Recent reports have highlighted the frequency of non-suicidal self-injury among gender and sexual minorities. 41.9% of transgender people have self-injured. I was unable to find a percentage for cis lesbian, gay and bisexual people beyond the general report that the rate was “much higher”. Gender and sexual minority (GSM) youth are at particular risk, as are cis women.
So let’s take a quick look at non-suicidal self injury this week. What is it? Why do people do it? And what should those who currently self-injure, and their loved ones, know?
Non-suicidal self injury (NSSI) is a term that refers to deliberate attempts to cause oneself injury without intending suicide. The “without intending suicide” is the important bit there. This is a separate phenomenon from suicidality, though both suicidality and NSSI can come from the same psychological source. NSSI can take many forms, but cutting and burning are the most common. People who have higher levels of stress, such as GSMs, are at higher risk for NSSI. Transgender people may have an additional risk factor because of extreme body dysphoria.
To most who have never participated in NSSI, it can seem baffling. Why would a person do that to themselves? While everyone has different reasons, at core NSSI is about survival. Many use it to defuse overwhelming emotions. Emotional pain is just like physical pain in the brain, causing activation of the same areas. All pain causes the release of morphine-like chemicals in the brain which buffer the pain, causing the sensation of a “high”. By creating physical pain in reaction to emotional pain, the person doing the NSSI can regulate their own emotions and cope. Other people who do NSSI are attempting to focus. When the world seems far away or they feel numb, pain can help them to feel something and give something to concentrate on. Lastly, some people who do NSSI do so as a way to punish themselves, as a way of asserting control in a powerless situation, or to communicate their emotional pain….or for any number of other highly personal reasons.
NSSI is not an ideal way of coping with life’s stressors. It can be addictive. It’s easy to hurt oneself too much and accidentally attempt suicide or develop infection. Scars and NSSI behavior attract attention, limiting one’s ability to get or maintain a job. Over time it can permanently change a person’s responses to stress and pain.
NSSI is often misunderstood, even in psychology and medicine. Most psychologists and physicians have never experienced NSSI or been close to people who have, so they fail to understand the reasons for NSSI. Until the DSM-V, the only psychological diagnosis that applied was that of borderline personality disorder, which most people who do NSSI do not have.
It can be difficult for a person who self harms to get help. Psychologists and physicians are legally bound to report individuals who are at risk of harming themselves or others to the police. While necessary, it limits confidentiality and can harm trust. Some professionals require that a patient sign a “no self harm contract” before receiving any treatment. Not all patients are willing or able to sign such a contract. Physicians have a limited set of options for treatment: medications (which can take 4-6 weeks to begin to work), referral to a psychologist or psychiatrist, do some level of psychological intervention themselves, or admit the patient to the hospital. And then there’s the question of affordability, especially if you’re unable to hold a job because of the self injury.
Despite these barriers, psychological and medical professionals can be very helpful for people seeking to stop self-injuring. At bare minimum, having a psychologist or physician in the loop can help if a particular incident of self injury goes further than intended. NSSI is a coping strategy, and psychologists and physicians can be very helpful for the issues lying underneath self injury, whether that’s depression, post traumatic stress disorder, or just plain stress.
Lastly, it’s important to know that people can and do learn non-NSSI coping strategies and learn to be self-injury free.
If you want to learn more about non-suicidal self injury, I highly recommend this website. It’s old and the current version is broken, so that links off to the Wayback machine version. It’s still one of the best sites written by people who intimately understand self injury and work to provide information and help others. For a modern alternative, this website also has support forums.