NSSI-Is My Teen at Risk?

October 11, 2014

Volume , Issue

Pa r e nt i n g Te e ns

What is NSSI?

Inside this issue:

What is NSSI

or ligaments, the long term harm is usually

restricted to scarring.4

So if self-injury is not an intentional attempt to

end ones life, then what s it? Self-injury can
be defined as purposely inflicting injury that
results in immediate tissue damage that is
done without suicidal intent, not socially sanctioned within ones culture, and not for display.3

Most Common Forms 1

of Self-Injury
Why Do Teens SelfInjure

Characteristics

Signs to Look For

How to Respond

Next Steps

Other names for NSSI:

cutting

self-injury

self-mutilation

self-harm3

Non-suicidal self-injury (NSSI) which can also

be referred to as cutting, self-harm, self-injury,
or self-mutilation, is a phenomenon which exists in both the developmentally delayed and
non-developmentally delayed populations.9
Although once a behavior found mostly among
the severely mentally ill, it has in more recent
years grown to almost epidemic proportions
in the general adolescent population.7
So what exactly is NSSI? At times, understanding what something is begins with a clear
analysis of what it isnt. With this in mind, its
important to understand that self-injury is not
a suicide attempt. Only .2% of suicide deaths
are a result of cutting. Since it is the skin that
is damaged, and not veins, arteries, tendons,

Most Common Forms of NSSI...

-cutting the skin

-self-hitting

-self-biting

-body carving

-picking at scabs

-self-inflicted tattoos

-head banging

-scratching

-ingesting sharp or toxic

objects to cause pain5

-burning the skin

-hair pulling

Page 2

Self-Injury in Teens

Why do Teens Self-Injure?

You may be wondering
why it is that someone
would do harm to their
own body? Although adolescents may have different reasons for engaging
in this behavior, research
suggests that the number
one reason for cutting is
emotional regulation.
Only when this function of
self-injury stops working
for that person one should
worry about suicide.10

Below are examples of

different feelings that
adolescents may have
trouble coping with or
regulating, so revert to
NSSI as their way of regulating these types of
emotions:

Distracts them from

overwhelming emotions
or difficult life circumstances

Relieves guilt and punishes themselves

Makes them feel alive,

or simply feel something, instead of feeling

Expressing feelings
they cant put into
words

Releasing the pain

they feel inside

Wanting to feel in
control

numb.8

The number one reason for cutting is

emotional regulation.

When Does Self-Injury Start and How Long Can it Last?

The #1 reason
for cutting is
emotional
regulation

Self-injury can start early in

life. Early onset self-injury is
common around the age of
7, although it can begin earlier. Yet most often, selfinjury behaviors begin in
middle adolescence between
the ages of 12 and 15.

Self-injurious behaviors can

last for weeks, months, or
years. Typically, when teens
self-injure it is cyclical rather
than linear meaning it can be
used for periods of time,
stopped, and then resumed
later when a teen is faced
with a stressful or hurtful
situation that they are having

Characteristics of Those Who Self-Injure

Although there are no clear cut characteristics for identifying whether your child
might be self-injuring, most people who self-injure tend to be perfectionists, unable to handle intense feelings, unable to express their emotions verbally, dislike
themselves and their bodies, and experience severe mood swings. 4 Sometimes
self-injury can also occur in conjunction with a mental illness such as depression or
an eating disorder.5
Its also important to keep in mind that NSSI is not a behavior that occurs only
within certain subcultures of the school (such as goth or emo groups), and can occur in ANY teen, regardless of group affiliation. Detecting self-injurious behavior can be difficult since the practice is often secretive and involve body parts
which are relatively easy to hide.7

difficulty coping with.

Self-injury is not exclusive to
the teenage years, and can
last well into adult-hood.1

Volume , Issue

Page 3

What Signs Do I Look for in My Child?

These are some discrete signs to look for in your teen if
you suspect they might be self-injuring.

Caption describing picture or graphic.

Continually wearing long sleeves or bulky clothing

when not appropriate

Refuse to be involved in activities that involve revealing skin or to change for P.E.

Show evidence of self-injury and/or emotional

distress in creative writing6

How to Respond if My Child is Self-Injuring

Parents need to be aware of their initial reactions if their child discloses their
NSSI, and to make sure they arent reacting negatively, excitedly, or with repulsion. Respond calmly, with little emotional response using a low-key, dispassionate demeanor. People who self-injure are generally emotionally disregulated,
so it doesn't help to add more emotion to the mix. You don't want to run the risk
of inadvertently reinforcing the behavior by being too supportive.10

Most self-injurers do not

articulate a desire to die
through their selfinjurious enactments.

It is also very important to remember that because those who

self-injure are also at greater risk
for attempting suicide at some
point (even though these are different behaviors), so anyone who
self-injures should be evaluated
for possible suicide risk.9

Rather, they speak of a

desire to escape from the
feelings of inner
deadness4

Nex t S t ep s t o Ta ke i f Yo ur Te en i s S el f I nj ur i ng
Once you have dealt with initial shock of learning that
your child is self-injuring, the next step is to help them
replace this behavior with one that is healthier, either as
a family or in conjunction with a trained mental health
specialist that specializes in replacement skills training.

Replacement skills training is a method of focusing on

developing and utilizing healthy behaviors as opposed
to restricting self-destructive behaviors. This is extremely
applicable when working with teens, who tend to do the
extreme opposite of what someone is demanding of
them.2

Examples of Replacement Skills

If your teen is cutting because they are sad, help them replace cutting
with a replacement behavior for dealing with sadness such as listening to music, journaling, or drawing.
If your teen is cutting because they are angry, find replacement behaviors for that anger such as vigorous exercising, snapping a rubber
band on their wrist, screaming into a pillow, or squeezing a stress
ball. These coping skills emphasize releasing their negative emotions
and increasing feel good endorphins, by using their body and hands
to in active ways.
If your teen is cutting to calm or soothe themselves, have them replace
this with coping skills that emphasize the senses (such as touch and
hearing) and also focus on helping them get to a more relaxed and
calm state of mind such as taking a hot bath, listening to calm music,
getting a massage, or wrapping themselves in a warm blanket.6

References
1 Cawood, Chelsea Dean, and Steven K. Huprich. "Late Adolescent Non-suicidal Self-Injury: The Roles Of Coping Style, Self-Esteem,
And Personality Pathology. Journal Of Personality Disorders 25.6 (2011): 765-781. Academic Search Complete. Web. 28 Sept
2014.
2 Hyldahl, Rebecca S. and Brent Richardson. "Key considerations for using no-harm contracts with clients who self-injure." Journal of
Counseling & Development 89 (2011): 121-127. Academic Search Complete. Web. 27 Sept 2014.
3 Lloyd-Richardson, Elizabeth E. "Non-suicidal self-injury in adolescents." The Prevention Researcher 17(1) (2010): 3-7.
4 Muehlenkamp, Jennifer J. and Patrick L. Kerr. "Untangling a complex web: How non-suicidal self-injury and suicide attempts differ."
The Prevention Reseacher 17(1) (2010).
5 "Self-Injury-A Guide for Parents and Caregivers." 2012. Self-Injury Outreach and Support. 22 Sept 2014. <http://
www.sioutreach.org/learn/parents>
6 Smith, Melinda. "Cutting and Self-Harm." 2013. Help Guide. 27 Sept 2014. <http://m.helpguide.org/articles/addiction/selfinjury>
7 "The Cornell Research Program on Self-Injury and Recovery." 2013. Cornell University. 28 June 2014. <http://
www.selfinjury.bctr.cornell.edu/about-self-injury.html#tab4>
8 Toste, Jessica R. and Nancy L. Heath. "School response to non-suicidal self-injury." The Prevention Researcher 17(1) (2010).
9 Trepal, Heather C. "Exploring self-injury through a relational cultural lens." Journal of Counseling & Development 88 (2010): 492499. Academic Search Complete. Web. 9 Oct 2014.
10 Van Nuys, David. "Wise Counsel Interview Transcript: An Interview with Barent Walsh, Ph.D. on the Nature and Treatment of SelfInjury." 2014. Seven Counties Services, Inc. 28 June 2014. <http://www.sevencounties.org/poc/view_doc.php?
type=doc&id=27111>.