You may have heard of the terms self-harm, self-injury, or non-suicidal self-injury (NSSI). But what do these terms mean, and how are they related to suicide?
According to Self-Injury Outreach and Support (SiOS), a collaboration between two Ontario universities, “non-suicidal self-injury (NSSI), also referred to as self-injury or self-harm, is the deliberate and direct destruction of one’s body tissue without suicidal intent and not for body modification purposes”. Individuals may engage in NSSI in a range of ways, which may pose different levels of risk to safety and health.
Importantly, NSSI does not include:
- Body modification such as tattoos, piercings, and other culturally supported practices.
- Indirect physical injury resulting from substance abuse or eating disorders
- Self-injurious behaviours (SIB) which may be seen among individuals with intellectual and developmental disabilities.
Determining how common NSSI is or how often it occurs can be difficult. Individuals who self-injure may not share that information with others and may be able to hide their behaviour. Individuals may also receive healthcare after engaging in NSSI, and their NSSI behaviour could be recorded as a suicide attempt, even if the individual did not have an intention or desire to die.
Why would someone self-injure?
Those who engage in NSSI do not necessarily want to die and are not attempting to take their own life. Research indicates that NSSI can be a coping mechanism which allows someone to deal with difficult emotions, stressful experiences, and low self-esteem.
Many who engage in NSSI understand that their behaviour may be viewed in stigmatizing ways and can carry risk. Some respondents have told researchers that self-injury is a “last resort” of coping tools to manage their distress. It is important to recognize that the behaviour can serve a specific purpose for many who self-injure, and often times is difficult to stop until other coping tools or strategies are developed.
Who is at risk for engaging in non-suicidal self-injury (NSSI)?
The presence of risk factors does not mean that someone will engage in self-injury behaviours, but it increases the chance that they might. Risk factors for self-injury can be social or situational, or emotional or personal.
Some risk factors for NSSI include:
- Having difficult relationships with family or friends
- Experiencing problems at school or work, such as bullying
- Dealing with discrimination, such as homophobia, racism or sexism.
- Having difficulties managing or regulating emotions.
- Feeling empty, disconnected, or isolated.
- Having a history of trauma or abuse
- Having a family history of self-injury or self-harm.
(Source: The Canadian Mental Health Association- Ontario).
It is important to note that there is no evidence that self-injury risk is impacted by socioeconomic status, and there is very little research to support differences by race and ethnicity. Lastly, while some may think women are at higher risk for NSSI, this gender divide is not always supported in peer-reviewed studies. (Source: The Cornell Research Program on Self-Injury and Recovery).
How to Help and Support Someone Struggling with NSSI
If you believe that someone is engaging in NSSI, it is important to refrain from reacting in anger, or from sharing judgment, shame, or pity. This is because “self-injury is most often a silent, hidden practice aimed at either squelching negative feelings or overcoming emotional numbness” (Source: The Cornell Research Program on Self-Injury and Recovery). Shaming someone for using NSSI to cope with their strong emotions and difficult life experiences might encourage them to hide their pain further and could prevent them from seeking help in the future.
Instead, if you are concerned about someone and their behaviour, you can reach out and start a caring conversation. Try to listen calmly and without judgement and ask open-ended questions. This can help the person share their feelings and experiences. If you are concerned that the person may be at risk for suicide as well, you can ask directly.
To learn more about having a caring conversation and supporting someone at risk of suicide, visit How Do I Start the Conversation – Waterloo Region Suicide Prevention Council.
While self-injurious behaviour is not necessarily a warning sign of thoughts of suicide or intent to attempt suicide, it is important to encourage the individual to see a health professional to ensure any NSSI behaviour is not life-threatening.
NSSI Prevention
Unfortunately, prevention strategies for NSSI is a slow-growing area of research. The Cornell Research Program on Self-Injury and Recovery suggests the following possible strategies for preventing NSSI behaviour:
- Enhance capacity to cope and regulate emotional perceptions and impulses.
- Enhance social connectedness.
- Avoid strategies that increase knowledge of NSSI forms and practices.
- Equip adults, especially those that work with youth or young adults, to recognize and respond to signs of self-injurious behaviour.
- Promote positive help-seeking behaviours, and resources for support.
- Educate youth to understand the role media plays in influencing behaviour.
Resources for Help and Support
- Adult Resources – Waterloo Region Suicide Prevention Council
- Youth Resources – Waterloo Region Suicide Prevention Council
Resources for Further Learning:
Understanding and Finding Help for Self-Harm (Canadian Mental Health Association- Ontario).
Self-Injury Outreach and Support (sioutreach.org)
The Cornell Research Program on Self-Injury and Recovery
Tofthagen, R et al. (2021). Men who self-harm- A scoping review of a complex phenomenon. Journal of Advance Nursing, 1-25.
Woodley, S. et al. (2021). “How individuals who self-harm manage their own risk- ‘I cope because I self-harm, and I can cope with my self-harm’. Mental & Physical Health, 124(5).
Victor, S. and Klonsky, E.D. (2018). Understanding the social context of adolescent non-suicidal self-injury. J Clinical Psychology 74(12): 2107-2116.