Non-Suicidal Self-Injury: What is it and What is it not

by James A. Bishop, M.S.

What is it?

Non-Suicidal Self-Injury (NSSI) has gone by many names: deliberate self-harm, self-mutilation, and self-injurious behavior. Although it goes by many names, the definition does not change. NSSI is purposely self-inflicted injurious behavior in the absence of suicidal intent. Importantly, NSSI excludes self-injurious behaviors that are for cultural practices, such as ritualistic mutilation, or in the course of a developmental disorder such as Autism Spectrum Disorders.  

The self-injurious behaviors can range from something as innocuous as nail biting, to more severe injuries such as cutting or burning of the skin. Most of these injuries occur on areas of the body that are easily concealed by clothing, such as the legs, chest, shoulder, and upper arm. The behavior can be very secretive.

NSSI is known to occur in a variety of recognized psychological disorders including Borderline Personality Disorder, Eating Disorders, and Mood Disorders. Individuals may have been physically or emotional abused, emotionally or physically neglected, or have experienced a trauma as a child. Others may have been sexually abused and be in an environment that minimizes or denies that the trauma occurred. In other words, there are a variety of circumstances that might lead to self-injurious behavior.

To date, NSSI is not a uniquely recognized disorder in the Diagnostic and Statistical Manual, 5th edition (DSM-5); however, it has been proposed as a recommended diagnosis given the plethora of research surrounding the topic. The suggested diagnostic criteria state that an individual engages in this behavior to relieve themselves of a negative feeling or unwanted cognitive state (e.g., depression, anxiety). In fact, the individual may also be trying to induce a more positive state. Someone engaging in this behavior may have unresolved social difficulties and seek to remedy this by harming themselves. The intention is to dull a psychological or emotional pain with a physical pain. It has been suggested that NSSI is a maladaptive way of coping: using physical pain to cover up, or distract from some form of psychological trauma or difficulties.


What is it not?

NSSI is often stigmatized: individuals are blamed for the behavior and accused of attention seeking. There is a notion that individuals that self-harm are just “looking for attention.” This is far from the truth. Those that self-harm are very secretive about the behavior, and indeed, most self-inflicted injuries occur in places on the body that are easily hidden.

Another school of thought is that individuals who engage in this behavior want to kill themselves but are too scared to follow through with it, or complete a suicide attempt. In truth, the motivation for the NSSI is survival, ridding oneself of a noxious state of mind or distressing experience. The motivation is not to end one’s life. NSSI should instead be considered in this framework: it is a matter of life, not death; survival, not extinction.