Understanding Non-Suicidal Self-Injury and Informal Support Approaches

Background

I wrote this because someone close to me shows these behaviors, specifically skin cutting and skin pinning. I realized I didn’t fully understand it, so I started exploring the topic more seriously. The goal is simple. When they talk about it, I don’t want to misinterpret or react the wrong way. I want to understand what they mean so the conversation feels more aligned and not disconnected.

Definition

At a high level, self-harm behaviors are commonly split into two categories, non-suicidal self-injury (NSSI) and suicidal behavior (SB) [7]. In this write-up, the focus is on NSSI.

Self-harm, or non-suicidal self-injury, refers to deliberate and intentional injury to body tissue in the absence of suicidal intent. It is defined as the act of injuring oneself deliberately without the aim of ending one’s life, usually causing mild to moderate physical damage that is considered socially unacceptable. Common examples include burning, hitting oneself, or cutting the skin with a sharp object [6]. In many cases, self-harm is done as a way to shift from emotional pain to physical pain, which can feel more manageable or provide temporary relief [1].

Self-injury often begins during adolescence, usually between the ages of 12 and 14. Several studies show that the prevalence peaks around age 15 and then decreases in early adulthood, although some findings suggest a later onset between ages 17 and 20, which means the pattern can vary [2]. Adolescence itself refers to the transitional stage between ages 10 and 19 [2]. It is a sensitive and vulnerable period where a person learns how to internalize and express emotions. When unhealthy coping mechanisms are learned or used [3], a wide range of problematic behaviors can appear. In short, self-harm is often a coping mechanism for teenagers who experience psychosocial pressure, such as family conflict [4] and academic pressure [5].

The Psychological Meaning of Skin

The skin is a fairly simple organ from a physiological perspective, but socially and psychologically it is highly complex. People are often judged based on their skin, and even concepts of beauty are closely linked to it. The skin also acts like a visible surface where emotional states are displayed. Emotions such as rage, shame, or fear can show through physical changes like flushing, blushing, or becoming pale.

At the same time, the skin functions as a boundary between the outer world and the inner self. It separates the environment from the individual. Even though people can sometimes feel emotionally merged with others in certain situations, in everyday life we still experience ourselves as being contained within our own skin. What is inside the skin is considered the self, and what is outside is not.

Because of this symbolic importance, it is not surprising that the skin becomes a common site for self-injury. It is most often cut or burned, but it can also be scratched, slapped, pinned with sharp objects, or deliberately infected. In this way, self-injury can be understood as making internal emotional distress visible through the body [8].

Helping a Teenager Who Self-Injures (NSSI)

When helping a teenager who self-injures as a non-medical supporter, the first step is to create a safe and non-judgmental space where open conversation is possible. This means being able to talk about the behavior without reacting with shock, while still gently checking whether there are any thoughts related to suicide. It is important to understand that self-injury often serves a purpose, such as reducing overwhelming emotions or managing social stress. Because of that, instead of reacting immediately, it is more helpful to focus on what the behavior might be communicating.

Involving the family is also important, since family support, warmth, and good communication can act as strong protective factors and help create a more stable environment. A practical step is to work together on a simple crisis plan. This can include identifying early warning signs, listing coping strategies or distractions, identifying people they can reach out to, and limiting access to objects that may be used for self-harm.

Encouraging professional help is also necessary, especially through evidence-based approaches such as Dialectical Behavior Therapy for Adolescents, which focuses on building emotion regulation skills. It is also important to understand that no medication has been proven to directly treat self-injury, so the focus remains on emotional and relational support. In situations where there is acute distress or very high stress, a brief hospital stay may be needed to ensure safety while the individual learns to manage their distress in a more controlled environment [9].

References

[1] Y. Y. Zeng, S. Saeed, and S. H. Hu, “Non-Suicidal self-injury: Pain addiction mechanisms, neurophysiological signatures, and therapeutic advances,” J. Clin. Med. Res., vol. 17, no. 10, pp. 537–549, Oct. 2025, doi: 10.14740/jocmr6332.

[2] L. Tilton-Weaver, D. Latina, and S. K. Marshall, “Trajectories of nonsuicidal self-injury during adolescence,” J. Adolesc., vol. 95, no. 3, pp. 437–453, Apr. 2023, doi: 10.1002/jad.12126.

[3] Y. Wu, Y. Zhang, C. Wang, and B. Huang, “A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression,” Front. Public Health, vol. 12, p. 1434958, Jul. 2024, doi: 10.3389/fpubh.2024.1434958.

[4] S. E. Victor, A. E. Hipwell, S. D. Stepp, and L. N. Scott, “Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset,” Child Adolesc. Psychiatry Ment. Health, vol. 13, no. 1, p. 1, Dec. 2019, doi: 10.1186/s13034-018-0261-0.

[5] A. Steinhoff, L. Bechtiger, D. Ribeaud, M. Eisner, and L. Shanahan, “Stressful life events in different social contexts are associated with self-injury from early adolescence to early adulthood,” Front. Psychiatry, vol. 11, p. 487200, Oct. 2020, doi: 10.3389/fpsyt.2020.487200.

[6] S. Kim, S. Woo, and J.-S. Lee, “Investigation of the subtypes of nonsuicidal self-injury based on the forms of self-harm behavior: Examining validity and utility via latent class analysis and ecological momentary assessment,” J. Korean Med. Sci., vol. 38, no. 17, p. e132, 2023, doi: 10.3346/jkms.2023.38.e132.

[7] A. Poudel, A. Lamichhane, K. R. Magar, and G. P. Khanal, “Non-suicidal self-injury and suicidal behavior among adolescents: Co-occurrence and associated risk factors,” BMC Psychiatry, vol. 22, no. 1, p. 96, Dec. 2022, doi: 10.1186/s12888-022-03763-z.

[8] A. R. Favazza and R. J. Rosenthal, “Varieties of pathological self-mutilation,” Behav. Neurol., vol. 3, no. 2, pp. 77–85, 1990, doi: 10.1155/1990/572716.

[9] M. Apicella et al., “Non-suicidal self-injury in adolescents: A clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments,” Front. Psychiatry, vol. 16, p. 1605508, Jul. 2025, doi: 10.3389/fpsyt.2025.1605508.