Even though self-harming behavior has gained a considerable amount of attention in the last two decades, it continues to be seriously misunderstood. For starters, people often think that self-injury is synonymous with cutting, but it also includes intentionally self-inflicted burns, self-hitting or bruising, extreme skin picking or scratching, even deliberately breaking a bone. Formally called nonsuicidal self-injury, or NSSI, the disorder is recognized as a distinct condition in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, rather than incorporated as a symptom of borderline personality disorder as it was previously.
Many people perceive that cutting and other forms of self-injury occur mostly among young, white females, but at least 35 percent and up to 50 percent of those who engage in self-harm are male, notes Allison Kress, a clinical psychologist in the Seattle area who specializes in working with people who self-injure. “People self-injure regardless of race and socioeconomic status,” she explains. What’s more, NSSI is more common than you might think: Prevalence rates among teenagers range from 15 to 30 percent, depending on the study, and a survey of 439 adults in the U.S., published in the journal Psychological Medicine, found that 6 percent had engaged in self-harm at some point in their lives.
Here are six other things that may surprise you about who engages in self-harming behavior and why:
Self-injury is not a cry for help, as many people believe.
“It’s a myth that NSSI is done to get attention or to provoke some sort of reaction from other people,” says Brittain Mahaffey, a clinical psychologist at the Mind-Body Clinical Research Center at the Neurosciences Institute at Stony Brook Medicine. “For folks who self-harm, it’s a way for them to manage their emotional pain.”
Indeed, the behavior usually occurs when someone is alone, and often the person hides the signs of self-injury because he or she feels a deep sense of shame about it. Typically, it isn’t until people decide to seek help that they reveal they’ve been engaging in self-injury.
[Read: How to Help Someone Else Who Has Depression.]
Inflicting self-injury often makes people feel better — for a while.
People who engage in self-injury are usually “more on the emotionally sensitive end of things but don’t have the requisite skills to effectively regulate their emotions,” explains Michael Hollander, an assistant professor of psychology at Harvard Medical School and McLean Hospital. “Self-injury helps with modulation of emotions. Many of these people have a hard time identifying and labeling their emotions and feelings. Others experience self-loathing and want to escape the emotional experience because it’s so painful.”
Often “self-injurers have poor problem-solving abilities and communication skills,” says Brooke Ammerman, a doctoral candidate in clinical psychology at Temple University who has done research on NSSI. “They also have reported higher levels of self-criticism and self-hatred.” One way or another, self-injury often becomes a distraction tactic, a way to numb emotional pain with physical pain or a form of self-punishment. For some people, “it satisfies a deeply held belief that they need to be punished,” Hollander explains, and “it’s satisfying on two levels: justice has been done because they deserved it and it leads to emotional relief.”
There are several theories as to how this plays out: One is that when tissue injury occurs, endorphins are released into the bloodstream and they have a calming effect. Another relates to the “pain offset relief” explanation — the notion that people feel relief when the pain ends and much better than before the physical pain began, Hollander says.
[See: How to Find the Best Mental Health Professional for You.]
Like other unhealthy coping strategies, self-injury can become a habit.
Self-injurious behavior can become a pattern when people get positive reinforcement for it — if they feel better after cutting or burning themselves, for example — and this becomes their primary tool for coping with negative emotions. “They do this because it works better than anything else they’ve tried,” Kress explains. “It puts the pain outside [the body] where it’s easier to cope with.” But it’s a temporary fix at best, and the distressing feelings are likely to return — at which point the cycle may start again.
Self-injury is often accompanied by other mental health problems.
“Self-injury is not the primary problem — the primary problem is what’s motivating the person to cut [or self-harm] in the first place,” Kress says. After all, engaging in self-injury is a way of acting out feelings instead of expressing them with words, she adds.
It’s true that self-harm may be a symptom of borderline personality disorder, but the behavior also can accompany depression, anxiety, panic attacks, post-traumatic stress disorder and eating disorders (especially binge eating disorder or bulimia), Mahaffey says. Adults with a history of NSSI who engaged in self-harm frequently and/or recently were found to have greater symptoms of depression, panic and anxiety, poorer emotion regulation and greater alcohol misuse, according to research published in the January 2018 issue of Psychiatry Research.
Meanwhile, a study in a 2015 issue of Comprehensive Psychiatry found that more aggressive forms of self-injury (like self-hitting) are associated with higher levels of trait aggression. Those who have a history of physical, sexual or emotional abuse are also at higher risk for self-injury, Kress adds.
[See: Am I Just Sad — or Actually Depressed?]
People who self-harm generally are not trying to kill themselves.
The truth is, “people who self-injure know the difference between self-injury and attempted suicide,” Hollander says. In most cases, self-injury is not a rehearsal for a suicide attempt. On the contrary, these self-inflicted wounds serve as a “life raft” for them, helping them cope with distress and continue on with life, Kress says. “It’s a very different mentality.”
But that doesn’t mean people who engage in self-injury can’t become suicidal in the future, especially if the emotional problems that are triggering the injurious behavior mount, Kress says. But it isn’t the NSSI that directly increases suicide risk. A study in a 2016 issue of Psychiatry Research found that people with a history of NSSI who have a strong sense of perceived burdensomeness (a feeling that others would be better off without them) and thwarted belongingness (social disconnection and loneliness) are more likely to experience suicidal ideation.
There isn’t a medication that treats NSSI directly, but therapy can help.
Of course, if the person has depression, anxiety or another coexisting mental health disorder, treating the underlying disorder with medication may help ease the emotional distress so the person doesn’t feel the urge to cut or self-harm as much, Kress notes. But there isn’t a drug that’s designed to treat NSSI directly.
One of the most effective interventions for self-injury is dialectical behavior therapy, or DBT, which teaches distress tolerance skills and helps people learn to better regulate their emotions through individual and group therapy, Mahaffey notes. Other forms of therapy that help people identify their unhealthy, negative beliefs and behaviors and replace them with more adaptive or positive ones also can make a difference.
The important thing to remember is: “Self-injury is 100 percent treatable,” Kress says. “It’s a behavior, and behaviors can be changed.”
More from U.S. News
Myths and Facts About Self-Injury
Bleeding Away the Pain: the Ins and Outs of Self-Harm
Am I Just Sad — or Actually Depressed?
6 Things You Didn’t Know About Self-Injury originally appeared on usnews.com
