“I go to the boxing gym to release steam when I’m mad or angry”
“Nothing clears my mind like a nice long run when I find myself frustrated”
“Mediation is the only way I can manage my anxiety”
“I carry a small razor in my purse and cut myself to cope with stress”
One of these coping strategies is different from the others…
As shocking as that last statement may sound, the act of hurting oneself to cope with stress, anxiety or frustration actually has a name, non-suicidal self-injury (NSSI) and it affects 17% of adolescents, 15% of college students, and about 5% of adults.
NSSI, often simply called self-injury, is the act of deliberately harming the surface of your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. Rather, this type of self-injury is an unhealthy way to cope with emotional pain, intense anger, and frustration.
Like many disorders, NSSI can take on many forms. From literally cutting one’s skin with a knife or scissors to rubbing an area of the skin so vigorously as to cause actual physical damage and pain. Each person suffering from NSSI has his or her “preference” and “rituals” for self-mutilation, similar to an alcoholic who may have a drink of choice. However, the physical outcome manifests, the underlying emotional cause of this disorder is the real culprit.
Most people who use NSSI are not suicidal; however, the repeated act of self-mutilation and the emotions that cause them can become more severe over time if not properly and swiftly treated. Depressive and anxiety disorders are common. Many feel emotionally dysregulated due to a variety of factors including, but not limited to, a history of trauma or abuse, bullying, shame, family dysfunction, school or other daily pressures, low self-esteem/worth, loneliness, depression, etc.
Cutting (or any other form of NSSI) sometimes releases endorphins, similar to a strenuous workout (or even sex), killing the pain momentarily and raising one’s mood. On the opposite end, a person who has trouble feeling any emotions at all may use NSSI as a way to feel something, anything “real” to replace the emotional numbness. Typically, after the initial “high” wears off, hurting themselves will cause feelings of guilt and shame causing them to hurt themselves again, suppressing their feelings further, and thus the dangerous cycle is perpetuated and can be extremely hard to find a way out.
What to look for?
Aside from the most common form of NSSI, which is physical cutting of the skin, it is important to note that any of the below rituals may also be considered as NSSI:
- Burning (with lit matches, cigarettes or hot, sharp objects like knives)
- Carving words or symbols on the skin
- Hitting or punching
- Piercing the skin with sharp objects
- Pulling out hair
- Persistently picking at or interfering with wound healing
Recognizing that someone is using NSSI to cope with their emotions isn’t always easy. The best thing you can do to help is to ensure they start to learn proper and less harmful ways to cope with the emotional pain that is causing the act of self-harm.
How to stop NSSI behavior?
1. Begin some form of healthy mind-body outlet such as yoga, Pilates, running, Zumba class, kickboxing, etc to begin to integrate your physical and emotional selves.
2. Use your senses. Being mindful of what you see, hear, taste, smell and feel are powerful tools to engage more in the here-and-now. For example, go to the freezer and grab on to ice instead of cutting or rub your hands on a fuzzy blanket for calm-down stimulation.
3. Get support. Talk to someone you trust before you self-harm. Have an emergency plan with a list of names and numbers with you at all times. When you are in the emotional realm and the desire to cut is strong, it can be difficult to “think” about what to do. Create this crisis worksheet when things are calm.
4. Wait for just a little longer each time before you self-harm. If you automatically use self-harm to cope with strong emotions, wait one more minute. See if you can add a minute every day or every week. Try to gain some control over the behavior.
5. Draw the word DO NOT RELAPSE (or an X or another symbol) on the part of the skin where you typically injure as a visual reminder to not harm.
6. Distract yourself with something else – play music, dance, scream, hit a pillow or even sleep.
7. Throw out all sharp objects that you might use. Not having them accessible may provide time to think before acting.
8. Get professional help. Individual and group therapies are extremely effective as is medication or holistic remedies. Seek professional help. This is treatable once new coping strategies are gained and practiced.
The most effective treatment for NSSI is cognitive behavior therapy, specifically dialectical behavioral therapy (DBT), which helps to provide clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. When searching for a health care provider, be sure to find a therapist who has training in CBT and/or DBT.
For greater insight into interacting with those suffering from the issues mentioned in the article or if you would like to chat with others affected, I highly recommend joining the app, Reachout.
Dr. Lisa Herman is a Licensed Clinical Psychologist and founder of Synergy eTherapy, a tele-mental health group practice where all of the sessions are conducted by phone or video from the comfort of the client’s home. Dr. Lisa has over 17 years of post-graduate level clinical experience working with children, adolescents and adults who suffer from a wide range of mental health concerns including anxiety, depression, relationship difficulties, substance abuse and other emotional or behavioral disorders. Dr. Lisa started Synergy eTherapy with the mission of increasing access to high-quality mental health care for everyone.