5 Things You Should Know about Non-Suicidal Self-Injury

woman hugging pillowConfusion, anxiousness, hurt, disappointment, and anger may be among the feelings parents experience if they discover that their teen is self-injuring. The teen, too, is likely experiencing negative thoughts and emotions. The following provides a description of non-suicidal self-injury, risk and protective factors, and suggestions for how parents can and should not respond after discovering that a teen is engaging in self-injurious behavior.

1. What Is Non-Suicidal Self-Injury?

Non-suicidal self-injury (NSSI) is an intentional injury to one’s own body with the absence of suicidal intent. People who engage in self-injury typically do not intend to die by suicide and tend to deny suicidal ideation was present while engaging in a self-injurious act. It may also be called self-harming, self-injury, or self-mutilation. It is a coping skill often associated with depressive symptoms, self-criticism, and difficulty accessing or regulating feelings. It exists in different forms, including burning, cutting, biting, hair pulling, scratching, or pinching the skin to obtain a sense of relief from strong emotions that may feel overwhelming. The self-injuring behavior creates a release of endorphins, the “feel-good” neuropeptide sometimes associated with “runner’s high.” Although NSSI is distinct from suicidal behavior, it is a risk factor for possible suicide attempts.

2. How Does NSSI Begin and Who Is Most at Risk?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) says that NSSI tends to start during the early teen years, generally peaks by late twenties, and then declines. Research shows mixed results regarding risk factors, such as trauma, that may lead to NSSI, and protective factors that may help prevent it. The DSM-5 suggests that individuals often learn of self-injuring behaviors from someone they know and may try the behavior themselves. People using self-injury may be doing so as a form of self-punishment for something they feel is deserved, because the behavior reduces upsetting feelings or reduces upsetting thoughts, because the behavior results in desired attention from a specific person, or to demonstrate feelings that are difficult to express. One protective factor is providing adequate social support from friends and family. Increases in negative self-talk and a depressed mood suggest greater risk of NSSI and suicidal behavior.

3. What Can I Do to Help My Teen If He or She Self-Injures?

Parents of a teen who self-injures can:

  • Ask the teen if he or she is self-injuring if you suspect the behavior but are unsure if it’s happening.
  • Tell your teen you’re concerned about the behavior.
  • Talk to your teen about getting help from a counselor or finding a mental health professional.
  • Reassure your teen that asking for help is OK and it doesn’t mean he or she is weak or crazy.
  • Let your teen know you love him or her; you may not approve of the behavior, but you love your child for who he or she is.

4. What Should Parents NOT Do When They Learn Their Teen Is Self-Injuring?

The following behaviors can lead teens to shut down or escalate an already tense situation:

  • Don’t shame or criticize your teen by saying things like, “What’s wrong with you?”
  • Don’t accuse your teen of self-injuring for attention.
  • Don’t minimize the problem by saying it’s just a phase.
  • Don’t buy your teen expensive items because he or she tells you that’s the only way he/she will stop self-injuring.
  • Don’t hurt yourself in front of your teen trying to make it understood how much it hurts you knowing he or she self-injures.
  • Don’t punish your teen; self-injuring is its own form of self-punishment or self-abuse.

5. How Can Professional Support Help?

A professional counselor can help address and reduce self-injuring behaviors. Focusing on building new coping and problem-solving skills helps someone who self-injures increase his or her repertoire of behaviors used to manage distressing emotions. Processing traumatic experiences that may be associated with self-injuring behavior can help validate feelings about the event.

Having a strong therapeutic relationship between a therapist and the person self-injuring is also important since it can help create a collaborative and safe environment to practice new skills. A collaborative therapeutic alliance can be a necessary first step to begin identifying patterns of thoughts, feelings, and behaviors that lead to a self-injuring incident or may be maintaining a self-injuring behavior.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Marjie L. Roddick, MA, LMHC, CTTS, therapist in Vancouver, Washington

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Claudia

    Claudia

    July 24th, 2015 at 7:42 AM

    I am very curious about this because it seems like this could be a very dangerous pattern for someone to get into.

  • Marjie L. Roddick, MA, NCC, LMHC

    Marjie L. Roddick, MA, NCC, LMHC

    July 24th, 2015 at 11:22 AM

    Hi Claudia, thanks for your comment and curiosity about self-injury. You’re right, for some teens self-injury can escalate into a destructive pattern. Self-injury is an unhealthy way to cope with negative feelings and usually is not the same as a suicide attempt, but an accidental suicide is possible. Signs that the behavior is escalating include an increase in talking negatively about oneself or an ongoing negative mood that includes feeling hopeless and/or worthless. For other teens, they may observe or learn healthier skills along the way that replace the self-injury and the behavior decreases. Learning the new skills may involve lots of positive (external) social support and role-modeling from friends and family, the teen’s own level of (internal) motivation, or a combination of the two.

  • Harold

    Harold

    July 24th, 2015 at 12:35 PM

    Parents should be aware that more and more kids are attempting this kind of thing and what thta says to me is that these are children who are crying out for help. There is something that they are missing when they self injure and it is up to parents to open their eyes to see that this is something real and that it can be very serious if not addressed quickly.

  • christie

    christie

    July 25th, 2015 at 7:13 AM

    Why has this become so prevalent? This is something that up until a few years ago I had never even heard of and now the trend seems to be everywhere. Is this a fad for some kids or is this something that is truly real and they are just catching on to using it to feed into these patterns of self harm that feel good to them? I guess you could just say that I am a confused grown up looking for answers before it hits my own home.

  • Manda

    Manda

    July 25th, 2015 at 7:07 PM

    I think awareness is becoming more widespread. I also think more people are seeking help or people are becoming more aware of what to look for and making attempts to help loved ones who are engaging in this behavior.

  • Leanne

    Leanne

    July 26th, 2015 at 4:02 AM

    This is something that has been going on for a long time. Self harm is usually a side effect or coping method for those suffering mental health problems. In recent years I have noticed that more teens (especially “emo” kids) are using it as a way of gaining attention and popularity which is annoying and infuriating as those who are truly suffering would never openly flaunt their self harm. These attention seekers are why society is so quick to dismiss such actions as attention seeking. If anyone has a child or any loved one who self harms please be supportive. reassure them that they are loved and wanted and that you will help and support them. never shame them for their actions or show anger… it will only make things worse.

  • Kenslee

    Kenslee

    July 25th, 2015 at 11:00 AM

    Regardless of what the reasons are behind that behavior it is destructive and I am not sure how you are supposed to remain supportive of the teen when you know that they are essentially harming themselves by doing tit.

  • Tracey-Lynne C

    Tracey-Lynne C

    July 26th, 2015 at 4:16 AM

    It’s not about condoning the behaviour, it’s about knowing the behaviours are a symptom and addressing the real cause, rather than shaming and alienating the person who doesn’t know how to manage the feelings they experience in a better way. You have to build a person up.

  • Andrea R

    Andrea R

    July 26th, 2015 at 7:04 AM

    I think any parent of a child tries to be as supportive as they can. In my situation I’ve a teen with a autism diagnosis. That said I’ve fought tooth and nail to get the correct support, but to no avail. He has injured himself in anger and aggression as well as property. It’s all well and good but when you seek professional advice you are lucky to get any especially when the child refuses to open up. You get 3 sessions with CAMHS and they are in a crisis now due to cuts. The children and social media situation seems to be fantasising self harm with each other, yet there are kids out there that need help, genuinely. It’s a parents worst nightmare. Which then also has a knock on effect on their mental health because I’m there at that point. I battle every day and I’m verbally abused by language etc. it is no walk in the park.

  • Holly

    Holly

    July 25th, 2015 at 6:47 PM

    I know a child that is only 8 that exhibits some of these behaviors

  • Ann Marie

    Ann Marie

    July 25th, 2015 at 7:27 PM

    i am diagnosed as having major depressive disorder and suicidal thoughts. When reading this my only question is; I seem to pull out my eyebrow hairs when I get emotional and never discussed this with anyone. Is this self harm?

  • Lily

    Lily

    July 25th, 2015 at 8:40 PM

    I have this as an adult. As a teenager I would cut myself with broken pieces of glass. Today at 55 I scratch and pick and dissect any cut or bug bite. Right now my legs are full of cuts what started off as mosquito bites 3 months ago now. I am going through PTSD yet again. This is

  • Lily

    Lily

    July 25th, 2015 at 8:43 PM

    When I don’t care about myself and self district,self mutilate, I hide it well although it’s been hot with summer heat I’ll wear stretch pants or long skirts.

  • Sunny

    Sunny

    July 25th, 2015 at 10:12 PM

    My daughter came to me and said she tried to cut herself, but couldn’t. I remained calm. We talked about the feelings that were driving her to want to do this.

    We discussed how dangerous it could be and that there were other ways to release those feelings. As a stop gap,I downloaded some Dialectic Behavior Modification worksheets aimed at adolescents and made her a self therapy notebook. This was her private space to write down her thoughts,feelimgs and triggers.
    We made an agreement that she was to text me ANYTIME she felt the temptation to harm herself.

    The next day I contacted a pediatrician who had been a business client of 7 years, explained what happened and worked to get her switched to this person’s practice. Fortunately, this clinic had just arranged for a child psychologist to start working from their office one afternoon a week. We got her started seeing him and she is getting the suppport she needs to deal with her feelings.

    Yes, I was freaking out inside the whole time but I knew I had to present a calm, safe non anxious sense to my daughter. Me falling apart would not help her.

    A similar thing happened with a friend’s daughter a few months before, but she had started cutting and the school discovered it. Helping my friend through the situation with her daughter prepared me (not that you can ever really be prepared to know your child is hurting that bad) for when my daughter came to me.

  • Millie

    Millie

    July 25th, 2015 at 11:03 PM

    I used to self-harm as a teenager. Now well in my adulthood, I still do it when emotions get the better of me. I do it in a place that is not visible to others and do not discuss it with friends/family. The way I see SH is giving a physical form to high levels of emotional distress – I’m in SO much pain, but it’s so abstract, I don’t know what to do with it. Cutting myself gives me a clear way to “tend to my wounds”. It’s a bit like when leg amputees use a mirror to create an illusion of their missing limb to scratch a “ghost itch”.

    I agree self-harm is awful and can really spiral out of control, but it is also a signal of serious psychological issues and rather than fixating on fixing the symptom (the physical harming), we should try to help with the mental source/cause of it.

  • Sharon

    Sharon

    July 26th, 2015 at 12:19 AM

    Parents are so controlling, teenagers need to make decisions and mistakes, parents want good exams results, the pressure on teenagers is so big from parents, all parents talk about is A stars, school tests, sporting events, when are children aloud to be kids.

  • Jen

    Jen

    July 26th, 2015 at 7:22 AM

    I found out my daughter had been doing this. I got her referred to a counsellor, with her help she was able to stop and hasn’t done it since. My daughter was very secretive and kept it well hidden. It turned out it was due to bullying at school from other teenage girls who had lowered my daughters self esteem, the councillor was amazing, I can’t recommend it enough. My daughter has now left school and got the first job she had an interview for. She is relaxed, happy and at peace with herself. It does seem much more common than it ever was, I know of four other girls who are doing similar things, unfortunately they have no access to counselling.

  • Sean

    Sean

    July 26th, 2015 at 4:25 PM

    I think that this is the thing- most of the kids who are doing this do keep it very much a secret so it can be hard to know that it is going on unless someone tells you or they finally decide to not make it such a secret anymore.

  • NICOLE

    NICOLE

    July 26th, 2015 at 5:58 PM

    Self-harm is sometimes all teens can do to express themselves. teens cant communicate very well when its about their feelings. just be understanding.

  • Zane

    Zane

    July 27th, 2015 at 6:48 AM

    What good would shaming a person be?
    They obviously are already in crisis mode with inflicting self injury

  • Millicent

    Millicent

    July 27th, 2015 at 2:23 PM

    As a parent I would be so concerned about what came next, what the next step was ultimately going to be when my child was planning this kind of self harm. I think that I would feel so helpless to stop it and yet forced into action before anything too dire happened.

  • ric

    ric

    July 28th, 2015 at 8:29 AM

    Get help!!
    This is not an issue that you should even try to have to do on your own

  • Jayda

    Jayda

    July 29th, 2015 at 11:37 AM

    We also have to be aware of the fact that this is starting at younger and younger ages all of the time. Kids are so overwhelmed with life in general these days that it seems only natural for lack of a better word that they are turning to things that will help them cope. And for some of the of course this is going to be self injuring.

  • Marjie L. Roddick, MA, LMHC

    Marjie L. Roddick, MA, LMHC

    July 29th, 2015 at 10:52 PM

    Thanks everyone for all the interest and interaction on this topic. It is difficult to say why self-injury remains so prevalent. Peer influence during the teen years may be a big factor. Learning that someone else is using self-injury may give the impression that peers find it an “acceptable” way to solve problems, which increases the chance of the behavior being adopted. As some comments have stated, it isn’t always easy to be supportive of someone you care about who is engaging in self-destructive behavior and it can lead to a feeling of helplessness. It is unfortunate, but some parents do use shaming as a technique to try to make their teens stop a behavior rather than doing the sometimes difficult work of helping or asking for help. Shaming may be the only skill the parent learned as a way to solve problems. In which case, a shaming parent and a self-injuring teen could both benefit from learning new ways to deal with problems. It’s encouraging to see posts from those who have gotten help and been able to work through the self-injuring behavior and move on to happy, healthy lives. These stories offer hope to those who might wonder if anything CAN help. For those still experiencing the pain, know that help is available when you are ready for it and there are many people who want to support you. Regarding the comment about pulling out eyebrow hairs, seeking out some help to determine what’s going on could be beneficial if you feel like it interferes in important areas of your life, if you have negative feelings and thoughts that go along with the behavior, and if the behavior is something you want to stop but have trouble doing.

  • aqua

    aqua

    July 31st, 2015 at 1:08 PM

    I have to say it really is not just about teens by a long shot.
    I suspect its because its only recently become acknowledged, accepted and talked about, that is skewing the data.
    That and a disinclination to face the reality.

  • Kenn

    Kenn

    July 31st, 2015 at 5:52 PM

    I want to give my experience with self harm because it might give others a realistic view of it’s lasting effects.
    I was abused throughout my childhood and became mentally and emotionally disturbed. I started self harming by cutting up my forearm. When my left arm became too raw, I moved to my legs, my belly and finally my right arm. I dabbled in burning, freezing and stabbing myself with sharp objects. The older, more mature I got, I noticed my left arm had no feeling in the forearm and normal sensations like cold and heat wouldn’t effect it the same as my right. I went to a neurologist and he told me the nerves are dead because of the years of abuse. Now as a 26 yo, I have scars that healed, but never fully gained proper pigmentation. So i’m looking at cutting wounds everyday as a constant reminder of my mistake and have the lack of feeling from it. It took me many years to realize what my triggers were, and i’m not mutilating myself anymore. The trigger for me was my abuse that was abandoned and left to a teen to handle. I’m betting the majority of people that are in my position have issues in their lives they are having trouble coping with, like abandonment from parents (even though the parents may not see it that way), constant abuse at school, lose of a loved one, friend or someone they were close too, etc. Not everyone has the will power to defeat there issues or the ability to create ulterior coping skills on there own. Parents who suspect self harm or any kind of trauma that is really disturbing the child, whats the harm with following the guide Marjie wrote out? Kids need there parents just as much as they need their children, everyone involved deserves there time to be heard and aided in overcoming there trauma so they don’t lash out on themselves.
    Thank you for reading

  • Mike

    Mike

    August 1st, 2015 at 10:06 AM

    Leanne, even when someone “flaunts” their self-harm, I don’t think it’s right to call it attention-seeking. At the root of it is still a psychological wound. If these children had received good care when they were younger they would have no need to seek attention through dramatic means.

  • Kelly

    Kelly

    August 14th, 2015 at 8:41 PM

    I think you hit the nail on the head. From my experience, with what I’ve seen with the girls that I know that cut or are cutting, it’s the only way that they are able to cope with some really big problems that they are facing and not by their choice! The adults that are involved are paying little or no attention to how their actions, words (or lack thereof) and decisions are affecting their children. They have either checked out or are simply too self absorbed in what is going on. In some cases, one or both parents are coping with a mental illness themselves and are completely incapable as a parent.

  • Susan

    Susan

    August 1st, 2015 at 12:47 PM

    I discovered my daughter had been self-harming (cutting her left forearm) after a friend told me that her daughter was doing it and she had covered it up with lots of bracelets and long sleeves. My daughter was also wearing these things all the time, and I immediately sensed she must be doing the same. When I asked her about it, she said she had stopped a couple of months earlier, with the help of friends and online forums (this is a great site : helpguide.org/articles/anxiety/cutting-and-self-harm.htm). It was a huge relief but scary as she had covered up her misery by pretending to be happy. As she was 14-15 at the time her need to be alone more often seemed age-appropriate, and her sudden, uncharacteristic irritation if anyone tried to come into the bathroom when she was in there. She started cutting herself again months later when the new school year started so we sought help – she saw a psychiatrist specialising in teens for several months, which was really helpful. It seems that although most often they want to hide it, there are also some kids who want to flaunt it and shock those around them (see an interesting personal account by Teal Swan youtube.com/watch?v=GdWXA8Plr84). There is without a doubt an increasing trend and a sense that it is a badge of honour amongst young people, whose pop idols now post YouTube clips about how they used to do it but got over it now, feeding the street cred. This is impossible to avoid, so education and support is needed, both for kids as well as parents and teachers.

  • Kenn

    Kenn

    August 1st, 2015 at 6:17 PM

    How would I tell the difference between someone self harming and being introverted?

  • Nessa

    Nessa

    August 2nd, 2015 at 2:14 PM

    you hear alot about teen self injury. But not that much about adult who do.
    I have cut off and on the last two years as an adult but never did as a teen. Why is that?

  • Laura

    Laura

    September 1st, 2015 at 9:26 PM

    For me cutting is like theid coming off the pressure cooker. When tears are not enough or I am all cried out I do it. I am an adult who was emotionally traumatized as a child by my mother.
    I now have other people who do much the same.

  • Marjie L. Roddick, MA, LMHC

    Marjie L. Roddick, MA, LMHC

    September 2nd, 2015 at 12:37 PM

    Laura, thank you for sharing about your experience with cutting. The analogy you provide of a pressure cooker can really give people a good sense of what it must feel like for you, and maybe others, to have feelings that build up inside and create a pressure that self-injury helps to alleviate. I’m sorry to hear about the emotional abuse you experienced during childhood, I hope you are able to receive support if you need it.
    Kenn, an introverted person is generally someone who appears shy or hesitant to interact with others. Someone who is using self-injury may appear not only reluctant to interact but also may seem depressed or irritable and use harsh self-talk in conversation.
    Nessa, it is difficult to say what may have started the cutting habit in the last couple of years as an adult. Your question seems like a great one to explore through counseling or with other supports you may have.
    I agree that parents may have difficulty knowing what’s going in their teens’ lives. Teens are often trying to establish independence and don’t want their parents knowing what they’re doing all the time. Parents may have a hard time recognizing their teens are having a problem, especially if they are coping with their own mental health concerns. Education through parenting classes, online articles, books, or support groups can be helpful.

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