The Truth About Non-Suicidal Self-Injury: 5 Myths and Facts

The very idea that someone would intentionally physically hurt himself -- to feel better -- is something that many people find difficult to understand, even unfathomable. But the reality is that non-suicidal self-injury is much closer to home than you might think.
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Most of us take every precaution to keep ourselves safe and healthy. We wear our seatbelts, we refrain from that second piece of cake, we go to the gym. The very idea that someone would intentionally physically hurt himself -- to feel better -- is something that many people find difficult to understand, even unfathomable. But the reality is that non-suicidal self-injury -- what used to be called self-mutilation -- is much closer to home than you might think.

Non-suicidal self-injury (NSSI) is common across various age groups. Recent research shows that it is alarmingly common in young children. A study published in the journal Pediatrics found that nearly 8 percent of third-graders reported injuring themselves without intent to die. That number increases as individuals age, with up to 23 percent of teenagers and 38 percent of young adults reporting self-injury. Statistically speaking, that means 1 out of every 5 people you know has engaged in NSSI. If that statistic is shocking to you, you're not alone. There are a lot of myths and stereotypes about NSSI that haven't been supported by scientific research. Here are just a few:

Myth #1: Self-injury... That's a girl problem, right? Wrong. Rates of NSSI are actually similar between men and women. When we look at samples of people who self-injure, the gender split is usually 50-50. There may be differences in the ways men and women exhibit NSSI, but both genders are equally likely to hurt themselves. For example, in my own research, women were more likely to cut and scratch themselves while men were more likely to burn themselves.

Myth #2: When people say "NSSI," they mean "cutting." Many people think of cutting and burning when they think of self-injury, but there are many other ways to inflict physical harm on one's body. Any behavior that is done to cause tissue damage, but without intent to die, can be NSSI. Common behaviors include picking at the skin or scabs, self-hitting, or biting. Although people used to think that cutting was the most common behavior, recent research indicates that scratching and skin-picking may actually be as common as, if not more common than, cutting.

Myth #3: NSSI is a cry for help -- or, someone who hurts himself on purpose is being manipulative. The idea of intentionally causing injury to oneself is foreign to many people and difficult to understand. Why would someone hurt himself on purpose? For many people who engage in NSSI, the behavior is a way of dealing with aversive feelings, thoughts, or situations. Most people who engage in NSSI do so to regulate emotional and physical experiences, such as reducing feelings of sadness or anger. Even though you might think that the pain of self-injury would make someone feel worse, people often do it because it makes them feel better, at least short-term. NSSI is an adverse coping strategy, but people engage in it because it's easily available and effective at regulating emotional, physical, and social experiences.

Myth #4: People who hurt themselves on purpose are trying to kill themselves, even if they say they're not. Although both suicide and NSSI involve intentional injury, they are distinct behaviors. Most importantly, they differ in intent to die; by definition, NSSI must be performed without suicidal intent. However, a significant number of people with a history of suicide attempts also report a history of non-suicidal self-injury, and our research has shown that history of self-injury without suicidal intent is a key risk factor for attempted suicide. Although the behaviors are distinct, the link between them further emphasizes the need to address NSSI.

Myth #5: Self-injury is a sign of a larger problem. This one may not be a myth. But let's be clear what we're talking about: In the current Diagnostic and Statistical Manual, which is used by psychologists, psychiatrists, physicians, and other mental health professionals to diagnose psychiatric disorders, NSSI is listed as a symptom of only one disorder, borderline personality disorder. However, not everyone who engages in NSSI has borderline personality disorder. In fact, self-injury isn't symptomatic of just one disorder. Research that colleagues and I have conducted has shown that self-injury can also be associated with a large number of other disorders, including depression, anxiety, eating disorders, and substance abuse. I've also found that some people who self-injure don't even meet criteria for a psychiatric disorder.

Given the significant negative consequences associated with NSSI, like scarring, infection, increased risk of self-injury, depression, anxiety, and shame, it is essential that we correct these myths. Only by educating ourselves about NSSI will we be able to prevent misdiagnosis and make sure that our friend, coworker, brother, mother, or child gets the treatment that he or she really needs.

This piece was written in association with The Op-Ed Project.

For more by Peggy Andover, Ph.D., click here.

For more on mental health, click here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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