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This is a follow up to last month’s blog about kids who spend lots of time in their heads chewing on all the awful things that have happened to them in their short lives. We concluded with recognizing the value of writing or talking about the painful stuff but thinking about all the sensory details of the pleasurable times. We realized that the consequences of unfettered negative rumination have been found to include Nonsuicidal Self-Injury (NSSI). So now, with last month’s ideas in hand, let’s return to a closer look at NSSI.  I found a good review of the current literature on (NSSI) in the Canadian Journal of Psychiatry by authors Klonsky, Victor and Saffer entitled Nonsuicidal Self-Injury: What We Know, and What We Need to Know. I’ll further summarize their review here in an effort to clarify how this scary behavior can be better understood.

Though once only thought to be a symptom of Borderline Personality Disorder (BPD), Nonsuicidal Self-Injury (NSSI) is now recognized as distinct from BPD. It is, however more often seen among psychiatric populations, and like children with a history of chronic trauma, in those who experience emotional distress, such as negative emotionality, depression, anxiety, and emotion dysregulation.

NSSI is typically seen as cutting, burning, scratching, and banging or hitting, and most people who self-injure have used multiple methods. It is most common among adolescents and young adults where it is seen in 15% to 20% of these populations. Onset usually occurs around age 13 or 14. These numbers are consistent globally.

It is equally common in males and females though females tend to use cutting while males typically use hitting or burning (none of which are associated with lethality). It is typically seen in those prone to self-directed negative emotions and self-criticism and “more common among people who report non heterosexual orientations (for example, homosexual, bisexual, and questioning).”

NSSI appears most commonly as a function to (temporarily) alleviate overwhelming negative emotion or as self-punishment. Feelings of calm and relief are reported to follow events. Less commonly, is NSSI used to influence other people or obtain sympathy/attention though this is the “conventional wisdom” that haunts this practice. Surprisingly, NSSI most often occurs in the absence of any suicidal ideation. But

Over time NSSI is highly associated with future suicide attempts. It is thought that the NSSI events ease the fear of the pain associated with possible death. So, bottom line,

  1. Listen closely to expressions of
    1. negative self-valuation,
    2. concerns about sexual/gender identity,
    3. emotional dysregulation,
    4. depression,
    5. anxiety
    6. suicidal ideation
  2. Consider it an emergency any time you find a convergence of suicidal ideation and cutting, burning, or hitting the self.
  3. Until then, keep any psychiatrist or therapist informed of any NSSI you suspect/know about/hear about.
  4. Trust that it is unlikely that the NSSI is intended to manipulate you, get sympathy or attention. It is more likely to bring temporary relief from emotional pain.
  5. Be Curious. Be Patient. Offer a challenge to negative self-valuation and introduce authentic affirmations to the daily routine. Celebrate small victories.


  1. Check out the AZAFAP Event Calendar at https://azafap.gnosishosting.net/Events/Calendar.
  2. Our Friday night Happy Hour Chats and Tuesday afternoon Coffee Chats continue online. Some find me and a single other participant; others find a conversation among 4 to 6 people. The topics range from the silly to what hobbies have us in their grip to what life has thrown in our path. If you ever find yourself wanting a bit of grown-up conversation, consider joining us (check your email for the unchanging link).
  3. Parent Mentor Partners: AZAFAP has trained volunteer parents as mentors who are ready to help support foster, kinship, and adoptive parents through one-to-one conversations. Interested? Fill out the form at https://www.azafap.org/family-support-services/
  4. The Caring for Caregivers project provides counseling sessions for those who do not have insurance to cover counseling services. Find the information and link at https://www.azafap.org/family-support-services/
  5. I encourage you to check out what Dr. Bruce Perry has to offer. Find his thoughts at https://www.pcaaz.org/wp-content/uploads/2019/07/B21-Insightful-Caregiving-Intimacy.pdf and at https://www.neurosequential.com.

Thanks for listening. Maintain yourself so you can be there reliably for others.