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Cutting to Escape From Emotional Pain?

An introduction to self-injury.

Source: Lopolo/Shutterstock

Why on earth would someone purposely want to cut his or herself? As odd as this might seem to many of us, non-suicidal self-injury (NSSI), such as cutting, burning, or intensely scratching oneself without suicidal intent, is a major problem that most people don't know much about.

We may not hear much about NSSI in the news, because it is sort of a taboo subject. Yet, despite how taboo it may seem, it is actually quite common—especially for girls in high school and college. Current estimates suggest that approximately 4 percent or more of the population self-injure, and as high as 14 percent of adolescents may do so.

NSSI can often lead to emergency room visits due to severe injuries, and these injuries can cause permanent nerve damage for some. Given all of this, you would think that more people would pay attention to the growing public health concerns of NSSI!

So why would someone ever want to purposely inflict pain or injury on his or herself? Studies conducted by Nock and Prinstein (2004, 2005) suggest that there are four primary reasons for engaging in NSSI:

1. To reduce negative emotions

2. To feel "something" besides numbness or emptiness

3. To avoid certain social situations

4. To receive social support

Although instances of all of these reasons for NSSI occur, a common misconception is that NSSI is primarily a form of social manipulation. In reality, a number of studies have found that the primary reason for NSSI is reason number one: to reduce negative emotion.

This seems like such a bizarre reason! How is it that inflicting physical pain or injury could be used to deal with emotional pain? Despite how paradoxical this may seem, people most often report the following reasons for NSSI: to stop bad feelings, to relieve feelings of aloneness, emptiness, or isolation, to distract from other problems, to decrease feelings of rage, to release tension, and to control racing thoughts.

I bring up the topic of NSSI on my blog, Overcoming Self-Sabotage, because self-injury can be used as a maladaptive approach to stress, similar to the way that many people use alcohol or drugs to help them "forget" about their problems for a little while. Similarly, many people who self-injure do so to cope with stressful situations or upsetting problems with other people. However, this usually backfires and thus causes more problems.

Many come to view self-injury as their only way of dealing with problems and become dependent on it. The effects of NSSI can start to wear off over time, resulting in the need for more frequent and more severe injuries to get the same effect. Those who self-injure often have trouble with other areas of their lives, such as school, work, and relationships.

The worst thing of all about NSSI is that it is strongly connected to later suicide attempts and death by suicide. This outcome alone is a great reason for concern! Given all of the problems that can arise from self-injury, and the fact that it is often used as a way of coping with emotional pain, it is without a doubt "self-sabotage."

So how is it that self-injury works as a coping tool? Currently, we do have some understanding of why it can help people deal with negative emotion.

As one way of understanding it, I will discuss a model suggested by Chapman and colleagues (2006), who have proposed the Experiential Avoidance Model of self-injury. This model suggests that, because of things like distraction, self-punishment, and release of endorphins, self-injury may help people avoid feeling negative emotion.

These individuals may find upsetting emotions to be too difficult to handle, or they may be generally opposed to experiencing any negative emotion at all, and thus NSSI may be a way for helping them avoid the emotional experience. Because NSSI helps individuals avoid and escape negative emotion, it may then become rewarding and more "addictive" in a repetitive cycle. Thus, when upset, the natural instinct may become to self-injure.

In this post, I have only touched the tip of the iceberg on NSSI research. Fortunately, new and exciting findings on this topic are being generated on a regular basis. Although I will write about the treatment of NSSI in future posts, this current post is just meant to provide a general understanding of NSSI.

I will leave you with this final note, however. Many who self-injure are reluctant to give up doing so, because it is such a powerful way to relieve negative emotion. For them, it is a primary tool for dealing with stress and upsetting situations, and they feel like they will be helpless without it. Yet, study after study shows that NSSI causes more problems than it solves over time, and it can potentially lead to a tragic end: suicide.

Thus, if you self-injure, I encourage you to seek professional help and strive to find a new tool for coping, because this one will only lead to more suffering. NSSI truly is a "false friend."

More from Edward A. Selby Ph.D.
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