• Have you ever wanted to bang your head on a wall and actually done it? Or secretly tried to cut away the pain of your existence? You’re not alone. Acts like this are considered Nonsuicidal Self-Injury.

What is Nonsuicidal Self-Injury?

• Nonsuicidal Self-Injury, or NSSI, is intentional, self-inflicted, low-lethality bodily harm of a socially unacceptable nature, performed to reduce and/or communicate psychological distress.
• You might be thinking—“What the heck is socially acceptable self-injury?” As an example, some cultures engage in practices like scarification, which is considered to be socially acceptable.
• It’s also important to note that self-harm and suicidal behaviors are different. In suicide, the intent is to permanently end life and escape pain. In NSSI, the intent is typically relief from an unpleasant feeling (e.g. anger, emptiness, shame). NSSI is typically low-lethality, meaning that you would be unlikely to die from the injury; for example, shallow cuts on an inner thigh. However, there have been individuals who have hurt themselves more severely than intended.
• NSSI is most common among adolescents and young adults, usually starting around age 13 or 14. Lifetime rates in these populations are about 15% to 20%. In both adolescents and adults, rates of NSSI are highest among those with a history of mental health disorders such as depression, anxiety, problems with emotion dysregulation, and distressing negative emotionality, particularly those with self-directed negative emotions and self-criticism.
• A common myth is that women engage in this behavior more than men; the research shows that the rates of NSSI are actually equal. What appears to be different between men and women is the method used. Women are more likely to engage in cutting while men are more likely to engage in hitting or burning. NSSI is more common among LGBTQIA+ folks and White people are more likely than BIPOC to self injure.

Why and how do people self-injure?

• Let’s get deeper into the intention behind NSSI.
• In contrast to suicidal behavior, the intent of the self-injuring person is not to terminate consciousness, but to modify it. The overwhelming majority of self-injuring individuals report that they harm themselves in order to relieve painful feelings like anger, shame or guilt, frustration, contempt, anxiety, tension, and panic. A smaller proportion of self-injurers report feeling too little emotion. They may state that they feel “empty,” “like a zombie,” “dead inside,” or “like a robot.” These individuals self-injure to provide relief for this absence of feeling.
• The key point regarding intent is that a suicidal person wants to end their experience; a self-injuring person wants to modify their experience, to reduce distress, in order to live another day.
• Some of the most common methods of NSSI include cutting, scratching, carving and skin picking, self-hitting, head banging, self-burning, self-inflicted tattoos, interfering with wound healing, and hair-pulling. In my practice, I have seen all of these behaviors and it’s important to note that depending on the individual, they may engage in these behaviors several times a year, month, or week. While a person who struggles with suicide may only attempt once, I have worked with teenagers and adults who were engaging in self-injury multiple times per week.

How to cope with NSSI

• While I will give some basic strategies for how to cope with NSSI, I can’t stress enough that if you or someone you know struggles with this, it’s imperative that you seek treatment.
• Now, we all know how much I love acronyms. Here are a couple from Lisa Ferentz, a social worker who specializes in this issue.
• The first step is to identify your triggers for self-harm. A trigger is any event, situation, or memory that elicits the urge to self-injure. To identify these triggers, you can use the acronym REACTS, which stands for:
• Relationships: Who were you with? What interactions did you have with people around then?
  Emotions: What emotions were you feeling as you moved toward planning or actually performing a self-harming behavior?
  Awareness of My 5 Senses: What did you smell, hear, taste, or touch when you got the urge to harm yourself?
  Context: Where were you? What was going on around you?
  Thoughts: What thoughts were present before you took action?
  Sensations in the Body: What did you notice in the body before acting?
• Having this information can help you cope with triggers that lead to these harmful behaviors.
• For instance, if you notice that you always want to self-harm after talking to your friend Sally, you might want to contemplate different ways of interacting with her or if she should be your friend. If you realize that you always feel hot in your body before you self-harm, you might want to use strategies to cool down. This might include taking a cold shower or sitting in front of a fan for a period of time.
• As in all situations, information is power, and understanding the precipitating factors of your self-harm will arm you against this behavior in the future. Once you have this information, you have to set an intention that when you feel the impulse to engage in self-injurious behavior that you will use a healthy coping strategy in its place.
• For this, we can use the CARESS acronym. CARESS stands for:

C.A.—Communicate Alternative

• Hurting the body is a way to communicate feelings, needs, thoughts, and unresolved trauma. You need to identify other, non-injurious ways to communicate. These can include:
• • Draw/paint the body part you want to “hurt.”
  • Draw the emotions that accompany the urge to engage in self-harm.
  • Make a collage of words/images that capture your thoughts and feelings.
  • Write a poem about your feelings.
  • Draw an outline of your body and write words on various body parts.
  • Write about what was happening when you felt the urge to self-harm.
  • Choose lyrics to a song that capture your mood.

R.E.—Release Endorphins

• People feel better after they self-harm because the brain releases endorphins (naturally occurring opiates) in response to pain/body trauma. You need other ways to experience the release of endorphins.
• • Run up/down a flight of stairs.
  • Do 100 jumping jacks.
  • Go for a run.
  • Follow your favorite fitness YouTuber through a workout.
  • Put on music and dance.
  • Listen to your favorite comedian.
  • Watch a funny movie/TV show.
  • Read a funny book.
  • Hold or pet a stuffed animal or a pet.
  • Hug a pillow.

S.S.—Self-Soothe

• You’ll need to learn new strategies that promote self-care and decrease anxiety from future triggering events.
• • Wrap yourself in a weighted blanket.
  • Take a warm shower/bubble bath.
  • Light scented candles or oil.
  • Play soothing music.
  • Read positive affirmations.
  • Massage hands with a soothing lotion.
  • Slowly savor a warm cup of tea.
  • Sit with a friend.
  • Lie in the grass and watch the clouds.
  • Listen to a guided imagery or meditation app on your phone.
• With each of these strategies, Lisa recommends doing at least one behavior from each category for 15 minutes.
• I would further encourage that once you identify healthy methods to express yourself that you make sure you have any tools needed.
• For instance, if you choose to color, it’s not helpful if you don’t have crayons and coloring books available to you. You want to make the use of these strategies convenient and make self-injury inconvenient. You want to remove all of the razors you use for cutting from the home, but make sure you have your favorite body pillow nearby.