March is Self Harm Awareness Month. As we observe this month, we decided to rewatch our webinar from last March, “Understanding Self-Injury” with Dr. Michael Hollander.
In this blog we will discuss Non-Suicidal Self-Injury (NSSI).
What is NSSI?
When we refer to NSSI, we are talking about a person deliberately damaging their own body without the intention of suicide. One of the most common forms of NSSI involves cutting. And it’s also true that people can self-harm in many ways, including burning, punching walls, head banging, scratching, and skin picking.
What Is the Function of NSSI?
As DBT therapists, we know that about 80% of clients who self injure do it to regulate their emotions. For many of these folks, NSSI has a calming effect. When they are experiencing intense emotions, self-injury helps to “down-regulate” those feelings. The injury causes the body to release endorphins, which causes the person to feel calmer and reinforces the self-harming behavior.
And some use self injury to combat emotional numbness, or “up-regulate.” For these folks, the inability to feel emotion causes them misery, so they injure themselves in order to feel something.
We’ve also had clients who use NSSI as a suicide prevention tool. They cut, burn, or punch themselves to avoid acting on suicidal urges. In addition, some folks tell us that self injury acts as much needed validation of their intense emotions. (“If I’m upset enough to cut myself, I must have a really good reason!”)
NSSI In Adolescents
People who self-injure often start this behavior during adolescence. The average age of onset is between 9-15 years old. About 40% of adolescents stop within a year. Sadly, many of them continue to self-harm into adulthood. So what can parents and clinicians do to help?
The most important thing for us to understand about NSSI is this: What we see as the problem, those who self-injure see as their solution. Simply asking someone to stop–or worse, punishing teens for self-injury–isn’t effective. Because NSSI functions as an emotional regulation strategy and provides immediate relief from painful emotions, it is incredibly difficult to abandon without alternative coping skills.
Treatment for NSSI
Dialectical Behavior Therapy is the gold standard treatment for NSSI behaviors. Not only can DBT help reduce this harmful behavior, it can also help people to build a life worth living.
Self-injurious behavior is a short-term solution to emotional misery, and it does nothing to solve the long term problems that caused those intense emotions. It keeps people stuck in misery. With DBT, people can work on solving those problems so that they no longer feel the need to harm themselves.
How to Honor Self-Harm Awareness Month
Self-Harm Awareness Month provides an important opportunity for clinicians to raise awareness, reduce stigma, and improve care for people who self-harm. Here are several ways clinicians can meaningfully honor this month:
1. Educate yourself by attending specialized training on the latest evidence-based approaches for NSSI assessment and treatment. You can start with our webinar, “Understanding Self-Injury” with Dr. Michael Hollander.
2. Host informational sessions for colleagues, patients, and community members about recognizing warning signs, understanding risk factors, and available resources.
3. Review and update screening protocols to ensure all patients are appropriately assessed for self-harm behaviors.
4. Create a supportive, non-judgmental environment where patients feel safe discussing self-injury without fear of stigma or punishment.
5. Share resources such as helplines, crisis text services, and support groups with patients and their families.
6. Partner with schools, community organizations, or mental health advocacy groups to expand awareness efforts beyond clinical settings.
7. Practice self-care and seek support when needed, as working with patients who self-injure can be emotionally challenging.
Remember that awareness efforts should continue beyond the designated month, as consistent attention to NSSI is essential for improving long-term outcomes for our clients.
