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Jason Washburn, PhD, ABPP, from Northwestern University Feinberg School of Medicine explains how self-injury and self-harm can effectively and compassionately be managed in inpatient settings. Season 1 | Episode 14 Podcast/ Season 1 | Episode 14 Managing Self-Injury in Inpatient Settings Jun 4, 2021 with Dr. Jason Washburn Managing Self-Injury in Inpatient Settings with Dr. Jason Washburn 00:00 / 01:04 When is it appropriate for someone who engages in nonsuicidal self-injury (NSSI) to be admitted to an acute psychiatric inpatient program? And how realistic is it to expect no self-injury or self-harm to occur at all while in the hospital? How should hospital staff respond and intervene when someone engages in self-injury while on an inpatient unit? In this episode, Dr. Jason Washburn addresses these questions and discusses how hospital staff can foster empathy and compassion for individuals who self-injure while respecting their autonomy and also keeping them safe. Learn more about Dr. Washburn and his work here . Below are links to some of his work, including his books as editor and new research. To learn more about AMITA Health and its treatment for self-injury, click here . Washburn, J. J. (2014). Self-injury: Simple answers to complex questions . Hoffman Estates, IL: Alexian Brothers Press. Washburn, J. J. (2019). Nonsuicidal self-injury: Advances in research and practice . New York: Routledge. Slesinger, N. C., Hayes, N. A., & Washburn, J. J. (2021). Understanding predictors of change in a day treatment setting for non-suicidal self-injury . Psychology and Psychotherapy: Theory, Research, and Practice, 94 , 517–535. 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

2023 - 2024 Home / Collaborative Research Program / CANDI Validation in Youth Characteristics of nonsuicidal self-injury disorder in youth and psychometric evaluation of the Clinician-Administered Nonsuicidal Self-Injury Disorder Index Mentor/s: Johan Bjureberg 2024 - 2025 Project Overview Affiliation: Karolinska Institutet, Sweden Project description: Although NSSI usually debuts in adolescence, few studies have examined the full set of DSM-5 NSSID diagnostic criteria in youth. In this study, we will analyze the reliability and validity of the structured diagnostic interview Clinician-Administered NSSI Disorder Index (CANDI) and provide information on the clinical characteristics and features of DSM-5 NSSID in youth. Data on the internal consistency, factor structure, and construct validity of the CANDI and associated characteristics of NSSID will be analyzed in a clinical sample of youth (N = 166; (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) with recent recurrent NSSI (≥5 days with NSSI the past year and ≥1 episode in the month). Participants and their caregivers completed self-report measures of NSSI characteristics, psychopathology, and emotion dysregulation, and clinicians assess diagnostic interviews of borderline personality disorder (SCID–II), common mental disorders (Mini International Neuropsychiatric Interview), global functioning, and clinical severity. Applicants should have the following skills: Interest in psychometric evaluations and experience conducting literature search Junior research responsibilities: Conducting literature search, drafting the manuscript, and assist in data analysis Anticipated outcome(s) for junior researcher: Co-authorship on an academic peer-reviewed paper Time commitment: Approximately 1 day per week for 6 months Application Deadline: June 1, 2024 Apply Now

Lexy from Australia shares her story of lived experience of self-injury and stigma and how it has influenced her work in researching self-injury and self-harm. Season 1 | Episode 13 Podcast/ Season 1 | Episode 13 Lived Experience of Self-Injury & Stigma: Lexy's Story May 21, 2021 Lived Experience of Self-Injury & Stigma: Lexy's Story 00:00 / 01:04 In this episode, Lexy details her experience of engaging in nonsuicidal self-injury (NSSI) and the stigma she has encountered as a result of self-injury and self-harm. Lexy is the current Student Representative of the International Society for the Study of Self-Injury (ISSS) and a PhD candidate working in the area of self-injury stigma. She is currently working on multiple projects looking at how self-injury stigma is experienced and how it is portrayed in the media. She has recently published a paper outlining how researchers can better understand self-injury stigma: Stigma and nonsuicidal self-injury: Application of a conceptual framework (Staniland, Hasking, Boyes, & Lewis, 2021) Follow Dr. Westers on Instagram and Twitter (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter (@ITripleS). BIG NEWS! The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their " Top 15 Clinical Psychology Podcasts You Must Follow in 2021 ." Click here to see the full Top 15 list. Previous Next

Home / Awards / Invited Fellow / Dr. Nancy L. Heath Dr. Nancy L. Heath Previous Dr. Nancy L. Heath is a Professor of Educational and Counselling Psychology at McGill University (Canada). Her research examines resilience, emotion regulation, and self-injury in adolescents and young adults, with a focus on the school context. Dr. Heath has been a leader in promoting supportive educational environments for students coping with mental health challenges, emphasizing prevention, early intervention, and destigmatization. Her work bridges psychology and education, helping teachers, counselors, and peers respond with understanding and care. As a founding member of ISSS, Dr. Heath is deeply valued for her compassionate leadership, her mentorship of young researchers, and her steadfast advocacy for youth mental health. Next ISSS Fellow | 2023

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

Tattoo artist Elena from Illusions by Ink Studio in Irving, Texas, discusses paramedical tattooing and invites her client with lived experience of self-injury to share her experience with camouflage tattooing of her self-harm scars. Season 4 | Episode 56 Podcast/ Season 4 | Episode 56 Paramedical Tattooing for Self-Harm Scars, with Tattoo Artist Elena & Her Client Dec 27, 2024 Paramedical Tattooing for Self-Harm Scars, with Tattoo Artist Elena & Her Client 00:00 / 01:04 What is paramedical tattooing and scar camouflage and how is it different than other treatments for self-injury scars? Not everyone with lived experience of nonsuicidal self-injury (NSSI) wants or needs to address self-harm scars, but some may choose to reduce or get rid of them as part of their recovery journey. Elena from Illusions by Ink Studio ( https://illusionsbyinkstudio.com/ ) walks us through her approach to paramedical tattooing for self-injury. Her client "H" joins the conversation, sharing her experience as someone with lived experience of NSSI and why she chose this type of tattooing for her self-injury scars. Connect with Elena on Instagram @illusionsbyink_studio , on Facebook here , and on YouTube @Scarcamouflagetattoo . You can reach her at elena@illusionsbyinkstudio.com . Below are a couple papers referenced in this episode: Allroggen, M., Kleinrahm, R., Rau, T. A. D., Weninger, L., Ludolph, A. G., & Plener, P. L. (2014). Nonsuicidal self-injury and its relation to personality traits in medical students . The Journal of Nervous and Mental Disease, 202 (4), 300-304. Plener, P. L., Brunner, R., Fegert, J. M., Groschwitz, R. C., In-Albon, T., Kaess, M., Kapusta, N. D., Resch, F., & Becker, K. (2016). Treating nonsuicidal self-injury (NSSI) in adolescents: consensus based German guidelines . Child and Adolescent Psychiatry and Mental Health, 10 (46). Previous Next

Kirsty Hird, PhD, from The Kids Research Institute Australia explains in depth why people self-injure or self-harm according to six specific theoretical models of nonsuicidal self-injury (NSSI). Season 5 | Episode 62 Podcast/ Season 5 | Episode 62 Why Do People Self-Injure? Part 2 Jun 27, 2025 with Dr. Kirsty Hird Why Do People Self-Injure? Part 2 with Dr. Kirsty Hird 00:00 / 01:04 Dr. Kirsty Hird, a Research Officer in the Youth Mental Health team at The Kids Research Institute Australia, adds to Episode 1 of The Psychology of Self-Injury podcast by explaining in depth and in layman's terms why people self-injure according to the six most common/popular theoretical models. Connect with Dr. Hird on LinkedIn here , view her staff profile here , and follow her on ResearchGate here . Below are two of her papers related to today's interview as well as a few other resources referenced in this episode: Hird, K., Hasking, P., & Boyes, M. (2023). A comparison of the theoretical models of NSSI . In E.E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 24-40). Oxford University Press. Hird, K., Hasking, P., & Boyes, M. (2022). Relationships between outcome expectancies and non-suicidal self-injury: Moderating roles of emotion regulation difficulties and self-efficacy to resist self-injury . Archives of Suicide Research, 26 (4), 1688-1701. Gray, N., Uren, H., Pemberton, E., & Boyes, M. (2023). Profiling ambivalence in the context of nonsuicidal self-injury . Journal of Clinical Psychology, 79(8) , 1699-1712. Ramsey, W. A., Berlin, K. S., Del Conte, G., Lightsey, O. R., Schimmel-Bristow, A., Marks, L. R., & Strohmer, D. C. (2021). Targeting self-criticism in the treatment of nonsuicidal self-injury in dialectical behavior therapy for adolescents: a randomized clinical trial . Child and Adolescent Mental Health, 26 (4), 320-330. Gratz, K., & Tull, M. (2025). Acceptance-based emotion regulation therapy: A clinician’s guide to treating emotion dysregulation and self-destructive behaviors using an evidence-based therapy drawn from ACT and DBT . Harbinger Press. Below are links to the original 6 theoretical models discussed in this episode: Four Function Model - Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior . Journal of Consulting and Clinical Psychology, 72 (5), 885–890. Experiential Avoidance Model - Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model . Behaviour Research and Therapy, 44 (3), 371–394. Emotional Cascade Model - Selby, E. A., & Joiner, T. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation . Review of General Psychology, 13 (3), 219–229. Integrated Model - Nock, M. K. (2010). Self-injury . Annual Review of Clinical Psychology, 6 (1), 339–363. Cognitive-Emotional Model - Hasking, P., Whitlock, J., Voon, D., & Rose, A. (2017). A cognitive-emotional model of NSSI: Using emotion regulation and cognitive processes to explain why people self-injure . Cognition and Emotion, 31 (8), 1543–1556. Barriers and Benefits Model - Hooley, J. M., & Franklin, J. C. (2018). Why do people hurt themselves? A new conceptual model of nonsuicidal self-injury . Clinical Psychological Science, 6 (3), 428–451. Previous Next

Scandinavia Home / Collaboration / Local Chapters / Scandinavia Unifying NSSI-research Velkommen til den danske afdeling af the International Society for the Study of Self-Injury (ISSS). Her vil du finde et overblik over fremtidige og tidligere nationale konferencer, kurser og netværker relateret til selvskade. Derudover vil der her på hjemmesiden fremgå, hvem der fra Danmark er en del af ISSS, samt hvordan man melder sig ind i ISSS. Welcome to the Danish chapter of ISSS. Here you will find an overview of upcoming and past national conferences, courses, and networks related to self-injury. Additionally, on this website, you will be able to see who from Denmark is part of ISSS, as well as how to become a member of ISSS. Upcoming Events View More Member List View More Get Involved! View More

16th Annual International Conference | 2021 | Online | June 23rd - 25th June Program Download the Abstract Book View all conference content here In 2021, we held our ISSS Conference online. Over 3 days we hosted a range of live and pre-recorded material, including: keynote addresses by our Inaugural Invited Fellows, Prof. Jennifer Muehlenkamp and Dr. Barent Walsh keynote address from our 2021 Rising Star, Dr. Sarah Victor a symposium from students and early career researchers in our Collaborative Research Program a roundtable discussion with individuals with lived experience of NSSI networking opportunities to connect people across the globe

Supports Resources / Supports Seeking Support is Self-Care There are a range of supports are available for individuals with lived experience of self-injury and for those who care about /for individuals who self-injure. We have put together a list of possible supports, including printable resource sheets, and links to organisations, advocacy and support groups, books, podcasts, and education. We acknowledge that people have different needs and find benefit in different types of suppo rt. The resources linked below include international charities, not-for-profit groups, work created by or in collaboration with ISSS members, registered charities, an d other resources and online spaces that may be helpful, interesting, or thought provoking. Note. While we have given each page a brief evaluation for appropriateness, the linked pages are not officially "endorsed" by ISSS and they may not be applicable to everyone. Support Type Title URL Education International Consortium on Self-Injury in Schools https://icsesgroup.org/ Online Support Self-Injury Outreach and Support https://sioutreach.org/ Education Shedding Light on Self-Injury https://www.self-injury.org.au/resource Advocacy To Write Love on Her Arms https://twloha.com/ Advocacy The Trevor Project https://www.thetrevorproject.org/ Advocacy Live Through This http://livethroughthis.org/ Podcast The Psychology of Self-Injury https://the-psychology-of-self-injury.simplecast.com/ Podcast Suicide 'n' Stuff https://suicide-n-stuff.com/ Podcast Before You Kill Yourself https://podcasts.apple.com/us/podcast/before-you-kill-yourself/id1446501856 Podcast Psychodrama https://podcasts.apple.com/us/podcast/psychodrama/id1504002821 Book Healing Self-Injury: A Compassionate Guide https://global.oup.com/academic/product/healing-self-injury-9780199391608?cc=us&lang=en& Online Support With Help Comes Hope http://lifelineforattemptsurvivors.org/ Online Support Now Matters Now https://www.nowmattersnow.org/ Online Support Self-Injury Recovery and Awareness https://www.thesira.org/

Nancy Heath, PhD, from McGill University in Canada explains how schools can respond appropriately to students who engage in self-injury and self-harm. Season 1 | Episode 20 Podcast/ Season 1 | Episode 20 Self-Injury in Schools Dec 3, 2021 with Dr. Nancy Heath Self-Injury in Schools with Dr. Nancy Heath 00:00 / 01:04 How can schools appropriately respond to students who engage in nonsuicidal self-injury (NSSI), whether the behavior occurs at home, on school grounds, or elsewhere? What protocols exist to support schools to better respond to students who self-injure? What role does liability play? In this episode, Dr. Nancy Heath of McGill University in Montreal, Canada explains how schools can support students who engage in self-injury and self-harm. Learn more about Dr. Heath's work here , and learn more about her work with the Development and Intrapersonal Resilience (DAIR) Research Team here . Learn more about the International Consortium on Self-Injury in Educational Settings (ICSES) at http://icsesgroup.org/ . Self-injury Outreach & Support (SiOS) offers resources for schools here and a list of do's and don'ts here . Visit SiOS at http://sioutreach.org and follow them on Facebook ( www.facebook.com/sioutreach ) and Twitter ( https://twitter.com/sioutreach ). Below are links to some of Dr. Heath's research as well as resources referenced in this episode: Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools . International Perspectives in Psychology: Research, Practice, Consultation, 9 (3), 176. Berger, E., Hasking, P., & Reupert, A. (2015). Developing a policy to address nonsuicidal self-injury in schools . Journal of School Health, 85 (9), 629-647. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 1: understanding nonsuicidal self-injury and the importance of respectful curiosity in supporting youth who engage in self-injury . NASN School Nurse, 35 (2), 92-98. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 2: how school nurses can help with supporting assessment, ongoing care, and referral for treatment . NASN School Nurse, 35 (2), 99-103. Lewis, S. P., Heath, N. L., Hasking, P. A., Hamza, C. A., Bloom, E. L., Lloyd-Richardson, E. E., & Whitlock, J. (2019). Advocacy for improved response to self-injury in schools: A call to action for school psychologists . Psychological Services, 17 (S1), 86–92. De Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2017). Non-suicidal self-injury in our schools: a review and research-informed guidelines for school mental health professionals . Canadian Journal of School Psychology, 32 (2), 122-143. Whitlock, J. L., Baetens, I., Lloyd-Richardson, E., Hasking, P., Hamza, C., Lewis, S., Franz, P., & Robinson, K. (2018). Helping schools support caregivers of youth who self-injure: Considerations and recommendations . School Psychology International, 39 (3), 312-328. Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., .Whitlock, J., & Wilson, M. S. (2016). Position paper for guiding response to non-suicidal self-injury in schools . School Psychology International, 37 (6), 644-663. Open access here . Book: Self-Injury in Youth: The Essential Guide to Assessment and Intervention (2008) by Drs. Mary Nixon & Nancy Heath 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

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