Physical pain has almost always been defined as the sensation that produces aversion reactions; that is, an unpleasant experience that we try to avoid. It appears when our nervous system registers that certain cell tissues have been injured and allows us to react in time to get away from danger.

However, human beings do not always act in a way that is consistent with this logic; in some cases pain is something that is intentionally sought, something that is achieved through self-injury. This is the idea behind the concept of Non-Suicidal Self-Injury .

What is Non-Suicidal Self-Injury?

Self-injury is very easily associated with suicide attempts, but in reality, in many cases, the goal that is kept in mind when it occurs is not death itself: self-injury is valued in itself, not as a means.

Thus, Non-Suicidal Self-Injury is the type of self-injury that occurs as a result of a learned dynamic to try to reduce anxiety levels through practices such as cutting, biting, or hitting hard objects that damage one’s body.

A mental disorder?

There is no broad consensus about whether Non-Suicidal Self-Injury is itself a mental disorder or a symptom that may reveal the presence of one. In the diagnostic manual DSM-IV it appears as a symptom linked to Borderline Personality Disorder, although in version V it appears as a diagnostic label of its own.

The truth is that this behavior is harmful in itself, but at the same time it can be considered a “lesser evil” that serves to alleviate a very high state of distress in which the root of the real problem lies.

Why does SLA occur?

What the SNA is trying to achieve is a feeling of momentary relief produced in part by the distraction of physical pain, which allows attention to be released from abstract ideas and memories that are even more painful.

According to the logic behind Non-Suicidal Self-Injury, the mere possibility of experiencing something other than that kind of anxiety and being a solution to rumination (thinking in a loop about something that produces discomfort) is valued very positively.

In other words, to understand why Non-Suicidal Self-Injury appears as a pattern of learned actions, it is necessary to take into account not the pain felt at the moment of injury, but the effect that this pain produces in a person who has been suffering for a long time for other reasons . In other words, it is not necessary to see the snapshot or frozen image of the self-injury, but the process of sensations and experiences that have led to that outcome, since that is what allows us to take into account the usefulness that the pain may have for the person. In that sense, it would resemble trichotillomania.

There is also an alternative explanation about the causes of NSA that links it to low self-esteem and a tendency to think negatively about oneself, whereby self-harm would be a way of reflecting that contempt for oneself through self-punishment . However, it is very possible that low self-esteem is another symptom of the underlying problem, and not the cause of Non-Suicidal Self-harm.

NSA as a predictor of suicide

Although the purpose of the NSA is not to end one’s life, it is true that its presence is a predictor of possible future suicide attempts .

A person who hurts himself will be more likely to propose to die, among other things because he has already assimilated the “ritual” that can lead to this kind of event and thinks about it more often. Moreover, the same causes that lead to this learned pattern of behaviour can lead to a desire to die, either in a more or less rational way or in the middle of a nervous breakdown.

Symptoms of Non-Suicidal Self-Injury

The most obvious symptoms of NSA are scars from cuts and bites and bruises from blows.

The cuts, which are very common, usually appear on the arms and legs , and therefore can be visible with a variety of clothing types. Other forms of self-injury are more discreet. Normally, one starts with parts of the arms and legs that are close to the thorax, since these are the parts of the extremities that are easiest to hide and at the same time are not as sensitive as the frontal parts of the trunk (as long as the inside of the arms is not injured).

The profile of people who harm themselves

Non-suicidal self-injury is more common among young people: primarily adolescents and post-adolescents. This may be because the emotional instability produced by the hormonal changes produces greater and more serious anxiety crises, added to the social changes that appear in this stage of life : doubts about one’s own identity, about what one is going to study, problems in fleeting relationships, etc.

In addition, there are certain personality traits that are more frequent among people who practice this kind of self-injury. These are people with a high impulsivity and emotionality (or sensitivity) who, in addition, have low self-esteem and value their abilities at a low and pessimistic level.

Treatments and psychotherapy

The most effective psychotherapeutic options are those that fall within the framework of Cognitive Behavioral Therapies, that is, that address both actions and thoughts. Specifically, Linehan’s Dialectical Behavior Therapy (DBT) , created especially to address cases of Borderline Personality Disorder, has been widely used.

The basis of these therapeutic approaches is to constantly postpone the moment of self-injury until it no longer occurs. This is a way of acting on behaviour that is reminiscent of addiction treatment.

In any case, the role of psychologists is focused both on decreasing the frequency and intensity of these behaviours and on learning ways of thinking and relating to others that allow to move away from stress in an adaptive and painless way . Similarly, a level of vigilance is maintained to detect moments in which suicidal ideation may appear.