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Deliberately hurting oneself is among those human behaviours 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 university and college students do not deliberately harm or injure themselves, it’s certainly happening on campuses, studies show.
“Self-injury can come and go,” says Dr. Stephen Lewis, Associate Professor of Psychology at the University of Guelph, Ontario, and Co-founder and Co-developer of Self-injury Outreach & Support (SiOS), an online outreach initiative for those who self-injure. “For some students, it may occur in response to particular stressors or triggers versus happening all the time; some students may self-injure in response to very intense distress or particular life events.” 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 school, 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 behaviour 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 is not 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 is not 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 are not considered self-injury, unless someone is seeking out pain as a substitute for healthier ways to handle distress.
- Heavy drinking or drug abuse is not technically a form of self-injury, though the behaviours 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 is not the same as BDSM, erotic practices that involve submission and dominance, which may include consensual behaviours 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. “Entering college coincides with a number of developmental changes that occur in adolescence, such as gaining autonomy from parents or increased reliance on peers,” says Dr. Michèle Preyde, Associate Professor of Family Relations and Applied Nutrition at the University of Guelph, Ontario. “Taken together, this time period can be a significant and stressful change.”
Self-injury is more common in young adults 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-injury was a way to release inner pain that I didn’t know how to talk about,” says a third-year undergraduate at St. Clair College, Ontario.
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 behaviour that they had managed to move past. “I didn’t stop [self-injuring] until I began seeing a psychologist—we never explicitly talked about my [self-injuring], because I was too embarrassed, but developing other healthy mechanisms helped me move past it on my own,” said a third-year undergraduate at the University of Waterloo, Ontario.
These are among the most common reasons for self-injuring:
1 To experience emotions differently
“For me, self-harm was a way to cope when I was upset. The physical pain distracted me from the emotional pain. Finding a different outlet was the key to my recovery.”
—Second-year undergraduate, Southern Alberta Institute of Technology
2 To “take away” or escape from unwanted feelings or thoughts
“It’s an escape from whatever painful experience I was facing—a temporary escape from reality and an ability to lose yourself in the grasp of pain.”
—Second-year undergraduate, Southern Alberta Institute of Technology
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 am 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
“In my experience, self-harm tends to be an extreme form of self-criticism and that I deserve to be hurt—to restrict or to engage in harmful behaviour—because I deserve the results for being a failure.”
—Second-year student, University of Victoria, British Columbia
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
- 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.
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).
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
- Even exposure to childhood abuse—for example, witnessing a sibling being abused—increases the later risk of self-harm, the researchers found.
- 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.
- 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.
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.
- 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 is not a problem that goes away when they graduate high school. It can continue into post-secondary, restart when pressure builds, or begin later, experts say. “It’s not uncommon for self-injury to be episodic in nature,” says Dr. Stephen Lewis, Associate Professor of Psychology at the University of Guelph, Ontario, and co-founder and co-developer of Self-injury Outreach & Support (SiOS), an outreach initiative for those who self-injure.
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 college 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 (see next page). 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 behaviour 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. Janis Whitlock, Director of the Cornell Research Program on Self-Injury and Recovery at Cornell University, New York. “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.”
self-injury involved punching walls and seeking out fights to vent anger and frustration. Usually under the influence of alcohol.”
—Fifth-year undergraduate (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 undergraduate (female), University of New Brunswick
How to help yourself or a friend who self-injures
Usually, when people learn alternate ways 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 undergraduate at Southern Alberta Institute of Technology. These three approaches can help you or a friend:
1 Reach out and talk
If you are self-injuring, reach out. Talk to a friend, mentor, RA, 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 your friend know you care and are ready to listen,” says Dr. Preyde. Seek out support for them as well as yourself, so that you’re in a strong position to be there for your friend.
“Go into it with a sense of ‘respectful curiosity,’” says Dr. Mary K. Nixon, Clinical Associate Professor of Psychiatry at the University of British Columbia and former network leader for the Interdisciplinary National Self-Injury in Youth Network of Canada (INSYNC), a research collaboration on self-injury. “Remind them that you care, but listen to them and get a sense of how comfortable or not they feel, and if they’d like your help and support. Being nonjudgmental is key.”
That said, it’s not on you to solve this. “It’s not [your] responsibility to fix things or to make them stop,” says Dr. Lewis. “Sometimes, it’s hard to understand why a friend self-injures or what to do or say, so it’s most important to carefully listen to what they have to say.”
How to talk to a friend 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 friend seriously. If your friend mentions any thoughts about suicide, especially a plan or method, call 911 or speak to a trusted faculty or staff member or campus counsellor.
- Encourage your friend to talk to a trusted mentor, RA, professor, coach, or member of their religious community; be there for them, but do not take on the full burden yourself.
- Encourage your friend to consider seeking help from a licensed mental health professional (for example, a psychologist, social worker, or counsellor—ask at your campus health centre or counselling centre).
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 favourite 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 favourite food and really allow yourself to enjoy the flavour. 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 are 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. Labelling 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 exam coming up next week and I’m anxious about studying 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 are grateful for or happy about in your life.
8 Actively cherish who you are:
Make a list of your accomplishments—e.g., “I do pretty well in school,” “I am a caring friend,” “I take excellent care of my dog.”
9 Sink into something else:
Read a book, story, or article. Listen to your favourite music, play an instrument, or sing (even if you have no musical talent!). Engage in your favourite 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 counsellor 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 student health centre or counselling centre may be able to help directly or refer you to an expert. Certain therapeutic techniques—such as cognitive behavioural therapy (CBT) or dialectical behavioural therapy—are designed to build healthy coping skills directly. If you ever feel suicidal, call 911, go to the nearest emergency room, or contact a local suicide crisis centre.
“Physically cutting my body seemed like the only way to cope,” says a second-year undergraduate at the University of Victoria, British Columbia. “I [took] myself to the ER because I had experienced awareness about this issue working in outpatient programs. It’s okay to go ask for help.”
Find out here Fourth-year undergraduate, University of Windsor, Ontario “There isn’t anything worse than the feeling of being trapped within your own mind and emotions, thinking there’s no one who will understand what you’re feeling. With Calm Harm, it’s like having a confidante at the touch of a button. When you feel the urge to self-injure, you log into the app. We’ve all battled with our inner demons, but this app helps redirect it in a way that’s productive or comforting.” USEFUL? FUN? EFFECTIVE?
It can help someone going through self-harm, or even someone who might harm others, by providing an outlet or distraction until the feeling passes. You choose comfort, distraction, expression, or release.
The app is engaging, entertaining, and a good distraction for those moments when you need an escape from your thoughts and feelings.
When feeling sad, I chose a comforting activity. For more stressful times, I chose an activity to help me express my feelings or release built-up tension. The app also tracks when you log in and what activity you chose, which helped me better understand my ups and downs.
Fourth-year undergraduate, University of Windsor, Ontario
“There isn’t anything worse than the feeling of being trapped within your own mind and emotions, thinking there’s no one who will understand what you’re feeling. With Calm Harm, it’s like having a confidante at the touch of a button. When you feel the urge to self-injure, you log into the app. We’ve all battled with our inner demons, but this app helps redirect it in a way that’s productive or comforting.”
Stephen P. Lewis, PhD, Associate Professor of Pschiatry, University of Guelph, Ontario; co-founder and co-developer of Self-injury Outreach & Support (SiOS).
Mary K. Nixon, PhD, Clinical Associate Professor of Psychiatry, University of British Columbia; Affiliate Associate Professor, University of Victoria, British Columbia.
Michèle Preyde, PhD, Associate Professor of Family Relations and Applied Nutrition, University of Guelph, Ontario.
Michelle M. Seliner, MSW, LCSW, Chief Operating Officer, S.A.F.E. Alternatives.
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.