MSU Extension Healthy Relationships

Nonsuicidal self-injury (NSSI) is defined as purposefully damaging one’s own body without the intent to die from the injuries. NSSI does not include the damage one does to one's own body related to accepted social or cultural customs. NSSI is also referred to as self-injury, self-harm, and self-mutilation. People who engage in NSSI may do so as part of nonsuicidal self-injury disorder or as a symptom of another mental health challenge. 

Risk factors for NSSI

Anyone could potentially self-harm, but certain groups of people or individuals are more likely to self-harm. Those at higher risk of engaging in NSSI include: 

• Teenagers and young adults.  
• Women (due to increased levels of stress compared to men). 
• People who are not cisgender. 
• People who are not heterosexual. 
• People who have a mental illness.  
• Survivors of trauma, abuse and/or bullying. 

Race and ethnicity are also associated with the risk of engaging in self-harm. White, Native American and Hispanic individuals self-harm at higher rates than Asian/Pacific Islander and Black individuals. Additionally, having a lesser connection and feeling of belonging to one’s ethnic group may increase a person’s risk. Another group at higher risk is those who currently serve or who have served in the military. Research is limited about other occupations and risk of self-harm.

How to recognize self-harm

There are varying motivations for engaging in intentional self-injury. Sometimes it is used as a form of self-punishment or as a way of communicating to others the distress that is felt inside. Other times it is done as a way of coping with intense emotional pain. Most often, it is a combination of these reasons.  

Just as the motive can be different, self-harm behaviors can vary between individuals and over time. Here are some common examples of self-injurious behavior: 

• Cutting or piercing the skin with knives, nails, razors and other sharp objects. 
• Punching, slapping or hitting oneself in the face or head or punching things like doors and walls. 
• Burning the body with cigarettes and lighters, typically behind the ears or other easy to conceal areas like the upper thighs.
• Causing bruises by pinching various parts of the body. 
• Deliberately overusing medications. 
• Binge eating or starving oneself. 
• Overexercising.  
• Abusing drugs and alcohol. 

Self-harming can lead to anxiety and feeling afraid or ashamed. Therefore, many who self-injure will attempt to hide it. There are some ways to tell if someone is engaging in it by watching for these warning signs: 

• Cuts, bruises and burns in various stages of healing throughout the body, especially on the thighs, stomach, wrists and arms. 
• Either having or hiding knives and other sharp objects. 
• Hiding scars and open wounds on the arms and legs by being fully covered without cause from religious, cultural or health reasons, even in hot weather. 
• Expressing self-hatred, having low self-esteem, blaming oneself for things beyond the person’s control or talking about punishing oneself. 
• Becoming withdrawn or displaying other signs of depression, such as sadness, hopelessness, despair and easily crying. 
• Suicidal thoughts. 
• Performing poorly at school and/or work. 
• Drug and alcohol misuse. 
• Relationship stress and strife. 

While NSSI is often used as a coping mechanism, it is not the safest or most effective strategy for managing emotional pain. This is because self-harming activities can lead to serious injury and increase the risk of suicide. Therefore, it is important to seek treatment for NSSI. It is possible to overcome self-harming behavior and to help someone else who may be self-harming.  

How to help 

It can be distressing to suspect or learn that someone you care about is self-harming. Since we might feel upset about the situation, we should first take some time to carefully consider our response before talking with them. It is important that we are calm and ready to listen when we start the conversation. Actions like yelling at, threatening or blaming the person will make your loved one not want to share their feelings with you or accept help from you.  

Once we are calm and have found a suitable time and place to talk about our concerns, we should focus the conversation on how the person is feeling. People often use NSSI to cope with difficult emotions. By listening nonjudgmentally and letting the person express their feelings, rather than focusing on self-harm behavior, we can help the person to feel heard and understood. This can help the person feel more supported and may make it easier for them to seek help.  

Another way we can encourage help is to have resources prepared to share with our loved one. A few options that could be provided, depending on the severity of the issue, are the Michigan Peer Warmline, 988 Suicide & Crisis Lifeline, or SAMHSA’s National Helpline. We could also encourage the person to talk to their doctor or a counselor. Regardless of what resources we suggest or what the person is willing to try, we can help by reminding them that there is hope for them to start feeling better and that they are not alone.   

While NSSI is separate from suicidal thoughts and behaviors, individuals who have self-injured are at higher risk of suicide and may be suicidal while also self-harming. If you are unsure if someone’s mental health challenge and self-harm behavior is related to or coinciding with suicidal thoughts, another way you can help is to ask them about suicide and support them as needed based on their answer.  

When helping a person who is self-harming, make sure to address any life-threatening or disability-causing injuries right away. A person may accidentally cause serious injuries when engaging in NSSI. If this is the case, we could call 911, take the person to the nearest emergency room and practice physical first aid as needed to help the person.  

Helping someone struggling with NSSI or any other mental health challenge can be difficult. We might be scared to say or do the wrong thing. Even if it’s a bit scary, it’s important to remember that not saying something could lead to worse outcomes for the person, so we should try to offer help when we are able. Becoming certified in Mental Health First Aid can help increase confidence and effectiveness in recognizing a mental health challenge and having supportive conversations. Consider becoming a Mental Health First Aider to ensure you are ready to support your friends, family and other community members who may be self-harming or experiencing other mental health challenges.