It can be quite scary to learn that some people injure their bodies on purpose. However, the concept of nonsuicidal self-injury can become less confusing by learning more about it. To begin, SI comes in many forms, such as cutting, scratching, burning, or hitting oneself. About 4 percent of the general population uses SI when experiencing emotional difficulties. SI is even more common in youth, and up to 38 percent of adolescents and young adults intentionally injure their bodies. Males and females use SI at similar rates, and other behaviors that seem to harm the body are distinct from SI (e.g., piercings, tattoos, substance use, fighting).
SI is not a suicidal behavior. In fact, many people use SI in attempts to make their lives better. However, it is important to note that individuals who use SI might have additional mental health concerns such as anxiety, depression, and suicidal ideation, which could contribute to suicidality. It is okay to ask someone, “Do you want to kill yourself?” This question will not persuade an individual to consider suicide. Rather, asking about suicide shows that you care, that you are open to discussing the topic, and that you understand how difficult life can be. If a loved one reports suicidal intentions call 9-1-1, or for non-emergencies call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Although many people who use SI are not suicidal, most are experiencing deep emotional pain. Emotional pain is linked to uncomfortable feelings in the body, such as a pounding heart or a headache, which can be hard to tolerate or regulate. Sometimes, people create physical pain as a way to channel emotional pain, expel uncomfortable feelings, and ultimately reduce tension within the body.
In addition to the emotional regulation function of SI, some people use SI in order to connect with themselves. Some people with intensely uncomfortable emotions dissociate from their feelings and become numb. The sudden physical sensation caused by SI can serve to bring people back to their bodies and confirm that they are alive and still capable of feeling.
SI can also be used to create a visual representation of the pain experienced within. The scabs and scars left behind validate the pain and discomfort experienced by an individual on the inside. Some people might also use SI to punish themselves if they hold blame or anger internally.
Although SI leaves physical evidence of feelings that are otherwise invisible, it is unfair to say that people who use SI “just want attention”. In fact, the majority of people who use SI keep the evidence well-hidden behind bulky clothes and away from social situations. If a person trusts enough to disclose SI, it certainly does indicate that he or she needs attention, love, help, and support, which should be given unconditionally.
Sometimes, loved ones can recognize the use of SI in an individual even if the person using SI is not ready or willing to disclose the behaviors. Warning signs include intense emotional pain, negative self-talk, scars in conspicuous locations of the body, recurring wounds, broken bones without reasonable explanation, impulse-control difficulties, internalized anger, and feelings of helplessness or worthlessness. Although SI is a relatively effective coping skill in the moment, many people who use SI do not feel better long-term and experience shame or guilt after conducting the injurious behaviors.
Individuals who use SI should seek mental health support. Trained professionals can navigate the nuances of suicide assessment, ethics, confidentiality, and evidence-based practices. Counseling is an excellent outlet to process uncomfortable emotions in healthy ways; eventually, counselors can help individuals identify more helpful coping skills that can potentially replace SI behaviors. It is important to note, though, that Individuals should not be asked to immediately stop using SI, which could remove the one coping skill that is helping them regulate emotions, channel uncomfortable feelings, and connect with their bodies. Instead, counseling is an intricate process that takes time, commitment, and patience.
It is important for individuals who use SI and their loved ones to avoid placing blame on themselves or others. Life is terribly difficult and challenging sometimes, and we all do the best we can with what we’ve got. SI is a common method for coping with difficulties, but sometimes people begin to feel ready for a change. When that time comes, it is important to withhold judgments, have open conversations, and seek professional support. There are many people in the community who understand, want to help, and have the skills to support a healthy change process.
Educational Leadership and Counseling
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This mental health awareness column was written by Nicole Stargell, a licensed professional pounselor, a licensed school counselor, and an assistant professor at UNCP.