More Than Cutting | What Is Non-Suicidal Self-Injury?

Are tattoos and piercings self-harm? What about full contact sports? This week I received a great question from @scan0017 about whether an intense work out routine could be self-harming as it does involve putting yourself through pain. As someone who has dealt with self-harming behaviors for almost 2 decades, I have found it hard to connect with people on this subject because so many have no idea what it is. So let’s talk about it.

Non-suicidal self-injury (NSSI) is hard talk about and engage with because so few know anything about. From friends and family to medical professionals, it remains a bit of black-box for many. In fact, even most people engaging in NSSI do not recognize their behavior as that. The problem is that you cannot address something if you don’t even know what it is. You cannot help those who suffer if you are blind to their suffering. This creates further isolation and confusion for people struggling and leaves their loved ones dumbfounded. So what is NSSI? And what is it not?

The words themselves makes a certain amount of sense: It is self-injury, so injury to self; and it is non-suicidal, so NOT done with the hope or goal of killing oneself. But that picture still leaves a lot unanswered. The term self-injury is sometimes swapped for terms like self-harm, self-mutilation, self-inflicted violence, or colloquially (and inaccurately) simply just “cutting.” It is the act of intentionally inflicting physical harm upon one’s own body—note that emotional self-harm is a related, but less studied behavior.

You may be asking “but what does it actually look like?” It is a good question, but does not have a clear answer. There is not yet a definitive set of behaviors that fall into this category, but the most common forms of NSSI are cutting or puncturing the skin, burning, biting, scratching, self-bruising (with fists or objects), and banging one's head or fist against an object. Some definitions have included behaviors such as pulling hair, excessive skin picking, and consuming toxic or harmful substances, but these are more often than not given different categories because the behavioral framework is different.

It may help to identify some behaviors that are not NSSI. Tattoos, piercings, full-contact sports, drug use, eating disorders, exercise, and stunts done as “showmanship” (think Jackass movies) and not usually considered self-harming behaviors. Even though most of them do involve some known and anticipated harm to your body, the motivation and psychological factors are different. It is not a hard and fast rule, but three questions I often ask are “Is the behavior performed with the intention to harm, as opposed to just resulting in harm as a known consequence?”; “Is the behavior socially unaccepted?” and “Is it done in secret and kept hidden from others?” If you answer no to any of the questions (meaning, It was not seeking the harm itself, it is socially accepted, or it is not kept hidden), then it likely is not NSSI.

The fact that NSSI is non-suicidal may sound counter-intuitive to people unfamiliar with the behavior. However, it is very common for people who self-injure to report that they actually do so as a means of relieving emotional pain. For me personally, it has been a suicide prevention behavior, albeit, a dysfunctional one. My goal is for more people to be willing and able to see not only self-harm behaviors in their own lives, but for others to gain an understanding and empathy for those who deal with NSSI. When something is confounding, foreign, and unknown, it is hard to enter in with genuine engagement and love. Sometimes we must engage out minds so that our hearts are equipped to do the soul-care work that is needed. There is hope. We are the solution.

Until next time, be blessed.

Sam

Image Sources: Sitting, Time
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