What Is Non-Suicidal Self-Injury?

cut bandage with "HELP" written on it

I remember the day I started self-injuring. It was January my senior year of high school. I was being sexually abused by a teacher and eventually I just snapped — I couldn’t handle anymore. When I got home that day, I grabbed a red-handled paring knife from the kitchen and slashed shallow cuts into my upper left arm until I counted 100. I needed some way to prove I had control of my body, to express the hard emotions I was feeling.

The relief from the pain, confusion, and distress was instant — it immediately calmed the chaos in my mind. Once I started, it was hard to stop. And so I found myself at 21 self-injuring to manage the hearings after reporting my abusive teacher. I was still self-injuring at 28 when I did an interview about my experience with perpetrators; grooming process of victims, and at 30 when I began processing 15 years worth of trauma. And finally, after 13 years of self-injuring, I was finally able to stop.

Through all of it, self-injury served as my friend, my relief, my secret sanctuary — but it also complicated my ability to cope with difficult emotions and to connect with other people. The damage is criss-crossed all over my arms in scars, messages of deep hurt, but also survival. Self-injury is both savior and monster, a complex way to deal with overwhelming emotions.

What Is Self-Injury?

Non-suicidal self-injury is defined as inflicting intentional bodily harm without suicidal intent. It often manifests through cutting, burning, or hitting oneself on the hands, arms, stomach, thighs, and other areas of the body. While it may seem counterintuitive, the main purpose of self-injury is to relieve severely distressing emotions.

“One of the things we’re finding out [in] recent research is that self-injurers tend to self-injure for a much more narrow reason, and that’s to escape really negative uncomfortable feeling states,” says Wendy Lader, co-founder of the pioneering S.A.F.E. Alternatives self-injury recovery program. “And that is basically the main reason.”

According to Current Psychiatry, self-injury relieves symptoms such as “untenable anxiety, depressed mood, racing thoughts, swirling emotions, anger, hallucinations, and flashbacks” for 90 percent of patients. In addition to calming distressing thoughts and emotions, self-injury also serves as a way to “feel real” and relieve “dissociation, depersonalization, grief, insecurity, loneliness, extreme boredom, self-pity, and alienation.”

Self-harm works because, as Smithsonian Magazine reports, “emotions are psychological, but they are also physical,” since physical and emotional pain are felt in similar areas of the brain. Self-injury becomes a maladaptive coping skill to regulate emotional affect through the physical body.

Who Self-Injures?

Self-harm impacts many people of all ages and genders. When we look at the numbers, per the Cornell Research Program on Self-Injury and Recovery, 17.2 percent of adolescents, 13.4 percent of young adults, and 5.5 percent of adults self-injure.

Self-injury is most common in adolescents, starting on average at around age 15. A large majority of young people who start self-injuring will typically “outgrow” the behavior after five years as their brain develops and they learn more mature skills to cope with emotions.

Contrary to popular belief, self-injury is equally common in both men and women. Women typically start self-injuring at a younger age and men are more likely to self-harm while high or drunk and in a social situation.

Myths About Self-Injury

Though self-injury affects men and women equally, the pop culture image of self-harm — the “emo teenage girl seeking attention” — is still so pervasive, self-injury remains one of the most stigmatized mental health issues out there. As a result, a few common myths persist about self-injury.

First, many equate self-injury with a suicide attempt. While those who self-injure do have a higher risk of suicide, self-injury itself is not a suicide attempt. It’s an attempt to feel better and regulate emotions, which is actually a good thing. Self-injurers generally want to get better and feel better, which is a much different objective than suicide.

“Most self-injurers, even though they say that ‘I don’t really want to stop,’ most of them do,” says Lader. “They really just want to release some emotional pain and if you can help them with that then they get better. With self-injury it’s sort of an internal process and if they can really like themselves and feel more comfortable in their own skin then they don’t need to self injure.”

Secondly, self-injury is not primarily an attention-seeking behavior. This myth persists with such regularity, many times self-injurers will find a lack of compassion from family members, friends, and even mental health professionals who write off the behavior as “just” trying to get attention.

While a part of self-harm may be to gain attention, often it’s at least secondary to a desire to feel better emotionally. Furthermore, if someone needs to injure themselves in order to feel seen and heard, this is a call for help that needs to be honored in its own right.

Finally, it’s still common to associate self-injury only with the diagnosis of borderline personality disorder, which further stigmatizes people who self-harm. While this can be a symptom of BPD, it’s not the only diagnosis those with self-injury may have. People with depression, post-traumatic stress disorder, anxiety, and other diagnoses, may also struggle with self-harm.

Treatment of Self-Injury

To recover from self-injury, it’s important to deal with the issues underlying self-harm itself, as it is mostly a symptom, rather than a standalone issue. In most cases, finding professional help is the first place to start.

While self-harm is better understood now, it’s still a good idea to find a clinician who truly has experience working with self injury. Finding proper help starts by being honest with on your intake assessment, or if you’re using online therapy, your Talkspace matching therapist. Also, look for referrals from sites that specialize in self-injury, such as S.A.F.E. Alternatives, the Self-Injury Foundation, or To Write Love On Her Arms.

Group support can also help those who self-injure. Though groups specifically for self-injury are sometimes hard to find, joining another type of group that will address the issues underlying self-injury can go a long way in providing additional support. For example, consider finding a 12-step program, a trauma therapy group, an LGBTQ support group, or a Dialectical Behavioral Therapy skills class.

When working with a mental health professional, they will help teach those who self-harm immediate skills to cope with overwhelming emotions, while resolving the larger causes of self-injury, such as trauma, depression, or anxiety.

In-the-moment coping skills to interrupt urges to self-harm will be crucial to eventually stopping the impulse to self-injure. These skills include soothing or distracting activities such as taking a bath, going for a walk, coloring or drawing, journaling, or calling a friend.

As a person who self-injures learns to use alternative coping skills and begins to resolve the causes of self-injury, they will begin to heal. Recovery may not happen overnight. It takes time, effort, and hard work to end self-injury, and often years, as it did in my case. But know that full recovery and a life free of self-harm is possible.

“[Self-injurers are] creative, bright, wonderful, people who have so much to give and this is a behavior that was really…destroying their lives,” says Lader. “Once they’re free of that, it’s just amazing what they can do.”

Published by

Renee Fabian

Contributor