An Introduction to Nonsuicidal Self-Injury

Jack Shaver, Christina Robillard, & Darian Colpitts

November 1, 2022

What is NSSI?

Nonsuicidal self-injury (NSSI) is deliberate, self-inflicted damage to one’s body that is not intended as a suicide attempt or a socially sanctioned act. Common methods of NSSI are cutting, burning, scraping/scratching, and hitting oneself [1].The prevalence of NSSI has been increasing over time, with some studies showing at least a two-fold increase amongst adolescents since 2007 [2]. Although NSSI is distinct from a suicide attempt, it is a risk factor for future suicide attempts. For many individuals, NSSI functions as a coping strategy to regulate difficult emotions, communicate interpersonal distress, and/or to punish oneself. Due to the stigma and misunderstanding surrounding NSSI, many people conceal this behavior from those around them, including friends, romantic partner(s), family, and mental health professionals. It is therefore imperative to be ready to respond to an NSSI disclosure when/if it happens, to ensure that the person feels supported and they can get the help they need. 

Do I Need Special Training?

The thought of supporting someone regarding their NSSI may be daunting for some, as we often think we need special certifications, education, or skills to do so. This is actually not true! Even without specialized training, you can play a fundamental role in the process of getting the individual the help they need. Considering the individual felt comfortable enough to disclose the distress they are experiencing to you, they may not be aware of the diverse resources and support services available to them, or may not have felt ready to disclose their experiences to anyone else. It may be useful to know that a poll taken from a sample of adolescents found that many individuals between the ages of 12-18 were not sure whether parents or teachers could do anything to help with their NSSI [3], which aligns with other data demonstrating that adolescents are more likely to disclose to a friend or peer than a mental health professional.  These findings emphasize that we need to do better, especially with the adolescent population, by developing more accessible resources for supporters of those who self-injure [4].

How Should I Respond to a NSSI Disclosure? 

 Despite the complexity of factors at play, there are many components of responding to a disclosure that are universal and can be used by anyone. The first step  to remember is to remain calm, non-judgmental, and supportive, keeping in mind that disclosing NSSI is a courageous thing to do and may leave the individual feeling vulnerable. Often we lose focus during a disclosure and worry about how we feel or how others may react, when the emphasis should be on the individual reaching out for help. It is natural that supporting an individual who engages in NSSI can be an emotional experience for both parties, which is why it may be helpful to remember that your responsibility is to validate the individual’s feelings, experiences, and emotions, rather than casting judgment about their behaviors.  

Strategies and Things to Remember:

  1. Avoid big displays of shock, as your reaction will likely be meaningful to the individual. 
  2. Use “respectful curiosity,” which may involve inviting the person to share about their experiences of NSSI. For example, you can ask the person, “what does self-injury do for you?” and “what kind of things trigger your self-injury?”. You can also ask the person about the pros and cons of NSSI.
  3. Use Active Listening Skills to validate the individual’s feelings, emotions, and experiences.
  4. Ensure that the individual’s physical needs are also considered (e.g wound-care, access to sterile materials). If wound care is needed, offer the person medical supplies (e.g., a band-aid) or bring them to the hospital in serious cases. Provide this care in a matter-of-fact way and refrain from becoming highly emotional. 
  5. Be aware of resources you can look at collaboratively with the individual disclosing to you OR be willing to look for appropriate resources together! (Many preliminary resources can be found in the list we provide below)
  6. Reach out for help! Although NSSI is a private and personal issue, the best support is always given through collaboration and team-work (friends, parents, teachers, mental health professionals). All roles in the process are equally important and you should not attempt to “solve” or “fix” the individual’s situation by yourself. 
  7. Practice humility! It is not your job (or anyone’s) to have the answer to everything. The most important element is your willingness to be respectful and empathetic; while taking the situation and the individuals well-being seriously.
  8. Ensure the individual has a crisis line saved in their phone. This can help both parties feel better, as the individual will have access to immediate support if needed. 
  9. Do not promise to keep secrets because if an individual really needs help, it is your responsibility to help them get it. 
  10.  Ask the individual if it’s okay for you to check-in with them periodically, this helps them feel as though they are not alone and maintains an important point of contact. 

 

Preliminary Resources to Learn More:

  1. Exploring Self-Harm and Mental Health: Self-Injury in Schools (Podcast) https://podcasts.apple.com/us/podcast/self-injury-in-schools-with-dr-nancy-heath/id1545452037?i=1000543813382
  2. International Consortium on Self-Injury in Educational Settings (Resource List) http://icsesgroup.org/for-schools-and-parents
  3. http://sioutreach.org/ (Non-Profit Outreach Initiative)
  4. http://www.selfinjury.bctr.cornell.edu/ (Resource List)
  5. https://nowmattersnow.org/skills (Distress Tolerance Skills Training)
  6. https://youthspace.ca/ 
  7. http://www.selfinjury.bctr.cornell.edu/resources.html 

 

Examples of How to Respond to an NSSI Disclosure Using Active Listening: 

Using Validation:

     1. “Thank you for sharing this with me, it takes a lot of courage to reach out for help. How do you think I could best support you right now? We can think about this together.”

     2.  “It sounds like this has been a really difficult time for you. If you are comfortable, could you share  a bit more about what you’ve been going through lately? The emotions and feelings you’ve been experiencing?”

Using Normalization:

  1. “It makes sense that you’re engaging in NSSI given what you are going through at the moment. You’re not alone. A lot of people go through this. Thank you for sharing your experiences with me”. 

Open-Ended Questions:

  1. “Is there anything that is really stressing you out right now that I can help you with?”

 

 

References

[1]  Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know. The Canadian Journal of Psychiatry, 59(11), 565-568.

[2]  Duffy, M. E., Twenge, J. M., & Joiner, T. E. (2019). Trends in mood and anxiety symptoms and suicide-related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590-598.

[3]  Berger. (2013). “Listen to them”: Adolescents’ views on helping young people who self-injure. Journal of Adolescence., 36(5).

[4]  Gayfer, B. L., Mahdy, J. C., & Lewis, S. P. (2020). Peer reactions to non-suicidal self-injury disclosures: a thematic analysis. Counselling Psychology Quarterly, 33(1), 79-99.

Title image by redgreystock from https://www.freepik.com/free-vector/flat-man-with-symptoms-depression-disorder-overhead_22510929.htm#query=apathy&position=6&from_view=search&track=sph

 

Recommended Further Reading:

Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Nonsuicidal self-harm in youth: A population-based survey. Canadian Medical Association Journal, 178(3), 306–312. https://doi-org.ezproxy.library.uvic.ca/10.1503/cmaj.061693

Reinhardt, M., Rice, K.G., Durán, B.S. et al. A Person-Centered Approach to Adolescent Nonsuicidal Self-Injury: Predictors and Correlates in a Community Sample. J Youth Adolescence (2022). https://doi.org/10.1007/s10964-022-01628-y

Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide & life-threatening behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070

Wester, K., Trepal, H., & King, K. (2018). Nonsuicidal self‐injury: Increased prevalence in engagement. Suicide and Life-Threatening Behavior, 48(6), 690–698. https://doi-org.ezproxy.library.uvic.ca/10.1111/sltb.12389

International Society for the Study of Self-Injury (2018, May). What is self-injury? Retrieved from https://itriples.org/about-self-injury/what-is-self-injury.