March is Self-Harm Awareness Month, a vital time for us to lean into the complexities of Non-Suicidal Self-Injury (NSSI). To provide the best care, we must first shift our perspective: while we see the injury as the problem, our clients and loved ones often see it as their only available solution.
What Is NSSI?
NSSI refers to the deliberate damaging of one’s own body without suicidal intent. While cutting is the most commonly discussed form, self-harm manifests in many ways, including burning, punching walls, head-banging, scratching, or skin picking.
The Function: Why Do People Self-Injure?
In the DBT world, we look at the function of the behavior. Approximately 80% of clients who self-injure do so to regulate intense emotions.
- Down-Regulating: For many, the act has a calming effect. The physical injury triggers a release of endorphins that quiet emotional storms.
- Up-Regulating: For those feeling “numb” or dissociated, self-injury is a way to feel something—bringing them back to reality.
- A Tool for Survival: Surprisingly, some clients use NSSI as a suicide prevention tool, using the pain to avoid acting on suicidal urges. Others use it as a form of self-validation: “If I am hurt this badly, my internal pain must be real.”
The Adolescent Landscape
Self-injury often begins between the ages of 9 and 15. While about 40% of adolescents stop within a year, many carry the behavior into adulthood. Because NSSI provides immediate—albeit temporary—relief, simply asking a teen to “just stop” (or using punishment) is rarely effective. Without alternative coping skills, they are being asked to give up their only life raft in a high-conflict sea.
The Path to a Life Worth Living
Dialectical Behavior Therapy (DBT) remains the gold standard for treating NSSI. While self-injury is a short-term fix for misery, it doesn’t solve the long-term problems that cause the pain. DBT provides the “skills behind the thrills,” helping clients build a life where self-harm is no longer a necessary tool.
7 Ways to Honor Self-Harm Awareness Month
How can we, as a clinical community, move the needle this month?
- Educate: Inquire about specialized training. Our webinar, “Understanding Self-Injury” with Dr. Michael Hollander, is a great place to start. Many great webinars are for rent on the DBT-LBC website.
- Advocate: Host info sessions for colleagues or the community on recognizing warning signs.
- Audit: For clinicians, review your screening protocols to ensure every patient is appropriately assessed.
- Validate: Cultivate a non-judgmental environment where clients can speak freely without fear of stigma.
- Connect: Keep a list of helplines and crisis text services ready for families. Find our resource list here.
- Partner: Work with local schools or advocacy groups to expand awareness.
- Reflect: Practice self-care. NSSI behaviors are emotionally taxing for clinicians, parents, and caregivers; ensure you are seeking your own consultation and community for support.
Remember, our commitment to understanding NSSI shouldn’t end when the month does. Consistent, compassionate attention is what ultimately changes outcomes for our clients.