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Deliberately hurting oneself is among those human behaviors that seem baffling and counter-intuitive from the outside. A student who parties, gets depressed, and ends up cutting himself may fear that his peers just wouldn’t get it. A student who realizes that a friend pulls out her own hair may have no idea how to help. While most students don’t deliberately harm or injure themselves, it’s certainly something that’s happening, studies show.
“Self-injury tends to go through jags,” says Dr. Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery at Cornell University, New York. “It’s not uncommon for someone to not injure for a year and then start again in [school] when they get triggered by a variety of stressors—everything from academic to romantic problems.” Understanding self-injury can help clue us in to the complexities of our own and others’ experience, and lead us to healthy ways to handle the stresses of being a student, however they manifest.
What is self-injury?
When people intentionally cause harm, pain, or damage to their own body, without the intent to die, it’s called non-suicidal self-injury (or self-harm). We tend to think of self-injury as cutting. In reality, it can be any type of behavior that intentionally causes tissue damage to the body, so it could involve burning, pulling out hair, or some acts of externalized aggression, such as punching walls. Self-injury may happen under the influence of drugs or alcohol (though using alcohol or drugs isn’t itself considered self-injury). Self-injury is different from suicidal self-harm, which is motivated by the intent to die and includes suicidal thinking. That said, people who self-injure are more likely than others to consider suicide (see: What raises the risk for self-injury?).
- Self-injury isn’t necessarily used as a way to get attention from others. However, some people may self-injure because they haven’t yet learned how to ask for what they need in healthier ways. If someone needs attention, take it seriously.
- Self-injury may co-occur with other issues, such as depression or anxiety, but it is not itself a disorder, diagnosis, or disease. Self-injury is a symptom.
- Eating disorders, such as anorexia or bulimia nervosa, are different from self-injury, though people with eating disorders are at higher risk of self-injury compared to the general population, according to a 2015 meta-analysis by the Cornell Research Program on Self-Injury and Recovery.
- Tattoos and piercings aren’t considered self-injury, unless someone is seeking out pain as a substitute for healthier ways to handle distress.
- Heavy drinking or drug abuse isn’t technically a form of self-injury, though the behaviors are often related. A 2011 study in the Journal of American College Health found that almost one in five students who self-injured did so when under the influence of alcohol or other substances.
- Self-injury isn’t the same as BDSM, erotic practices that involve submission and dominance, which may include consensual behaviors that cause physical pain. Self-injury is about seeking emotional release, while consensual BDSM practices are about sexual pleasure.
- Self-injury may be a means by which some people feel more in control of how and when they experience pain.
Why do some people self-injure?
Self-injury can happen as a result of not being able to cope with certain stressors or emotions. “The behavior is seen a lot in [students] because the pressures during this timeframe—like grades, relationships, and jobs—increase,” says Dr. Retta Evans, associate professor of Community Health and Human Services at the University of Alabama at Birmingham.
Self-injury is more common in those who are also experiencing depression or anxiety, sexual abuse or trauma, eating disorders, or substance abuse. People who are LGBTQ are also at relatively high risk, perhaps because of the stress of social judgment. “Self-harm was an outlet for the internal turmoil—the physical pain was much more bearable than the anxiety I was going through alone,” says a first-year graduate student at the University of Delaware.
People self-injure for a variety of reasons. Sometimes those reasons evolve over time. In our survey, many students referred to self-injury as a temporary behavior that they had managed to move past. “As a child, I was sexually abused by an uncle. I started [self-injuring] the third year it [was] happening. But with time [and through] hearing other stories, I began to accept that it wasn’t my fault. The more I talk about it, the more I’m beginning to have self-confidence,” said a second-year student at Indiana Institute of Technology.
These are among the most common reasons for self-injuring:
1 To experience emotions differently
“Self-injury normally happens for me because emotional sadness is so strong and I want to have a way to physically see and feel the pain.”
—First-year graduate student, University of Memphis, Tennessee
2 To “take away” or escape from unwanted feelings or thoughts
“Self-injury to me meant an escape from emotional pain that I did not understand and did not want my family to see. It happened because I did not want to be seen as weak in my family’s eyes; I was supposed to be a role model.”
—Fourth-year student, Dominican University, California
3 To bring recognition to their problems
“Sometimes emotions are just too much to handle, and you feel as though no one can understand what you’re trying to convey. And so this frustration becomes too much, and you lash out.”
—Third-year graduate student, Emory University School of Law, Georgia
4 To avoid taking anger out on someone else
“I got so angry that I hurt myself because I couldn’t hurt the other person. I’m a nice person, but when people do mean things toward me, I hurt myself instead. It’s the only way I can vent.”
—Fourth-year graduate student, Berea College, Kentucky
5 To punish yourself or help you deal with a failure
“To me, it meant an outlet for what I was feeling—or not feeling. I self-injured as a form of self-criticism or punishment. When I messed up, I thought I deserved it.”
—Second-year graduate student, Texas Christian University
6 To continue the habit
“Self-injury was a form of punishing myself for perceived ‘stupidity’ when it began. But it’s currently a compulsion when I experience severe frustration or stress.”
—Second-year graduate student, University of Rhode Island
What raises the risk for self-injury?
- Most people who self-injure start in their early to mid-teens, according to the Cornell Research Program on Self-Injury and Recovery.
- However, two studies found that close to 40 percent of participants who self-injured first did so at age 17 or later (Journal of Mental Health Counseling, 2008).
- Most self-injurers (80 percent) stop within five years, research shows.
2 Depression and anxiety
- In a 2009 study, participants with depression, anxiety, and perfectionist personality traits were significantly more vulnerable to self-injury, according to Suicide and Life-Threatening Behavior.
- People who self-injure are more likely than others to consider or attempt suicide, research suggests. This may be because “people who have practice hurting their bodies may find it easier to hurt themselves lethally,” researchers say (Cornell Research Program on Self-Injury and Recovery website).
3 Child abuse and trauma
- Adolescents who had been abused as children were significantly more likely to self-injure than their peers who had not been abused—especially if they had been abused by more than one individual, a 2015 study in the journal PLOS One found.
- Even exposure to childhood abuse—for example, witnessing a sibling being abused—increases the later risk of self-harm, the researchers found.
4 Eating disorders
- A large cohort of people who self-injure—54–61 percent—also have some form of eating disorder, such as anorexia or bulimia, according to a 2007 meta-analysis in Suicide and Life-Threatening Behavior.
- Bulimia is more likely than other eating disorders to co-occur with self-injury, according to the Journal of Adolescent Health (2011).
- Women with eating disorders are more likely to also self-injure than men with eating disorders, according to the same study.
5 Substance abuse
- Drug use and frequent heavy drinking are associated with higher rates of self-injury, according to a 2010 study of almost 6,000 students in the Journal of Addictive Behaviors.
- The researchers also found that self-injurers who used drugs were more depressed (another risk factor for self-injury) than those who didn’t use drugs.
6 Minority sexual or gender identity
- Lesbian and gay adolescents are over twice as likely to self-injure as their heterosexual peers, according to a 2011 study in the Journal of American College Health.
- People who identify as bisexual have the highest rates of self-injury. The same study found that bisexual adolescents were over three times as likely to self-injure as their heterosexual peers.
- The higher rates of self-injury among the LGB community may be due to societal judgment about their identity, the stress of coming out, and the lack of belonging (especially among those who identify as bisexual), the researchers speculated.
- Self-injury is relatively common among trans youths, especially those with higher levels of transphobia (conflict about their own identity) and interpersonal tensions, according to the Journal of Sexual Medicine (2016).
Most people who self-injure start as teens—but self-injury isn’t a problem that goes away when they graduate high school. It can continue into adulthood, restart when pressure builds, or begin later, experts say. “It’s very episodic, for a lot a people,” says Dr. Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery at Cornell University, New York.
People don’t talk much about self-injuring, so it’s hard to know how commonly it happens. In a 2011 study, 15 percent of students said they had self-injured at some point, and 7 percent had in the past year (Journal of American College Health), though estimates vary. In surveys, more women tend to report self-injury than men. On campuses, however, women and men may self-injure at similar rates. Most people who self-injure don’t seek support, research shows.
Research is currently mixed on this issue. Girls and women seem to self-injure more commonly than boys and men do. But some studies suggest that during young adulthood, men and women may self-injure at similar rates. For example, the 2011 study of college students found that women were more likely than men to report that they had ever self-injured, but women and men were equally likely to say they had self-injured within the past year (Journal of American College Health). (The student comments in this article come from men and women.)
Researchers have two main theories that may help explain the perceived gender differences in self-injury:
- Women are more likely to speak up about self-injury; perhaps societal gender stereotypes make it easier for women than men to talk about emotional health issues.
- Men’s self-harming behavior may be brushed aside as “typical male aggression.”
“In some ways, men are better at hiding it than women [perhaps due to traditional gender roles]. If we see wounds on a guy’s knuckles we [might] assume he’s been working on a car or in a fight,” says Dr. Whitlock. “To an outsider, it looks like they’re trying to cause someone else pain, but the underlying motivation is often to cause themselves pain. For women, the telltale cuts on arms or ankles might be more obvious.”
“My self-injury involved punching walls and seeking out fights to vent anger and frustration. Usually under the influence of alcohol.”
—Fifth-year student (male), University of New Brunswick
“For many years I cut my thighs. They are horribly scarred now. I chose my thighs because I was embarrassed and didn’t want it to be obvious. I did it to cope and calm down because it always cleared my head. I was in a dark place, but I hid it from my friends and family—just like the scars.”
—Fourth-year online student (female), University of New Brunswick
How to help yourself or a friend who self-injures
Usually, when people learn how to cope with their emotions and talk about how they feel, they experience less of an urge to hurt themselves. Simple techniques and skills can decrease the intensity of emotions and make them more manageable. “Finding a different outlet [for distress] was the key to my recovery,” says a second-year student at SAIT Polytechnic, Alberta. These three approaches can help you or a friend:
1 Reach out and talk
If you’re self-injuring, reach out. Talk to a friend, your partner, mentor, professor, member of your religious community, or member of your support group (in person or online). Ask for their support, and spend time with people who make you feel good.
If you’re concerned that someone else may be self-injuring, check in with them. “Let [them] know you care,” says Dr. Lance Swenson, associate professor in psychology at Suffolk University, Massachusetts. “Remind your friend you’re there to listen. Tell them you can help them get help. Most people who self-injure aren’t consciously aware of why they’re [doing it], at least not in the moment.” Seek out support for yourself too, so that you’re in a strong position to be there for your friend.
“Let [them] know you care,” says Dr. Lance Swenson, an associate professor in the psychology department at Suffolk University, Massachusetts. “Remind your friend you are there to listen. Tell them you can help them get help. Most people who self-injure are not consciously aware of why they’re [doing it], at least not in the moment. They shouldn’t feel like they have to face it alone.”
That said, it’s not on you to solve this. “The roots of self-injurious behavior are likely very complicated. No matter how much you care about a [person], and how hard you try to help, they may continue this behavior despite your best efforts to help them,” says Dr. Davis Smith, a physician at the University of Connecticut.
How to talk to someone you are concerned about:
- Ask straightforward, direct questions in a calm manner, such as, “Are you thinking about hurting yourself?”
- Actively listen—focus on what they’re saying—then offer support.
- Take your loved ones seriously. If your friend mentions any thoughts about suicide, especially a plan or method, call 911 or speak to a dean or counselor at your school or in your community.
- Encourage your friend to talk to a trusted mentor, professor, coach, or member of their religious community; be there for them, but do not take on the full burden yourself.
- Encourage them to consider seeking help from a licensed mental health professional (for example, a psychologist, social worker, or counselor—ask your health care provider or at counseling services at your school or in your community).
2 Test coping strategies and figure out what works
If you’re concerned about a friend, you may be able to help them explore these techniques. If you’re self-injuring, test these strategies and take note of what helps. “Distress tolerance skills” can be used in place of self-injury. See Get help or find out more (below) for more info.
1 Do the opposite of what you feel:
For example, listen to your favorite upbeat song, or watch a funny YouTube video. Look in the mirror and smile—watch as your expression changes.
2 Exercise hard and fast:
Do 25 jumping jacks, go for a jog, or dance around the room. Research shows that cardio exercise can reduce your stress and improve your mood. Regular physical activity can be protective.
3 Use your five senses:
This helps you connect with what is going on around you and anchor yourself in the present moment. For example, sink your heels into the floor or ground and focus on how it feels beneath your body. Hold something soft or fuzzy. Squeeze a stress ball. Place a cool, wet washcloth on your face. Light a scented candle and breathe in deeply. Cook and/or eat your favorite food and really allow yourself to enjoy the flavor. Go for a walk or drive and take in the sights and smells. Take ice from the freezer and hold it tightly in your hand. Get into warm water (take a shower or bath).
4 Take slow, deep breaths:
Imagine you’re blowing up a balloon. When you inhale deeply, your lower belly should expand. Count to three on each inhale and each exhale.
5 Think about your emotions:
Face them instead of pushing them away. Labeling an emotion (e.g., “My heart is racing and I’m feeling anxious”) can often help you figure out why you’re feeling that way (e.g., “I have a big presentation coming up next week and I’m anxious about preparing for it”). Write down how you’re feeling in a notebook or journal.
6 Focus on your heart:
Put your hand on your heart so you can feel your heartbeat and count the beats per minute. Try to slow down your heart rate by taking slow, deep breaths.
7 Actively cherish what you have:
Look at pictures on your phone or computer that make you smile. Make a list of all of the things you’re grateful for or happy about in your life.
8 Actively cherish who you are:
Make a list of your accomplishments—e.g., “I’m an amazing researcher,” “I’m a caring daughter,” “I take excellent care of my dog.”
9 Sink into something else:
Read a book, story, or article. Listen to your favorite music, play an instrument, or sing (even if you have no musical talent!). Engage in your favorite hobby or master a skill, such as gardening, cooking, baking, playing a video game, knitting, painting, or drawing.
10 Prioritize sleep:
Get up as close to the same time every day as possible; this will help you go to bed at a more regular time too. Your bed is for sleeping only (no electronics or social networking). Relish it.
3 Consider seeking professional support
Checking in with a counselor can relieve some of the pressure and help you find strategies and resources you wouldn’t otherwise know about—whether it’s you who’s self-injuring or your friend. Your healthcare provider or a counselor at your school or in your community may be able to help directly or refer you to an expert. Certain therapeutic techniques—such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT)—are designed to build healthy coping skills directly. If you ever feel suicidal, call 911, go to the nearest emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-8255.
“I used to self-harm back when I was dealing with a lot. I eventually sought out counseling—and it was the best decision I’ve made,” says a first-year graduate student at the University of New Hampshire. “I’m so much happier and healthier, and can better manage my stressors and issues now that I’ve talked through the things that cause them to happen.”
Find out here Second-year undergraduate, Elgin Community College, Illinois “Calm Harm is a self-help tool, based on dialectical behavioral therapy, that helps users prevent self-harm the moment when urges arise. The app is based on the idea of “riding the wave” of emotional stress past its peak, until things get a little bit easier.” USEFUL? FUN? EFFECTIVE?
Calm Harm provides ways you can blow off some steam—anytime, anywhere. Whether I need comfort, a distraction, to express my feelings, or a way to release, the app lists dozens of strategies.
You’re able to review some of the recommended activities, which was fun. That way, you can test out a few to try before the time comes when you use it for real, because scanning through impractical solutions will lead to frustration and discouragement.
Remembering to take advantage of the app takes some practice. It’s almost like I needed an app to remind me to use Calm Harm.
Second-year undergraduate, Elgin Community College, Illinois
“Calm Harm is a self-help tool, based on dialectical behavioral therapy, that helps users prevent self-harm the moment when urges arise. The app is based on the idea of “riding the wave” of emotional stress past its peak, until things get a little bit easier.”
Retta R. Evans, PhD, MCHES, associate professor, program coordinator, Community Health & Human Services, University of Alabama at Birmingham.
Michelle M. Seliner, MSW, LCSW, chief operating officer, S.A.F.E. Alternatives.
Lance P. Swenson, PhD, associate professor, Suffolk University, Boston, Massachusetts.
Janis Whitlock, PhD., director, Cornell Research Center on Self-Injury and Recovery, Cornell University, New York.
Andover, M. S., Morris, B. W., Wren, A., & Bruzzese, M. E. (2012). The co-occurrence of non-suicidal self-injury among adolescents: Distinguishing risk factors and psychosocial correlates. Child and Adolescent Psychiatry and Mental Health, 6, 11–17. doi: 10.1186/1753-2000-6-11
Arcelus, J., Claes, L., Witcomb, G. L., Marshall, E., et al. (2016). Risk factors for non-suicidal self-injury among trans youth. Journal of Sexual Medicine, 13(3), 402–412.
Batejan, K. L., Jarvi, S. M., & Swenson, L. P. (2015). Relations between sexual orientation and non-suicidal self-injury: A meta-analytic review. Archives of Suicide Research, 19(2), 131–150. doi: 10.1080/13811118.2014.957450
Cornell Research Program on Self-Injury and Recovery. (n.d.). Self-injury. Retrieved from http://www.selfinjury.bctr.cornell.edu/perch/resources/siinfo-2.pdf
Ernhout, C., Babington, P., & Childs, M. (2015). What’s the relationship? Non-suicidal self-injury and eating disorders. The Information Brief Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY.
Favazza, A. (1987). Bodies under siege: Self-mutilation in culture and psychiatry. Baltimore, MD: Johns Hopkins University Press.
Heath, N. L., Toste, J. R., Nedecheva, T., & Charlebois, A. (2008). An examination of non-suicidal self-injury among college students. Journal of Mental Health Counseling, 30(2), 137–156.
Hoff, E. R., & Muehlenkamp, J. J. (2009). Nonsuicidal self-injury in college students: The role of perfectionism and rumination. Suicide and Life Threatening Behavior, 39(6), 576–587.
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11, 129–147.
Jacobson, C. M., Muehlenkamp, J. J., Miller, A., & Turner, J. B. (2008). Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. Journal of Clinical Child & Adolescent Psychology, 37(2), 363–375.
Linehan, M. M. (2014). Dialectical behavioral therapy skills training manual: Second edition. New York, NY: Guilford Press.
Lloyd-Richardson, E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192.
Nock, M., Joiner Jr., T., Gordon, K., Lloyd-Richardson, E. E., et al. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72.
Nock, M., & Prinstein, M. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Counseling and Clinical Psychology, 72(5), 885–890.
Nock M., & Prinstein, M. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114(1), 140–146.
Nock, M., Prinstein, M., & Sterba, S. (2009). Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults. Journal of Abnormal Psychology, 118(4), 816–827.
Peebles, R., Wilson, J. L., & Lock, J. D. (2011). Self-injury in adolescents with eating disorders: Correlates and provider bias. Journal of Adolescent Health, 48(3), 310–313.
Serras, A., Saules, K. K., Cranford, J. A., & Eisenberg, D. (2010). Self-injury, substance use, and associated risk factors in a multi-campus probability sample of college students. Psychology of Addictive Behaviors, 24(1), 119–128.
Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disorders: The extent and nature of the association. Suicide and Life Threatening Behavior, 37(4), 409–421.
Swannell, S. V., Martin, G. E., Page, A., Hasking, P., et al. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis, and meta-regression. Suicide and Life Threatening Behavior, 44(3), 273–303.
Sweet, M., & Whitlock, J. (2010). Therapy: Myths & misconceptions. Cornell Research Program Self-Injury and Recovery. Retrieved from http://www.selfinjury.bctr.cornell.edu/perch/resources/therapy-myths-and-misconceptions-pm.pdf
Whitlock, J. L., & Selekman, M. (2014). Non-suicidal self-injury (NSSI) across the lifespan. In Oxford Handbook of Suicide and Self-Injury, edited by M. Nock. Oxford Library of Psychology, Oxford University Press.
Whitlock, J. L., Muehlenkamp, J., Purington, A., Eckenrode, J., et al. (2011). Nonsuicidal self-injury in a college population: General trends and sex differences. Journal of American College Health, 59(8), 691–698.
Yates, T., Carlson, E., & Egeland, B. (2008). A prospective study of child maltreatment and self-injurious behavior in a community sample. Development and Psychopathology, 20(2), 651–671.