Non-suicidal self-injury (NSSI), also referred to as self-injury or self-harm, is the deliberate and direct destruction of one’s body tissue, without suicidal intent and not for body modification purposes. Therefore this definition does not include tattooing or piercing, and indirect injury such as substance abuse or eating disorders. Also, this type of self-injury is different than “self-injurious behaviors” (SIB) which are commonly seen among individuals with intellectual and developmental disabilities.

Self-injury methods

The most common methods of self-injury include cutting, burning, scratching, and bruising. These injuries can range in severity from minor to moderate. Self-injury can start at any age, but most people who self-injure start when they are teenagers. Many people who start self-injuring in their teens continue into adulthood, while others may start self-injuring as adults. Although any one at any age may begin to engage in self-injury, research shows that the most common age of onset for self-injury is early adolescence, more than half of young adults who have engaged in self-injury recall starting at this time, however slightly less than a quarter recall starting before age 12.

How common is it?

Although anyone at any age may begin to engage in NSSI, the most common age of onset for NSSI is early adolescence. Between 14 to 24% of adolescents and 4% of adults in the community report engaging in NSSI at least once in their life.

Research has shown that the most common reason for self-injury is to cope with difficult feelings (e.g., distress, anxiety, stress, sadness).

Some people self-injure to punish themselves if they feel they have done something wrong or if they are really hard on themselves.

Some people may self-injure to tell others how they feel (when it is hard to say it in words).

Some people may self-injure when they feel disconnected from others or even themselves; this is often to feel something when they feel very numb or say they feel nothing at all or to connect with others.

Others will self-injure to avoid acting on thoughts or urges related to suicide.

There are many reasons people self-injure. By talking to your partner, you can get a better sense of why he/she is self-injuring and what he/she is going through.

Sometimes it’s hard to tell if someone is self-injuring. For many people, self-injury is secretive; it is often hard for them to discuss it with anyone, even their partner. At times, this secrecy may even be a signal that something is wrong.

Another important sign to look for is a significant change in your partner’s mood or behavior. If you notice that your partner is withdrawing from you or others and feeling down for a prolonged period of time, there may be something going on.

Often, when people self-injure, they experience more distress and other negative moods (e.g., sadness, frustration); they also become more distant from those around them.

Here are a few other possible signs of self-injury that are important to be aware of:

1. Unexplained cuts, burns or bruises; these typically occur on the arms, legs and stomach.

2. Noticing that your partner seems to be having more accidents or clumsiness resulting in cuts, burns, or bruises than is characteristic of them.

3. Finding razors, sharps, knives or other items that may be used to self-injure.

4. Noticing that your partner is spending less time with you, friends, or family and is withdrawing from activities he/she used to enjoy.

5. Noticing that your partner is being careful not to expose certain body parts to you or others. Your partner may withdraw from physical intimacy (e.g., may not want to be touched, may put up a physical barrier) in order to hide scars, wounds, or bruises.

6. Noticing that your partner is removing him/herself from intensely emotional arguments or moments and returning a short while later much calmer and less intense than when he/she left. As with many other possible signs of self-injury, this is not a definite indicator (your partner may have another way of calming down, like meditation), but is something to keep in mind.

Finding out that your romantic partner is self-injuring can be very difficult. Common reactions include:

– Being very worried and concerned about your partner.

– It is common to feel conflicted about whether you should tell someone or keep it a secret. Remember, the best way to help your partner is to support him/her in seeking help. Sometimes this means telling someone else.

– Feeling helpless because you don’t know where to go or who to turn to.

– Feeling guilty that this is too much for you to deal with and then feeling worried or trapped that you can’t leave your partner. This is a very common reaction to have.

– Feelings of sadness about what your partner is going through and empathizing with his or her distress.

– Feeling that your partner is being manipulative or thinking your partner should just “get over it.”

– You may worry that you have done something to upset them and caused them to self-injure. It is important to realize that this is not your fault. You did not cause your partner to self-injure.

These are all VERY normal reactions to have.

Here are a few things that may be helpful when talking about self-injury with your partner:

1. Choose a good time to speak with your partner. It is best to talk privately in a place where you can both be comfortable and when you feel calm. Do not bring up the subject if either one of you is upset.

2. Be honest about your level of concern.

3. Be aware of your emotions. If you are very angry or upset, it may not be a good time to have this conversation. Having this conversation when you are calm will be important.

4. Start by telling your partner why you are concerned. Show them that you care and are not judging their actions, but want to support them.

5. Focus the conversation on your partner’s feelings and validating his/her feelings by listening without trying to problem solve or “fix the situation.“

6. Do not accuse, threaten (e.g., ”if you don’t stop self-injuring, I’ll break up with you”), or make demands of your partner.

7. Ask open-ended questions using a supportive and calm tone. Work with your partner to understand what he or she is going through.

8. If your partner chooses not to tell you about their self-injury, be understanding and do not make your partner feel guilty for hiding it from you. Disclosing self-injury and talking about it can be an incredibly difficult thing to do.

9. If your partner is receptive to the conversation, ask questions about self-injury (e.g., how long he/she has been doing it, how often, and why it is done, including how it makes them feel). This can help you to better understand what your partner is experiencing.

10. Continue to support your partner throughout his/her efforts to stop self-injuring and/or through treatment.

If your partner does not want to talk about self-injury, that’s okay. It can be difficult at first. Continue to let your partner know that he/she is not alone and that you are there to support him/her. Let your partner know that you are concerned and that you will be there to listen when they are ready.

1. Support your partner. Know that you cannot stop your partner from self-injuring, but that you can play an important role in supporting your partner as he/she gets treatment for self-injury.

2. Listen to what your partner says and validate how they feel. Recognize that self-injury is a sign that they’re in distress and need your support.

3. Help your partner map out a plan of action for seeking help. Talk about how you can help him/her seek treatment and/or who you can talk to (e.g., a parent, a social worker, psychologist, doctor).

4. If your partner is at immediate risk of hurting him or herself in a life-threatening way, take him/her to the hospital. If your partner is not at immediate risk, talk to your partner about the next steps and who you may tell about his/her self-injury. If your partner has already hurt him/herself and you are concerned about the injury, take him/her to the hospital to ensure that the injury is well cared for.

5. Give your partner space when he/she needs it and continue to respect your partner’s privacy.

6. Be there to act as a sounding board for your partner. Giving your partner the chance to discuss whatever is bothering them may help them to release negative emotions and feel better.

7. Have patience and be there to support your partner. There are often setbacks along the road to recovery. This is completely normal. Treatment will take time.

8. Remember your partner is much more than his/her self-injury. Make time to continue to do things together that you enjoy. Laugh and have fun together.

7. It is also important to take care of yourself in order to support your partner in his/her recovery. It hurts to see someone you care about in so much distress that they harm themselves. Don’t be afraid to seek support yourself, whether that be from friends, family, or professionals; as many friends and family members of those who self-injure do. This is a difficult time for your partner, and also a difficult time for you.

8. Learning about self-injury is also important; the more you know, the more you’ll be able to help your partner and support him or her in his/her recovery. We’ve outlined a few helpful resources below.

In every romantic relationship there is a give and take where both partners’ needs are important and met. Obviously, in difficult times one partner’s needs may become more pressing; however, this needs to be time limited. If you feel that your partner’s difficulties are the sole focus of your relationship it may to useful to seek counseling or other forms of professional support about your concerns.

A serious concern for some partners of those who self-injure is feeling unable to leave the relationship because of their worry about their partner. This is understandable. It is important to seek support from a mental health professional to provide guidance in how to end the relationship in the least harmful way.

Self-injury is not a life-sentence. People CAN and DO STOP self-injuring. However, the longer your friend self-injures, the more difficult it can be to stop. It is important to remember that stopping a behavior that has become a frequently used unhealthy coping strategy will take time and effort and having a supportive friend can be helpful.

As discussed above, people who self-injure do it in private and work very hard to keep it a secret. Some people who self-injure will tell one or two close friends or family members; often they will tell other self-injurers online. Other people who self-injure will talk to a professional (like a counsellor, psychologist or a doctor) about their self-injury.

It is important that people who self-injure receive helpful resources and, if they are open to it, professionals who can support them in their efforts to cope better. Mental health professionals (such as counsellors, social workers, psychologists and psychiatrists) are trained to help people learn healthier ways to cope, and can be helpful in supporting a friend who self-injures.

People who self-injure cannot be forced to stop. Sometimes people who self-injure do not want to stop self-injuring. Remember that self-injury serves a purpose and stopping can be difficult. When people who self-injure start learning healthy ways to cope, then they find stopping self-injury easier.

You cannot force your friend to stop self-injuring; with support, however, many people will choose to stop.

These resources are recommended for anyone who has self-injured who wants to learn more about it and learn more about recovery.

Books

Gratz, K.L., & Chapman, A.L. (2009). Freedom from self-harm: Overcoming self-injury with skills from DBT and other treatments. Oakland: New Harbringer.

Websites

Safe Alternatives (SAFE)

Self-injury Foundation

Cornell Research Program on Self-injury and Recovery

Recover Your Life