. Some people may do self-harm as a result of a mental illness such depression, anxiety, an eating disorder, or psychosis, however, self-harm isn't always indicative of a mental illness, but rather of a lack of healthy coping methods to deal with emotions.

NSSI does not include risky activities that may end in harm, such as not wearing a seatbelt while driving or accidental harm that may occur when participating in dangerous sports.

Suicidal thoughts or behaviors, in which people want to terminate their life, are not the same as self-injury. When people self-injure, they frequently say they have no expectation or goal of killing themselves.

Self-injury does not include activities that may cause physical harm but are acceptable in our culture or are part of a recognized cultural, spiritual, or religious practice. Thus, body modification, nose/ear piercing, and tattooing are not commonly regarded as forms of NSSI.

What are the common methods of self-harm?

Common methods of NSSI include Self-cutting or self-burning,Self-punching,atttempting self-poisoning, eating too much or too little, biting oneself,Over-exercising, pulling your hair out and skin picking.

Why does a person do NSSI?

It is a complicated issue, and many people have no idea why they do NSSI. NSSI isn't always triggered by a major event; it can also be triggered by a slew of minor events.
The following are some of the most common reasons why people participate in NSSI: Pressure at school or work, bullying, worries about money, abuse of any kind (physical, emotional or sexual), bereavement, uncertainty about one's gender or sexuality, breakup from a relationship, loss of employment, Illness or a health issue (physical or mental such as depression, anxiety, OCD, Borderline Personality Disorder etc), low self-esteem, difficulty in handling stress, difficulty in handling emotions.

Individual factors (e.g., emotional dysregulation, psychiatric disorders etc.) and environmental factors (e.g., abuse, neglect, childhood maltreatments, attachment disruption) are two primary types of causative factors for NSSI. Childhood maltreatments were revealed to be a predictor of NSSI in adolescents and college students in the majority of studies that focused on early childhood traumatic events.

Exploration of environmental variables have found a substantial relationship between NSSI development and childhood sexual abuse. Researchers have emphasized the importance of parental relationships as causative agents of self-injurious behaviours, finding that insecure paternal attachment and both maternal and paternal emotional neglect were significant predictors of NSSI in women, while childhood separation was the main predictor of NSSI in men (usually from father).

Recent research has looked into the role of stressful life experiences in the development of NSSI. Adverse life events were linked to moderate and severe NSSI in Chinese teenagers. Researchers also found a lower likelihood of engaging in NSSI in those who had strong emotional stability.

NSSI is most typically used to relieve (temporarily) overwhelming negative emotion. NSSI is preceded by intense negative emotions, and its execution results in lessened negative emotions as well as sensations of calmness and relief. Slightly more than half of persons say they self-injure as a kind of self-directed rage or self-punishment. NSSI can serve a variety of additional purposes, such as influencing others or producing a physical indicator of mental pain, but each of these purposes is only relevant to a small percentage of persons who self-injure.

What are Adverse Childhood Experiences and how do Adverse Childhood Experiences (ACEs) lead to NSSI?

Childhood experiences can have a life-long impact on one's health. Children who have had a stressful and poor-quality childhood are more prone to engage in health-harming behaviors during adolescence (such as NSSI), which can lead to mental problems and also diseases later in life, such as cancer, heart disease, and diabetes. Individuals who have been exposed to ACEs are more likely to struggle in school, become involved in crime, and ultimately be less effective members of society.

The various forms of ACEs are physical abuse, sexual abuse, emotional abuse, drug abuse in the family, depression or any other mental illness in the family, suicide in the family,incarceration of a family member, domestic violence, parent separation or parental divorce, death of parent(s), emotional neglect, physical neglect, bullying and community violence.

Suicidal ideation and suicidal or NSSI are disproportionately common in people who have experienced childhood trauma or maltreatment because ACEs affect the emotional stability and distress tolerance of an individual and hence such individuals use NSSI as a means of dealing with emotions such as depression, anxiety and especially shame and guilt that they acquire because of ACEs.

What's the Connection Between Non-suicidal Self-Injury and Attempted suicide?

When compared to suicide attempts, NSSI is more common, includes different means (for example, cutting and burning rather than weapons, hanging, or self-poisoning), resulting in bodily harm that is less medically serious and produces less deadly damage. More importantly, those who participate in NSSI do not intend to commit suicide. In fact, NSSI is most often performed in the absence of suicidal ideation.

Common myths about NSSI

Self-harm has a lot of myths and stigma attached to it. Common myths include:

1. Only girls do NSSI. This has been proven false in studies. It's likely that boys and girls employ distinct means of self-injury.

2. NSSI is a form of attention-seeking behaviour. People who do NSSI frequently attempt to hide their behaviour. NSSI can be a cry for help in some situations.

3. People who do NSSI are suicidal. Some people use NSSI as a coping method. Some people but not all, who do NSSI, have suicidal thoughts.

The next article will discuss mental health first aid for someone who does Non-Suicidal Self Injury.


  • The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar) and is currently working as a child and adolescent mental health therapist at Child Guidance and Well-Being Centre at Institute of Mental Health And Neurosciences-Kashmir (IMHANS). He can be reached at [email protected]

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