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When actions speak louder than words: Understanding Non-Suicidal Self-Injury


In her academic career, Delia's research focus was primarily on self-harm. In her practice she builds upon approaches such as Cognitive Behavioural Therapy, Acceptance and Commitment Therapy, and Dialectical Behavioural Therapy.

Last Updated on March 14, 2024 by It’s Complicated

Did you know that two out of ten adolescents1 and almost one and a half out of ten young adults2 worldwide injure themselves? If you think about it, these figures are quite scary. Why, you may ask? The answer is simple: the likelihood that you know someone who has injured or still injures themselves is not so low, quite the contrary. But let’s start from the beginning: what does the word non-suicidal self-injury (or NSSI for short) mean?

Without boring you with all those clinical definitions, it is enough to know that NSSI includes a direct and deliberate behaviour aimed at damaging one’s own skin, and that does not have suicidal intents3. But we need to be careful here, because NSSI does not always (and exclusively) translates into cutting. Yes, cutting is the most common form of NSSI, but it is not the only one. Other methods include:

1. Scratching until bleeding,

2. Hitting the head against the wall,

3. Burning the surfaces of one’s own skin,

4. Prevent scars from healing, etc…

At this point you might wonder: “why would people voluntarily engage in such behaviour? Is it not counter-intuitive, given that, from birth, we all have the instinct to survive and escape danger? This behaviour goes against this instinct.” So, why would people engage in NSSI?

The reasons could be severalfold. Researchers, however, have identified the most common.

The intrapersonal function of NSSI

Source: Google images

This function, as the word states, has the aim to deal with internal (within the person) emotional states. According to research, people use NSSI to a) regulate their emotions, and specifically to escape negative states or induce positive ones, as well as to b) punish themselves for not being smart enough, good enough at school, good looking enough, skinny enough, having disappointed a loved one (e.g., parents, a partner, etc.). In both these cases, the purpose of NSSI is to cope with emotions experienced as overwhelming and difficult to handle.

The intrapersonal function (and the emotional regulation associated with it) is the most common reason that people mention when explaining why they used NSSI. In fact, when people experience emotions such as sadness, loneliness, anger or frustration, they use NSSI to help them decrease or escape from these emotions. Although we all have felt these emotions, some people experience them stronger than others, and this explains why they need “stronger methods” to get rid of them. It’s like the volume of the music: if for some people a medium level is just medium and does not bug them, for others is already too high and makes them uncomfortable.

The problem arises when, right after the NSSI act, people notice that they generally feel better, less tense, and the uncomfortable emotions temporarily disappear. So, this method to escape unwanted emotions really works! This means that people will use it every time they find themselves dealing with these emotions in the future, and this will create a vicious cycle between NSSI and difficult emotions. This makes sense, right? To you, this might not sound too scary or problematic at first…until you find out that people who engage in NSSI are more likely to have depression, eating disorders, and even have suicidal thoughts and attempts compared to those who do not engage in NSSI 4, 5. These are all very serious and dangerous mental health challenges that with the right support can be overcome.   

The interpersonal function of NSSI 

Interpersonal vs. Intrapersonal Skills: Why You Need Both to Succeed
Source: Google Images

Another less common reason to engage in NSSI is linked to the interpersonal function: in other words, everything that has to do with relationships with other people (external to us). In this case, people might use NSSI, for example, to communicate a level of distress. In a way it can be seen as a “cry for help”. Given that these people might not be able to deal with difficult emotions and situations by themselves, they use NSSI to get help from loved ones6. Here the title of a scientific publication in this field seems to be particularly appropriate: “Actions speak louder than words”7.

When looking at the reasons why people use NSSI, it is worth remembering that that the same person can use NSSI for different reasons simultaneously. It can also be that one person uses NSSI for different reasons in different phases of their lives.

But now that we know what NSSI is and what are the reasons why people use it, it is important to understand what NSSI is not. So, let’s debunk the three most common myths about NSSI together. 

Three myths about non-suicidal self-injury

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1. NSSI equals suicidality

Contrary to what you might think, and in line with its definition, NSSI is not synonymous with suicide. Yes, NSSI can make people more likely in the future to have suicidal thoughts or act on them, but it’s not the same. Sometimes it is actually the opposite: people might use NSSI to feel alive, to feel something, anything, even if that means to feel the burn in the skin. 

2. NSSI is just a phase that will pass

If you look at the research on NSSI, you will notice that this behaviour is particularly common during adolescence. This does not mean, however, that “it is just a phase”, that “it will pass by itself”, and that “there is nothing to worry about”. As you read previously, NSSI can be pretty serious and the earlier it starts, the more likely it is that it will continue in adulthood and lead to other serious issues. So, do not underestimate it. 

3. NSSI is a way to get attention from others or manipulate them

NSSI is actually a very private behaviour. Many people use it when they are alone, they try to hide it from loved ones as much as possible and often they are ashamed of it. Call it a “manipulation strategy” is then completely inappropriate and also hurtful.

Now that you know what NSSI is, what it is used for, and what the false beliefs about it are, you can act more sensitively and empathically around the people who engage in it, and hopefully help them deal with the emotional storm that they are living in. Because the people who use NSSI are more than their (physical) scars. 

If you want to know more about NSSI or you want to help someone who engages in it, feel free to visit the official website of the “International Society for the Study of Self-Injury” (ISSS; There you will find more resources and useful information.


1 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.

2 Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self‐injury in nonclinical samples: Systematic review, meta‐analysis and meta‐regression. Suicide and LifeThreatening Behavior, 44, 273-303.

3 Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 1–9.

4 Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2018). Self-injury age of onset: A risk factor for NSSI severity and suicidal behavior. Archives of Suicide Research, 23, 551–563.

5 Wilkinson, P. O., Qiu, T., Neufeld, S., Jones, P. B., & Goodyer, I. M. (2018). Sporadic and recurrent non-suicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study. The British Journal of Psychiatry, 212, 222-226.

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.

7 Tanner, C., Brügger, A., van Schie, S., & Lebherz, C. (2015). Actions speak louder than words. Zeitschrift für Psychologie/Journal of Psychology.

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