Search Results

2023 - 2024 Home / Collaborative Research Program / NSSI and other coping... Examining predictors of co-occurrence of NSSI with other potentially harmful coping behaviours Mentor/s: Briana Turner 2023 - 2024 Project Overview We collected prospective, monthly surveys from two cohorts of first year university students (n=704). A core aim of this study was to examine trajectories and co-occurrence of potentially harmful coping behaviours, including NSSI, during students’ first year of university. We administered a broad range of personality measures at baseline, in September (e.g., Ten Item Personality Inventory, BIS/BAS, Sensitivity to punishment and sensitivity to reward, UPPS-P impulsivity, DERS) as well as behavioral measures of decision-making. Subsequently, we collected information about participants’ mood, wellbeing, and engagement in various potentially harmful coping behaviours, namely NSSI, disordered eating, substance misuse, physical aggression, and financial risk-taking (compulsive shopping, gambling). Over the upcoming year, I intend to analyze co-occurrence of these behaviors over the year, as well as personality and behavioral predictors of distinct profiles of coping behaviors. I would welcome junior researchers to be involved in this project to refine skills in longitudinal data analysis. Application Deadline: June 11 2023 Apply Now Previous Next

Barent Walsh, PhD, author of "Treating Self-Injury: A Practical Guide" and Executive Director Emeritus and Senior Clinical Consultant at Open Sky Community Services in Worcester, MA, describes the forms, functions, and treatment of atypical, severe self-injury and self-harm. Season 1 | Episode 12 Podcast/ Season 1 | Episode 12 Atypical Severe Self-Injury May 7, 2021 with Dr. Barry Walsh Atypical Severe Self-Injury with Dr. Barry Walsh 00:00 / 01:04 When we talk about nonsuicidal self-injury (NSSI) in this podcast, we are typically referring to the most common forms of NSSI. But what about rarer, more significant forms of self-harm and self-harming behaviors that do not fit neatly within the typical definition of NSSI, like ingesting foreign objects to intentionally cause internal injury? And how do these forms of “Atypical Severe Self-Injury” differ in function and severity from more common forms of self-injury? In this episode, Dr. Barry Walsh details 3 specific forms of Atypical, Severe Self-Injury, explains their unique functions, and shares clinical guidelines for treating those who engage in Atypical, Severe Self-Injury. Learn more about Dr. Walsh and his work at Open Sky Community Services by visiting www.openskycs.org . Below are links to some of his research and publications referenced in this episode: Walsh, B. W. (2014). Treating self-injury: A practical guide (2nd ed.) . New York: Guilford. Walsh, B. W. (2019). Atypical, severe self-injury: How to understand and treat it. In J. J. Washburn (Ed.), Nonsuicidal self-injury: Advances in research and practice . New York: Routledge. Atypical and severe nonsuicidal self-injury as an indicator of severe psychopathology: Findings from a sample of high-risk community mental health clients (Hom et al., 2018) Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). Previous Next

Nani Kim, RN, at the University of Texas at Austin shares a review of research on help-seeking behaviors for self-injury and self-harm. Season 5 | Episode 63 Podcast/ Season 5 | Episode 63 Help-Seeking for Self-Injury Jul 25, 2025 with Nani Kim, RN Help-Seeking for Self-Injury with Nani Kim, RN 00:00 / 01:04 In this episode, Nani Kim, RN from the University of Texas at Austin talks all things help-seeking for nonsuicidal self-injury (NSSI). This includes common reasons people give for choosing to seek help for self-harm, common forms of help-seeking behavior for NSSI, how often individuals who self-injure seek help for their self-injury, why they choose to seek help, what types of help they receive, and what happens when they seek help for self-injury. Below are a few references from this episode: Kim, N., Young, C. C., Kim, B. R., Rew, L., & Westers, N. J. (in press). Help-seeking behaviors in adolescents and young adults who engage in nonsuicidal self-injury: An integrative review . Journal of Adolescent Health . Advance online publication (free to access through August 7, 2025). Nadler, A. (1987). Determinants of help seeking behaviour: The effects of helper’s similarity, task centrality and recipient’s self esteem . European Journal of Social Psychology, 17 (1), 57-67. Mackesy, C. (2019). The boy, the mole, the fox and the horse: Inspiring conversations on hope, love and personal growth . HarperOne. Previous Next

Ruth Tatnell, PhD, from Deakin University in Melbourne, Australia describes how the COVID-19 pandemic and first lockdown affected rates of self-injury and self-harm. Season 3 | Episode 33 Podcast/ Season 3 | Episode 33 Did Self-Injury Increase During the COVID-19 Lockdown? Jan 27, 2023 with Dr. Ruth Tatnell Did Self-Injury Increase During the COVID-19 Lockdown? with Dr. Ruth Tatnell 00:00 / 01:04 Early in the pandemic there was a lot of talk about how the initial lockdown and stay-at-home orders would affect people’s mental health, including risk for suicide and nonsuicidal self-injury (NSSI). In this episode, Dr. Ruth Tatnell answers questions about the pandemic's effects on rates of self-injury: Did the initial lockdown of the COVID-19 pandemic increase self-injury urges and behaviors like many people thought would happen? And do we know if self-harm has increased, decreased, or stayed the same since the first lockdown of the pandemic? Learn more about Dr. Tatnell and her work at Deakin University here , and connect with her on LinkedIn here . Below is her publication discussed in this month's episode as well as additional articles referenced in our interview: Tatnell, R., Terhaag, S., & Melvin, G. (2023). Covid-19 lockdown and non-suicidal self-injury: A Mixed methods analysis of NSSI during Australia's national lockdown . Archives of Suicide Research . Online ahead of print. Tanaka, T., & Okamoto, S. (2021). Increase in suicide following an initial decline during the COVID-19 pandemic in Japan . Nature Human Behaviour, 5 (2), 229–238. Read about the Harvard Happiness Study published in The Atlantic here . Read about the Cigna loneliness study here and their tips for addressing loneliness here . Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their " Best 20 Clinical Psychology Podcasts " and by Welp Magazine in their " 20 Best Injury Podcasts ." Previous Next

Kim Gratz, PhD, and Matthew Tull, PhD, from the University of Toledo walk us through Emotion Regulation Group Therapy (ERGT) intervention for nonsuicidal self-injury and self-harm. Season 3 | Episode 34 Podcast/ Season 3 | Episode 34 Emotion Regulation Group Therapy for Self-Harm Feb 24, 2023 with Dr. Kim Gratz and Dr. Matthew Tull Emotion Regulation Group Therapy for Self-Harm with Dr. Kim Gratz and Dr. Matthew Tull 00:00 / 01:04 A lot of therapies address the context in which nonsuicidal self-injury (NSSI) and self-harm may occur, but only a few treatments have been designed to address NSSI specifically. In this episode, we dive into one of these treatments: Emotion Regulation Group Therapy (ERGT). Drs. Kim Gratz and Matthew Tull from the University of Toledo in Ohio walk us through in significant detail each of the 90-minute 14 sessions of ERGT. Learn more about Dr. Gratz here and reach her at klgratz28@gmail.com . Learn more about Dr. Tull here and follow him on Twitter @MTTull . Learn more about the Personality and Emotion Research and Treatment (PERT) Laboratory within the Department of Psychology at the University of Toledo here , and follow the PERT Lab on Twitter @LabPert . Below are links to their research on ERGT referenced in this episode: Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with Borderline Personality Disorder . Behavior Therapy, 37 (1), 25-35. Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology . Personality Disorders: Theory, Research, and Treatment, 2 (4), 316–326. Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorde r. Psychological Medicine, 44 , 2099–2112. Gratz, K. L., Bardeen, J. R., Levy, R., Dixon-Gordon, K., L., & Tull, M. T. (2015). Mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder . Behaviour Research and Therapy, 65 , 29-35. Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjarehed, J., Jokinen, J., Lundh, L., Ljotsson, B., & Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: A multi-site evaluation in routine care using an uncontrolled open trial design . BMJ Open, 7 (10), e016220. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their " Best 20 Clinical Psychology Podcasts " and by Welp Magazine in their " 20 Best Injury Podcasts ." Previous Next

2023 - 2024 Home / Collaborative Research Program / Cognitive and emotional flexibility... Cognitive and emotional flexibility in youth with NSSI Mentor/s: Tina In-Albon 2023 - 2024 Project Overview The most common function of NSSI is emotion regulation. However, the differentiation between adaptive and maladaptive strategies is overly simplistic. More recent approaches focus on psychological flexibility, which is seen as an important determinant of mental health and well-being. More specifically, the present project will investigate behavioral, cognitive, and emotion regulation flexibility as well as its associations in youth with NSSI. Behavioral flexibility refers to the adaptive change of behavior in response to changing environmental contengenies. Cognitive flexibility, which refers to the ability to adapt responses/strategies based on environmental feedback. Emotion regulation flexibility refers according to Aldao et al. (2015) as “the degree of covariation between variation in the use of one or more emotional regulation strategies across a number of environments, while the environment might consist of external events or appraisals of emotional reactions to such events.” So, there are two core elements to emotional flexibility, sensitivity to situational demands and the ability to regulate emotions accordingly. Details will be discussed. Application Deadline: June 11 2023 Apply Now Previous Next

Jennifer Hughes, PhD, MPH, from the University of Texas Southwestern Medical Center, describes Dialectical Behavior Therapy (DBT) as an intervention for nonsuicidal self-injury and self-harm. Season 1 | Episode 19 Podcast/ Season 1 | Episode 19 Dialectical Behavior Therapy (DBT) for Self-Harm Nov 5, 2021 with Dr. Jenny Hughes Dialectical Behavior Therapy (DBT) for Self-Harm with Dr. Jenny Hughes 00:00 / 01:04 Dialectical Behavior Therapy (DBT) has been lauded as an evidence-based treatment for addressing suicidal and nonsuicidal thoughts and behaviors. In this episode, Dr. Jenny Hughes explains what DBT is, describes what "dialectical" means, and walks us through how each of the four modules of DBT can be used to address nonsuicidal self-injury and self-harm: (1) Emotion Regulation, (2) Distress Tolerance, (3) Interpersonal Effectiveness, and (4) Mindfulness. She also provides an update on the science behind DBT, including what aspects of the treatment are thought to be most effective in addressing self-injury. To learn more about DBT and opportunities for training in DBT as referenced in this episode, visit Behavioral Tech at https://behavioraltech.org/ . Learn more about Dr. Hughes' work at the University of Texas Southwestern Medical Center here , and follow her on Twitter at @DrJennyHughes . Watch her 2018 TEDx talk on Resilience: Growth Through Struggle at www.youtube.com/watch?v=Nr44v2__zrU . Below are links to some of her research on DBT among youth: Editorial: Dialectical Behavior Therapy and the Function of Self-Injury (2021) (1) Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial (2018) (2) Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions (2019) (3) Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators (2021). Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their " Top 15 Clinical Psychology Podcasts You Must Follow in 2021 " and by Welp Magazine in their " 20 Best Injury Podcasts of 2021 ." Previous Next

Allison from Washington State shares her story of lived experience of self-injury, scarring, and shame as well as how she makes sense of her self-harm scars in the context of her faith. Season 3 | Episode 42 Podcast/ Season 3 | Episode 42 Lived Experience: Allison's Story of Self-Injury & Scarring Oct 27, 2023 Lived Experience: Allison's Story of Self-Injury & Scarring 00:00 / 01:04 In this episode, Allison details her experience of engaging in nonsuicidal self-injury (NSSI) beginning in 9th grade and into her 20's. She explains the complex relationship she and many others have with their self-harm scars and discusses how her husband has supported her when she has self-injured. She also shares about how she makes sense of her scars in the context of her faith as a Christian. Read her To Write Love On Her Arms (TWLOHA) blog, "You are so much more than your pain," at https://twloha.com/blog/more-than-your-pain/ . Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS). The Psychology of Self-Injury podcast has been rated as one of the " 10 Best Self Harm Podcasts " and " 20 Best Clinical Psychology Podcasts " by Feedspot and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's " Best Mental Health Podcasts to Defy Stigma and Begin to Heal ." If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit. Previous Next

Sarah Victor, PhD, from Texas Tech University discusses the prevalence of self-injury among psychologists and psychology graduate students, how psychologists with and without lived experience of self-injury can appropriately provide therapy to clients and supervision to trainees with a history of self-injury, and how individuals with lived experience of self-injury can be involved in teaching and research on self-injury and self-harm. Season 1 | Episode 9 Podcast/ Season 1 | Episode 9 Psychologists with Lived Experience of Self-Injury Mar 26, 2021 with Dr. Sarah Victor Psychologists with Lived Experience of Self-Injury with Dr. Sarah Victor 00:00 / 01:04 How many psychologists have lived experience of nonsuicidal self-injury (NSSI)? What biases should mental health professionals with and without a history of self-injury keep in mind when treating or supervising someone who has lived experience? In this episode, Dr. Victor shares preliminary data that she has just begun analyzing regarding the prevalence rates of mental health difficulties and self-injury among psychologists and psychology graduate students. She provides guidance about how mental health professionals can provide appropriate care to therapy clients and supervision to trainees who have lived experience of self-injury and self-harm. She also discusses how individuals with lived experience can be involved in research and teaching. Learn more about Dr. Victor and her work in the Tracking Risk Over Time Lab (TRTL) at https://www.depts.ttu.edu/psy/people/svictor/ and her website at https://www.sarahevictor.com/ . Follow her on Twitter @sarahevictor . Below are links to some of her research and the resources referenced in this episode: Psychologists with lived experience of non-suicidal self-injury: Priorities, obstacles, and recommendations for inclusion (click here for the free version of the author's manuscript) LiveThroughThis.org Strategy for Patient-Oriented Research (Canadian Institutes of Health Research) Patient-Centered Outcomes Research Institute (PCORI) ClinicalTrials.gov Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). Previous Next

The International Society for the Study of Self-Injury's 17th Annual International Conference Held Online in 2022. 17th Annual Conference Home / Conferences/ 2022 June 22nd - 24th | Online Program The 2022 Annual International Conference was held online via Zoom, accessible to all paying ISSS members. The conference was packed with inspiring, compelling, and interesting talks from experts in the field from around the globe. View all conference content now!

Rachel Acheson, PhD, and Maria Papadima, PhD, from the Association of Child Psychotherapists in London describe how today's "adolescent crisis," including self-injury and self-harm, is often expressed through mental health language. Season 3 | Episode 39 Podcast/ Season 3 | Episode 39 Youth Crisis, Self-Harm, & Mental Health Language Jul 28, 2023 with Drs. Rachel Acheson & Maria Papadima Youth Crisis, Self-Harm, & Mental Health Language with Drs. Rachel Acheson & Maria Papadima 00:00 / 01:04 Amidst a global youth mental health crisis, is it possible that many young people are experiencing adolescent development challenges but are using mental health language to describe their distress? Even to the degree of experiencing crises that include self-harm like nonsuicidal self-injury and suicidal thoughts and behaviors? In this episode, Drs. Maria Papadima and Rachel Acheson share observations from their clinical work with youth, consider trends such as self-diagnosing through TikTok and Instagram, discuss how they walk parents and youth through these mental health crises, and offer a psychoanalytic perspective of current trends. Learn more about Dr. Papadima and her work at www.mariapapadima.com , and read her blog about "Self-diagnosis via TikTok" here . Below is the reference and link to their paper discussed in this episode: Acheson, R., & Papadima, M. (2023). The search for identity: Working therapeutically with adolescents in crisis . Journal of Child Psychotherapy, 49 (1), 95-119. Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). The Psychology of Self-Injury podcast has been rated #1 by Feedspot in their list of " 10 Best Self Harm Podcasts " and #5 in their " 20 Best Clinical Psychology Podcasts ." It has also been featured in Audible's " Best Mental Health Podcasts to Defy Stigma and Begin to Heal ." Previous Next

NSSI "Wiki" Welcome to the NSSI "Wiki" page! This page contains a brief summary of the most important things to know about NSSI. Introduction What is self-injury? Self-harm or deliberate self-harm (DSH) is an umbrella term that refers to any self-inflicted behaviour regardless of intent (1). This can include culturally appropriate behaviours (e.g. tattoos, body piercings), risky and dangerous behaviours (e.g. reckless driving), self-destructive behaviours (e.g. hair pulling, drinking excessively, behaviours associated with eating disorders), and poisoning - whether meant as an attempt to end life or not - and/or a suicide attempt. Non-suicidal self-injury also comes under this umbrella. Non-suicidal self-injury (NSSI), or self-injury, is the deliberate damage of body tissue without suicidal intent and for purposes not socially sanctioned (2). The term self-harm is typically used to describe both non-suicidal self-injury and suicide attempts. It is important to make a distinction between behaviours engaged with and without suicidal intent for a number of reasons: 1. The reason for the behaviors differ: suicide attempts are a way to escape life; NSSI is a way to cope with life; 2. The psycho-social factors associated with each behaviour can differ (3); 3. The behaviours often look different (e.g., in method, frequency, potential lethality) 4. The responses to each behaviour should differ Talking About Self-Injury Aside from distinguishing NSSI from self-harm, the way we talk about the behaviour itself is important. Traditionally, the discourse around NSSI has been grounded in a medical framework. That is, NSSI is seen as a symptom of an underlying condition that needs to be treated or ‘fixed’. The ultimate goal of treatment is seen as ‘curing’ someone of self-injury, where recovery is defined as a return to ‘normal’ functioning. Further, self-injury has been viewed from a deficit-based perspective. People who self-injure are seen to be lacking in a core skill such as emotion regulation or coping skills. This medical, deficit-based, backdrop can lead to NSSI, and the people who engage in the behaviour, as being further stigmatized and considered faulty in some way. Language is important. It shapes our shared understanding of concepts and ideas, gives value to these (e.g. as good or bad), and when used inappropriately can perpetuate stereotypes and stigma. When stigmatising language around NSSI is used (e.g., people who self-injure are crazy), individuals can internalize that messaging (e.g., I am crazy), which leads to the individual feeling devalued, misunderstood, and less likely to seek support (4). In recent years there has been a shift toward talking about NSSI in a non-stigmatizing, person-centred way, emphasizing that a person is not defined by their self-injury (5). When talking to someone who self-injures, adopt a respectful curiosity, showing a non-judgmental and genuine interest in what is going on for them (6). We suggest avoiding terms like ‘maladaptive’ and ‘contagion’ which suggest that someone is faulty in some way that is likely to spread to others (7,8). Top Tips Always be respectful when talking about NSSI, or people with a lived experience of NSSI Poorly-considered language can exacerbate stigma among people who already feel highly stigmatised Avoid language that defines a person by their behaviour (e.g., “cutter”; “self-injurer”) Avoid language that is value-laden (e.g., good/bad; maladaptive), or propagates stigma (e.g., attention-seeking) Use of appropriate language can foster open communication and facilitate support-seeking Check out specific guidelines for members of the media in reporting on and writing about NSSI. Following these principles, media guidelines have been developed to assist media in appropriate reporting of self-injury. These guidelines emphasize (9): Avoid use of NSSI-related images and details within text, especially of NSSI wounds and methods/tools Highlight efforts to seek treatment, stories of recovery, adaptive coping strategies as alternatives to NSSI, and updated treatment and crisis resources Avoid misinformation about NSSI, by communicating peer reviewed and empirically supported material, including distinguishing NSSI from suicide Present information neutrally; avoid exaggerated descriptions of NSSI prevalence and sensational headlines that include NSSI, especially the method of NSSI Use non-stigmatising language and avoid terms that conflate person and behaviour (e.g. ‘cutter’) Ensure that online article comments are responsibly moderated. NICE Guidelines https://www.nice.org.uk/guidance/ng225 ISSS Brausch, A. M., & Gutierrez, P. M. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. Journal of youth and adolescence, 39(3), 233–242. https://doi.org/10.1007/s10964-009-9482-0 Staniland, L., Hasking, P., Boyes, M., & Lewis, S. (2021). Stigma and Nonsuicidal Self-Injury: Application of a Conceptual Framework. Stigma and Health, 6. 312-323. Lewis SP. I cut therefore I am? Avoiding labels in the context of self-injury. Medical Humanities 2017;43:204. Walsh Hasking, P., & Boyes, M. (2018). Cutting Words: A Commentary on Language and Stigma in the Context of Nonsuicidal Self-Injury. The Journal of nervous and mental disease, 206(11), 829–833. Hasking, P., Lewis, S.P. and Boyes, M.E. (2019), "When language is maladaptive: recommendations for discussing self-injury", Journal of Public Mental Health, Vol. 18 No. 2, pp. 148-152 Westers Experiences of Self-Injury Disclosure of self-injury People can learn about another person’s self-injury in several ways including if they happen to notice signs of self-injury (e.g., seeing scarring, witnessing the person self-injure), being told by a third party, or when the person who has self-injured intentionally shares this information with them (1). When a person directly and willfully tells another person that they have self-injured this is considered to be “voluntary disclosure” of self-injury. Estimates of how many people have disclosed their self-injury voluntarily vary across studies, partly depending on the population being surveyed (2). Generally 40-50% of people who have self-injured have disclosed this to another person, amongst xxx. When people do disclose their self-injury they tend to tell people they have a personal relationship with rather than talking to professionals about their self-injury (2). Disclosures in personal relationships are often made in friendships and romantic relationships, though disclosures to parents and siblings are more common for younger people (2). Mirichlis. (2024). Understanding Voluntary NSSI Disclosure [Doctoral thesis, Curtin University]. Simone, A., & Hamza, C. (2020). Self-injury stigma Stigma refers to the culmination of stereotype, prejudice, and disrimination (ref). Many behaviors, experiences, and identities are stigmatized. While self-injury stigma has been described by individuals with lived experience, researchers have only recently begun to investigate its manifestations and impacts (ref). It is argued that self-injury stigma is distinct from other forms of stigma because self-injury is a socially unacceptable behavior associated with mental illness that can leave visible marks. As such, self-injury attracts three forms of stigma: behavioral (related to act of harming oneself), physical (related to the physical and sometimes long-lasting marks caused by self-injury), and mental (representing the aspect of NSSI stigma that overlaps with mental illness stigma). The NSSI Stigma Framework outlines four perspectives through which NSSI stigma manifests, with a fifth perspective being suggested in subsequent research. These perspectives represent how stigma is experienced and perpetuated. Additionally, the NSSI Stigma Framework identifies why self-injury is stigmatized, categorising manifestations of self-injury stigma into the domains outlined by Jones et al. (ref). Self-injury Recovery Historically, NSSI recovery has emphasised cessation of the behaviour. This, in many ways, aligns with traditional medical frameworks (Lewis & Hasking, 2020, 2021). Over the past few years, however, growing attention has been paid to understanding NSSI recovery from a lived experience perspective (e.g., Lewis et al., 2019; Lewis & Hasking, 2020, 2021, 2023). Efforts in this regard have pointed to the complexity of recovery and led to the development of a person-centred framework (see Lewis & Hasking, 2021). Consistent with its person-centred nature, the components of the framework will have varying levels of relevance to different people. In other words, recovery experiences vary and not all components will be relevant to a given person. Components can also differ in their salience for a person across time (e.g., one component may be more important early vs later in recovery). The main components of this framework are: Realistic Expectations and Setbacks: Given its nonlinear nature, there may be setbacks (e.g., instances of NSSI) during recovery; these are expected and normal. Normalizing Thoughts and Urges: Thoughts about, and urges, to self-injure are also a normal part of the process. These may never fully go away but will abate in frequency and intensity. Self-efficacy: People develop efficacy to resist urges and find alternatives to replace self-injury. Finding Alternatives: Recovery involves finding new ways to respond to NSSI urges and to meet the need(s) of NSSI. Identifying Strengths: All people who self-injure have strengths that can be drawn upon and fostered in recovery. Addressing Underlying Adversities: NSSI occurs in a context and a person’s unique adversities (e.g., mental health difficulties, trauma) merit attention. Addressing and Accepting Scarring: Scarring from self-injury may be a concern (e.g., being stigmatised, feeling shame). Support may be needed to promote scar acceptance. Navigating Disclosures: People may wish to share their lived experience at different time points; they should do so only when they are ready but may need support when making this choice. Self-acceptance and Self-compassion: While working on recovery, self-acceptance and self-compassion can be cultivated. Resilience and Meaning-making: People develop resilience and can find meaning in their lives by navigating through the above components Whereas some models of recovery suggest a stepwise progression, the person-centred framing of NSSI recovery emphasises a non-linear process. Thus, recovery is bound to ebb and flow (e.g., setbacks may occur). The non-linearity of the framework also means that the process itself may not have an ‘end-point’ and may continue ongoingly. Finally, a core tenet of this framework is that all people have strengths and that as people chart their own recovery path, they can build resilience, acceptance, and forge meaning in their lives (Lewis & Hasking, 2021, 2023). 1. Lewis, S. P., Kenny, T. E., Whitfield, K., & Gomez, J. (2019). Understanding self‐injury recovery: Views from individuals with lived experience. Journal of Clinical Psychology, 75(12), 2119-2139. 2. Lewis, S. P., & Hasking, P. A. (2020). Rethinking self-injury recovery: A commentary and conceptual reframing. BJPsych bulletin, 44(2), 44-46. 3. Lewis, S. P., & Hasking, P. A. (2021). Self‐injury recovery: A person‐centered framework. Journal of Clinical Psychology, 77(4), 884-895. 4. Lewis, S. P., & Hasking, P. A. (2023). Understanding self-injury: A person-centered approach. Oxford University Press. The Functions of NSSI People engage in NSSI for many different reasons, meaning it serves distinct functions for different people and within the same person. Research has shown that people first begin engaging in NSSI and continue doing so for a variety of intrapersonal (i.e., automatic) and interpersonal (i.e., social) reasons (1, 2; see Table 1). People who engage in NSSI report doing so for intrapersonal reasons much more often than for interpersonal reasons (3,4). Research has repeatedly shown that the most common function of NSSI is to lessen the intensity of negative internal states, including feelings of shame, guilt, anger, and sadness (2, 5, 6). Yet, some people report engaging in NSSI to end feelings of emotional numbness, to punish themselves, and as an alternative to acting on suicidal urges, all of which are self-reinforcing (5, 6, 7). Contrastingly, interpersonal or socially reinforced functions describe NSSI reasons that facilitate help-seeking and/or an escape from undesired social situations (2, 8). For instance, it may act as a way of communicating pain, indicating toughness, and keeping others who cause harm away (e.g., bullies, abusers; 9, 10). NSSI may also act to increase connectedness or in-group affiliation with peers (5,11). Table 1. Examples of Intrapersonal and Interpersonal Reasons for NSSI (5, 9) Intrapersonal (Automatic) Functions of NSSI Interpersonal (Social) Functions of NSSI While NSSI functions are often categorized as intrapersonal or interpersonal, it is worth noting that no function is purely interpersonal or purely intrapersonal (12). Though intrapersonal functions for NSSI are more common than interpersonal functions, many people report engaging in NSSI for the first time for social reasons (4, 9). For example, a person may begin self-injuring to feel more connected with peers who engage in NSSI but continue to do so to help them cope with negative emotions. Therefore, people’s reasons for engaging in self-injury are not limited to one particular interpersonal or intrapersonal function, and their reasoning can change over time (9, 12). 1. Klonsky, E. D., Glenn, C. R., Styer, D. M., Olino, T. M., & Washburn, J. J. (2015). The functions of nonsuicidal self-injury: Converging evidence for a two-factor structure. Child and Adolescent Psychiatry and Mental Health, 9(44), 1-9. https://doi.org/10.1186/s13034-015-0073-4 2. Nock, M. K. (2009). Why do people hurt themselves?: New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18(2), 78-83. https://doi.org/10.1111/j.1467-8721.2009.01613.x 3. Kim, H., & Hur, J. (2022). What’s different about those who have ceased self-injury? Comparison between current and lifetime nonsuicidal self-injury. Archives of Suicide Research, 27(2), 718-733. https://doi.org/10.1080/13811118.2022.2064256 4. Tatnell, R., Kelada, L., Hasking, P., & Martin, G. (2014). Longitudinal analysis of adolescent NSSI: The role of intrapersonal and interpersonal factors. Journal of Abnormal Child Psychology, 42, 885-896. https://doi.org/10.1007.s10802-013-9837-6 5. Klonsky, E. D., & Glenn, C. R. (2009). Assessing the functions of non-suicidal self-injury: Psychometric properties of the inventory of statements about self-injury (ISAS). Journal of Psychopathology and Behavioral Assessment, 31(3), 215-219. https://doi.org/10.1007/s10862-008-9107-z 6. Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759-769. https://doi.org/10.1016/j.jad.2017.11.073 7. Rallis, B. A., Deming, C. A., Glenn, J. J., & Nock, M. K. (2012). What is the role of dissociation and emptiness in the occurrence of Nonsuicidal self-injury? Journal of Cognitive Psychotherapy, 26(4), 287-298. https://doi.org/10.1891/0889-8391.26.4.287 8. Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226-239. https://doi.org/10.1016/j.cpr.2006.08.002 9. Lewis, S. P., & Hasking, P. A. (2023). Understanding self-injury: A person-centered approach. Oxford University Press. 10. Nock, M. K. (2008). Actions speak louder than words: An elaborated theoretical model of the social functions of self-injury and other harmful behaviors. Applied and Preventive Psychology, 12(4), 159-168. https://doi.org/10.1016/j.appsy.2008.05.002 11. Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2012). Interpersonal features and functions of nonsuicidal self-injury. Suicide and Life-Threatening Behavior, 43(1), 67–80. https://doi.org/10.1111/j.1943-278x.2012.00128.x 12. Taylor, P. J., Dhingra, K., Peel-Wainwright, K. M., & Gardner, K. J. (2024). The functions of nonsuicidal self-injury. In E. Lloyd-Richardson, I. Baetens, & J. L. Whitlock (Eds.), The oxford handbook of nonsuicidal self-injury (pp. 89-106). Oxford University Press. Estimated Prevalence NSSI usually begins during early to mid-adolescence (1). In non-clinical samples, approximately one in five adolescents report engaging in NSSI at least once (2,3). Among emerging adults (18-29 years), this increases to 42% (4). Commensurate with this, NSSI appears particularly common among college students (5). Recent results suggest that up to one quarter of college students have engaged in NSSI (6). Prevalence among adults aged over 30 years, averages 20% (4). Less work has explored NSSI among younger children. A recent meta-analysis of NSSI among pre-adolescents (before the age of 13 years) estimated a rate of 6.25% among community-based youth, and 37.38% among clinical samples (7). In clinical samples, rates of NSSI are higher, although estimates vary significantly based on study design, population studied, and lack of reliable epidemiological data (8). Brianna J. Turner, Andrew C. Porter, Christina L. Robillard. (2024). Average ages of onset and time to transition between self-injurious thoughts and behaviors: Retrospective evidence from two developmentally distinct samples, Journal of Affective Disorders, 363, 465-473, Moloney F, Amini J, Sinyor M, Schaffer A, Lanctôt KL, Mitchell RH. Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis. JAMA Netw Open. 2024;7(6):e2415436. doi:10.1001/jamanetworkopen.2024.15436 Xiao, Q., Song, X., Huang, L., Hou, D., & Huang, X. (2022). Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: A meta-analysis. Frontiers in psychiatry, 13, 912441. https://doi.org/10.3389/fpsyt.2022.912441 Liu R. T. (2023). The epidemiology of non-suicidal self-injury: lifetime prevalence, sociodemographic and clinical correlates, and treatment use in a nationally representative sample of adults in England. Psychological medicine, 53(1), 274–282. https://doi.org/10.1017/S003329172100146X Kiekens, G., Bruffaerts, R., Claes, L., Hasking, P., & Kessler, R. (2023). A longitudinal investigation of non-suicidal self-injury persistence patterns, risk factors, and clinical outcomes during the college period. Psychological Medicine, 53, 6011-6026. Hasking et al., (R&R). The Relationships Between Sporadic and Repetitive Non-Suicidal Self-Injury and Mental Disorders Among First-Year College Students: Results from the World Mental Health International College Student Initiative. Psychological Medicine. 14 January 2025 Liu, R. T., Walsh, R. F. L., Sheehan, A. E., Cheek, S. M., & Sanzari, C. M. (2022). Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis. JAMA psychiatry, 79(7), 718–726. https://doi.org/10.1001/jamapsychiatry.2022.1256 Muehlenkamp, Jennifer J., and Victoria Tillotson, 'Overview and Epidemiology of NSSI in Clinical Samples', in Elizabeth E. Lloyd-Richardson, Imke Baetens, and Janis L. Whitlock (eds), The Oxford Handbook of Nonsuicidal Self-Injury, Oxford Library of Psychology (2024; online edn, Oxford Academic, 23 Feb. 2023), https://doi.org/10.1093/oxfordhb/9780197611272.013.8 Male/Female Gender Differences Self-injury appears to be more common among women than men in North America and Europe (1). Differences in prevalence are especially pronounced in clinical samples, which estimate female patients are 1.5 to 1.8 times more likely to self-injure than male patients (2). Self-injury is also much more common among incarcerated women than incarcerated men (3). This gender disparity in rates of self-injury can be partially explained by women’s higher levels of psychological distress compared to men (4), a population-level phenomenon which can be attributed to a complex interplay of individual and sociocultural influences (5). However, gender disparities in self-injury prevalence vary geographically; rates of self-injury do not significantly differ between men and women in Asia (1). The factors influencing cultural and geographic differences in gender disparities are not well established. Evidence for gender differences in self-injury characteristics or clinical presentation is limited and mixed. It appears that men and women are largely similar in their reported reasons for self-injuring, with reducing tension, releasing anger or frustration, and self-punishment being the most common functions (6,7). There may be patterns of difference in the methods and locations of self-injury, with women more likely than men to scratch, rub, or pinch themselves and self-injure on their stomach or legs, and men more likely than women to self-injure on their chest (8). Women may also experience more self-injury urges (8) and greater versatility of self-injury functions than men (6), which may be indicators of more clinically severe self-injury. However, there is insufficient evidence to draw conclusions about male/female differences in self-injury presentation. Most English-language self-injury research over the past century has focused on the experiences of young women (9). Self-injury is likely underreported among men due to gender-based stereotypes which impact help seeking and bias interpretation of self-injuring behaviours (10). For example, clinicians and men themselves may not recognise their behaviours as self-injury, such as punching walls when upset which is generally interpreted as an act of aggression despite conforming to clinical definitions of self-injury. Moloney et al (2024) Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents A Meta-Analysis Muehlenkamp & Tillotson (2023) Overview and Epidemiology of NSSI in Clinical Samples. Oxford Handbook of Nonsuicidal Self-Injury. Winicox (2023) Prisons. Oxford Handbook. Lutz et al. (2023) Why is nonsuicidal self-injury more common among women? Hyde & Mezulis (2020) Gender Differences in Depression: Biological, Affective, Cognitive, and Sociocultural Factors Lutz et al. (2024) Gender Similarities and Differences in the Functions of Non-Suicidal Self-Injury Tofthaugen et al. (2021) Men who self-harm—A scoping review of a complex phenomenon Victor et al. (2018) Characterizing gender differences in nonsuicidal self-injury: Evidence from a large clinical sample of adolescents and adults Millard (2013) Making the cut: The production of ‘self-harm’ in post-1945 Anglo Saxon psychiatry Inckle (2014) Strong and Silent: Men, Masculinity, and Self-injury Populations at higher risk of self-injury People with psychiatric diagnoses Though some people who self-injure have no associated mental health condition, self-injury is much more common among people with psychiatric diagnoses and is associated with a range of different conditions. This includes mood, eating, anxiety, personality, behavioural, and psychotic disorders (1). Borderline Personality Disorder is the diagnosis most strongly associated with self-injury, since self-injury is one of its DSM-5-TR diagnostic criteria; an estimated 50-90% of people diagnosed with Borderline Personality Disorder have self-injured (1). Rates of self-injury are also high among people with panic disorder, PTSD, and binge-eating/purging subtype eating disorders (1). Muehlenkamp & Tillotson (2023) Overview and Epidemiology of NSSI in Clinical Samples. Oxford Handbook of Nonsuicidal Self-Injury. LGBTQIA+ people Individuals who identify as LGBTQIA+ are at much higher risk of self-injury than their cisgender heterosexual peers (1). Self-injury prevalence appears to be particularly high among transgender, non-binary, and other gender diverse young people and among bisexual women (2). Applications of Minority Stress Theory (4) and the Gender Minority Stress and Resilience Model (3) explain that this higher incidence of self-injury can be attributed to the psychological impact of stressors related to societal homophobia and transphobia (1). Distress associated with gender dysphoria can also be a trigger for self-injury (5). Zullo, Rogers, Taliaferro (2023) NSSI Among Sexual and Gender Diverse Youth. Oxford Handbook of Nonsuicidal Self-Injury. Liu et al. (2019) Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis Meyer 2003 Testa et al., 2015 Hird et al. (2024) Trans Young People’s Experiences of Nonsuicidal Self-Injury People who have experienced abuse or trauma Childhood abuse and neglect are well-established risk factors for self-injury, particularly emotional and sexual abuse (1,2). Traumatic experiences in adulthood, including sexual assault, can also contribute to the initiation of self-injury (3). There are many potential pathways linking trauma and self-injury. Trauma can be defined as an experience which overwhelms one’s ability to cope (4), and self-injury is often a means of coping with overwhelming distress. Research in neurobiology and child development describe the long-term impacts of trauma and how these can create vulnerability for self-injury (5,6). Individuals describe self-injuring to escape dissociation, intrusive memories, and other trauma symptomatology; to punish themselves in response to trauma-related shame; and to deter further abuse (6). Calvo et al. (2024) Childhood maltreatment and non-suicidal self-injury in adolescent population: A systematic review and meta-analysis Serafini et al. (2023) Early Childhood Trauma and Nonsuicidal Self-Injury. Oxford handbook of nonsuicidal self-injury. Watters & Yalch (2022) Relative effects of sexual assault and other traumatic life events on self-harm Herman (1992) Trauma and Recovery Kaes et al. (2021) Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review Smith, Kouros, Meuret (2014) The role of trauma symptoms in nonsuicidal self-injury. People in prisons People incarcerated in prisons and other forms of detention are at significantly higher risk of self-injury compared to the general population (1). Rates of self-injury tend to be highest in maximum-security settings. Contributing factors include high levels of suffering and low access to positive coping methods, isolation from social support systems, and low availability of professional mental health support. Self-injury can also be a means of influencing the environment in a setting where individuals are stripped of power and subjected to extreme adversity, for instance self-injuring in order to be moved from solitary confinement to a hospital facility. Winicov (2023) Oxford handbook chapter NSSI in the DSM Nonsuicidal Self-Injury is included in the 2024 update of the Diagnostic and Statistical Manual Fifth Edition (DSM-5-TR) in the category “Other Conditions That May Be a Focus of Clinical Attention”, with classifications for “Current Nonsuicidal Self-Injury” and “History of Nonsuicidal Self-Injury” (source link 1 ). This means that it is not yet a verified psychiatric diagnosis but may become one with further research. Nonsuicidal Self-Injury Disorder was initially included in the 2013 edition of the DSM-5 as a “Condition for Further Study” (source link 2 ). Several arguments have been made for the inclusion of NSSI as a standalone diagnostic category. Recently, the perspectives of people with lived experience has been explored i. Results from this line of research has illuminated both potential advantages and disadvantages (Lewis et al., 2017; Lengel et al., 2025). Among the main advantages identified are: potential improvements in the awareness and understanding of NSSI, reductions in stigma, increased comfort to disclose and seek support for NSSI, and facilitation of and improvements in treatment. In contrast, people with lived experience also see potential disadvantages. These include worsening of NSSI stigma, NSSI becoming a central focus at the expense of considering people’s other concerns (e.g., underlying mental health difficulties), and concerns about how a diagnostic category of NSSI may be used and whether it is even needed. Notably, DSM diagnoses for self-injury have been proposed several times in the past. Deliberate Self-Harm Syndrome was proposed by Kahan and Pattison in 1984, Repetitive Self-Mutilation Syndrome by Favazza and Rosenthal in 1990, and Deliberate Self-Injury Syndrome by Muehlenkamp in 2005. In 2009, Shaffer and Jacobson proposed Nonsuicidal Self-Injury as a DSM-5 diagnosis, leading to its current inclusion. Self-injury is also included in the diagnostic criteria for Borderline Personality Disorder in the DSM-5-TR. To receive the diagnosis, someone must endorse five out of nine possible criteria, one of which is: “Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” (source link 3 ). DSM-5-TR source link 1 DSM-5-TR source link 2 [lived experience sources] Kahan J, Pattison EM (1984) Proposal for a distinctive diagnosis: the deliberate self-harm syndrome (DSH). Suicide Life Threat Behav 14:17–35 Favazza AR, Rosenthal RJ (1990) Varieties of pathological self-mutilation. Behav Neurol. 3:77–85. Muehlenkamp JJ (2005) Self-injurious behavior as a separate clinical syndrome. Am J Orthopsychiatry. 75:324–333. Shaffer D, Jacobson C (2009) Proposal to the DSM-V Childhood Disorder and Mood Disorder Work Groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. DSM-5-TR source link 3 DSM-5-TR source link 4 Lengel, G. J., Ammerman, B. A., Bell, K. A., & Washburn, J. J. (2024). The potential impact of nonsuicidal self-injury disorder: Insights from individuals with lived experience. Qualitative Research in Medicine & Healthcare, 8, 12631. Lewis, S. P., Bryant, L. A., Schaefer, B. M., & Grunberg, P. H. (2017). In their own words: Perspectives on nonsuicidal self-injury disorder among those with lived experience. The Journal of nervous and mental disease, 205(10), 771-779. DSM-5 Criteria for Nonsuicidal Self-Injury Disorder A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent). B. The individual engages in the self-injurious behavior with one or more of the following expectations: 1. To obtain relief from a negative feeling or cognitive state. 2. To resolve an interpersonal difficulty. 3. To induce a positive feeling state. C. The intentional self-injury is associated with at least one of the following: 1. Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act. 2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control. 3. Thinking about self-injury that occurs frequently, even when it is not acted upon. D. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting. E. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. F. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual developmental disorder [intellectual disability], Lesch-Nyhan syndrome, stereotypic movement disorder with self-injury, trichotillomania [hair-pulling disorder], excoriation [skin-picking] disorder). Theoretical Models of NSSI Four Function Model The four function model asserts that NSSI serves four functions: automatic negative reinforcement, automatic positive reinforcement, social negative reinforcement, and social positive reinforcement (1). Automatic negative reinforcement occurs when one self-injures to avoid, reduce, or distract from an unwanted emotional state (1). This function suggests that NSSI can be a method of regulating emotions. This function is the most commonly endorsed by individuals who engage in NSSI (52.9%). Those who endorse this function are more likely to report higher feelings of hopelessness and past suicide attempts (1). Automatic positive reinforcement occurs when one self-injures to induce a desired emotional state (e.g. the desire to feel something or self-punishment) (1). Those who endorse this function are more likely to report symptoms of major depressive disorder and posttraumatic stress disorder (PTSD). Additionally, these symptoms are associated with feelings of emptiness and detachment (1). Social negative reinforcement occurs when one self-injures to avoid an unpleasant situation or task (1). This function is endorsed less often than the automatic functions. Social positive reinforcement occurs when one self-injures to gain something (e.g. care or attention) from others (1). Those who endorse this function have also reported awareness of a greater number of self-injury occurrences carried out by friends. 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. Experiential Avoidance Model The experiential avoidance model posits that NSSI is an avoidance behavior (similar to the social negative reinforcement function) where self-injury is used as a method of avoiding, escaping, or distracting from an unwanted emotion or external factor that promotes unwanted emotions (1). This model begins with a stimulus which triggers an unwanted emotional response. This response may trigger the urge to self-harm to escape discomfort. Consequently, the self-harming behavior is reinforced by the emotional relief that follows (1). 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. Emotional Cascade Model The emotional cascade model was initially developed to understand risky behaviors within the context of borderline personality disorder (BPD) but has since been applied to understand NSSI in general (1). This model is based on the concept of rumination, which occurs when an individual repetitively thinks about negative thoughts, feelings, or experiences (1). Individuals use rumination in hopes that it will help them solve problems or better understand their emotions. However, rumination is more likely to aid the individual in achieving the opposite outcome as it has been found to increase negative emotions (1). In the emotional cascade model, the negative emotions resulting from rumination causes further rumination which, in turn, results in greater negative emotions. This cycle is what is known as an “emotional cascade.” Individuals who get caught in these emotional cascades are more likely to engage in NSSI to disrupt the cycle of rumination and return to a more neutral emotional state (1). 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. Integrated Model The integrated model was designed to build upon the four function model by addressing genetic and environmental factors (e.g. childhood maltreatment or a hostile familial environment) that can lead to the development of intra- and interpersonal difficulties such as increased negative thoughts and emotions, poor distress tolerance, and social difficulties (1). These difficulties increase the risk of a person engaging in NSSI in response to stress. There exist a number of hypothesized processes by which someone who possesses these risk factors may come to self-injure. One example is the social learning hypothesis which suggests that if someone is exposed to self-injury through family, friends, or the media they are more likely to engage in the behavior themselves (1). Other theories suggest that people may self-injure because it is an efficient and effective method of regulating their emotions. Another process is the self-punishment hypothesis where one engages in NSSI to satisfy self-punishment desires (1). 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. Cognitive-Emotional Model The goal of the cognitive-emotional model is to explain why someone possessing NSSI risk factors would self-injure instead of using other emotion regulation strategies (1). This theory utilizes two elements from the social cognitive theory to explain what cognitions lead someone to self-injure: outcome expectancies (anticipated consequences of engaging in a behavior) and self-efficacy (perceived ability to engage in a behavior). It has been theorized that those who expect engaging in NSSI will yield a desirable outcome and have low self-efficacy to resist NSSI urges are more likely to engage in NSSI than others (1). 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. Barriers and Benefits Model This model implies that there are a variety of factors that can motivate a person to self-injure (benefits), along with a number of factors that may deter them from doing so (barriers, 1). Benefits of engaging in NSSI include reduction of negative emotions, self-punishment, peer group affiliation (self-injuring to maintain status within a group), and communicating distress (1). Common barriers of engaging in NSSI include lack of awareness of the behavior, positive representations of the self, pain avoidance, blood/wound aversion, and social norms (experiencing stigma, 1). 1. Hird, Hasking, & Boyes (2024) A Comparison of the Theoretical Models of NSSI. Oxford Handbook of Nonsuicidal Self-Injury. History Non-suicidal self-injury has been recognised and studied as a distinct clinical phenomenon for well over a century, particularly in the USA. Although the 20th-century psychiatrist Karl Menninger is often credited with the initial clinical characterization of self-injury (then called self-mutilation) in his 1938 book Man Against Himself (1), there are many earlier examples (2). 19th-century asylum records distinguish between self-injury with and without suicidal intent (3). In 1896, doctors George Gould and Walter Pyle categorized self-mutilation into three groups: those resulting from "temporary insanity from hallucinations or melancholia; with suicidal intent; and in a religious frenzy or emotion" (4). Several case studies of patients who self-injure were published in the late 19th and early 20th century (2), largely written from a psychoanalytic perspective. Clinical focus on self-injury began to grow in the 1960s. The first research symposium on “impulsive self-mutilation” was held in 1967 in Maryland, USA (5). The papers presented at this symposium set the tone for self-injury research in the following decades, including introducing the term “delicate self-cutting” as a primarily female behaviour (6). The first self-injury specific treatment centre in America was opened by Dr Wendy Lader and Karen Conterio in 1986 (7). The late 1980s saw the publication of two landmark books, Bodies Under Siege: Self-mutilation in Culture and Psychiatry (1987) by Dr Armando Favazza and Self-Mutilation: Theory, Research, and Practice (1988) by Dr Barent Walsh and Dr Paul Rosen, which set out classification frameworks for various types of non-suicidal self-injury and provide clinical guidance for their treatment (8,9). In 1989, the first conference focused on lived experience of self-harm was held in the UK by the advocacy group Survivors Speak Out (10). Public and professional interest in self-injury grew substantially in the 1990s. Prominent psychologists Dr Marsha Linehan, Dr Bessel van der Kolk, and Dr Judith Herman advanced the field with their discussions of self-injury in the context of Borderline Personality Disorder and childhood trauma (11,12). The number and diversity of mental health professionals publishing on self-injury greatly expanded, introducing new ways of understanding self-injury including feminist psychology and lived experience perspectives (13,14). Self-injury also became more prominent in the media, particularly after a 1995 BBC interview in which Princess Diana disclosed experiences of self-injury (15). The International Society for the Study of Self-Injury was founded in 2006 (16), marking the beginning of a global collaboration to promote evidence-based information about self-injury. The field of professionals dedicated to improving support for people who self-injure, and public awareness of self-injury, has continued to grow since then. Menninger (1938) Man Against Himself Angelotta (2015) Defining and Refining Self-Harm: A Historical Perspective on Nonsuicidal Self-Injury Chaney (2017) Psyche on the skin: A history of self-harm Gould & Pyle (1896) Anomalies and Curiosities of Medicine Burnham & Giovacchini (1969) Symposium on impulsive self-mutilation: Discussion Pao (1969) The syndrome of delicate self-cutting https://selfinjury.com/home/about-us/history/ Favazza (1987) Bodies Under Siege: Self-mutilation in Culture and Psychiatry Walsh & Rosen (1988) Self-Mutilation: Theory, Research, and Practice Chaney & Copperman (2023) Women Listening to Women: Radical Reflections on Self-Injury Support Van der Kolk, Perry, Herman (1991) Childhood origins of self-destructive behavior. Linehan (1993) Cognitive-behavioral Treatment of Borderline Personality Disorder Smith, Cox, & Saradjian (1998) Women and Self-Harm Self-Harm: Perspectives from Personal Experience (1994) https://www.independent.co.uk/life-style/royal-family/princess-diana-panorama-secrets-prince-charles-affair-bulimia-martin-bashir-b1205376.html https://www.itriples.org/copy-of-who-we-are