From the desk of a psychologist!

Tina had a friend who used to show up with different kinds of marks on her hands or feet. This friend used to really cover her body well, which Tina presumed to be because of religious reasons or parental pressure.Sometimes, they resembled burnt marks, while most of the time they were cut marks.Tina used to think that she has a friend, who is accident prone but after a few years she started connecting the dots. She understood that there was something not right with her friend. Tina started researching and from there she came to know about ‘ NSSI’.

Now, because of the lack of research in this field there are different terms floating and people use it as synonyms. Actually there is a very minor difference in them, let’s try to understand them in a better way:

Self Injury is the act of physically hurting yourself on purpose without the intent of committing suicide. It is a method of coping during an emotionally difficult time that helps some people temporarily feel better because they have a way to physically express and release the tension and the pain they hold inside. In other people hurting themselves produces chemical changes — endorphins, which are the same chemicals that cause a “runners high” — in their bodies that make them feel happier and more relaxed.

Emotionally or verbally punishing yourself isn’t self-injury, instead it’s what a lot of people call negative self-talk.

Unprotected sex, getting a piercing or tattoo for the pain of the act, starving yourself, etc. Those all are self-destructive but they’re not necessarily self-injury.

Emotional Cutters are people who injure themselves on purpose by making scratches or cuts on your body with a sharp object .

Self-harm includes self-injury ( as described above) and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions.


I thought for this article I’ll use the term ‘ Self Mutilation’ but then I understood that the term used is actually ‘ Non-Suicidal Self Injury ( NSSI). Aaron D. McClelland rightly points out, ” The term “self-mutilation” is an antiquated and misapplied descriptor for NSSI  in that it speaks to intent, however, within the vast majority of those who self-injure, their intent is for affect regulation, NOT to cause disfigurement. Many in the self-injury support community consider the term “self-mutilation” to be derogatory, hurtful and only adds to the mythology of the disorder. Most prefer the term self-injury or self-harm.”

In this post we are going to use NSSI but the title will also carry self mutilation because there are very few who understands and knows the proper term.

If you are one of those who have not seen or heard about it the first question that will crop up in your mind is going to be

” Why anyone will do so, as in harm oneself?”

This is an excerpt from a NSSI – “Because of all the abuse I began to self injury myself. It was a way to forget all the pain that was on the inside of me eating me alive. I first began doing this about the age of 8. I would take a hammer and beat my hands with it or take a hot iron and iron my hands or stomach. That worked for a little while and the burns and bruises were easy to cover up. As time passed and the abuse kept on, that didn’t seem like it was enough anymore so then I began doing the cutting along with the burning and beating. To see the wounds…made the pain inside not seem so real. You may say didn’t it hurt? My answer would be NO I didn’t feel anything. because the pain inside was just too intense and I had numbed myself to ALL PAIN. I didn’t love anyone, not even myself!”

As aptly contributed by Manjeet, ” Studies conducted by Nock and Prinstein (2004, 2005) suggest that there are four primary reason for engaging in NSSI: 1) to reduce negative emotions, 2) to feel “something” besides numbness or emptiness, 3) to avoid certain social situations, and 4) to receive social support. Although instances of all of these reasons for NSSI occur, a common misconception is that NSSI is primarily a form of social manipulation. In reality a number of studies have found that the primary reason for NSSI is reason number one: to reduce negative emotion. This seems like such a bizarre reason! How is it that inflicting physical pain or injury could be used to deal with emotional pain? Despite how paradoxical this may seem, people most often report the following reasons for NSSI: to stop bad feelings, to relieve feelings of aloneness, emptiness, or isolation, to distract from other problems, to decrease feelings of rage, to release tension, and to control racing thoughts. .”

Candance shares, “I’ve worked with adolescents in the foster care system in Orange County, California, for the past 17 years and most often teens who engage in self-mutilation (cutting) are not trying to kill themselves. Instead they find superficial cutting relieves in internal emotional pain they are feeling. It’s like releasing a valve that is built up with pressure, as the emotional pain disolves and afterward they feel better. The children who tend to engage in this behavior are often the ones who won’t talk to others about their pain or problems, but rather let it build up internally, which leads to the cutting. This behavior is also contagious in that child who witness a peer engaging in the behavior may try it as well.”

Larraine emphasizes, “I too work with young people (11-19) who self harm and I with agree Candace, that yp say self harming helps alleviate the internal pressure that builds up around issues they struggle to deal with. My experience here in England is that YP do talk to peers but issues relating to family, peers or educational expectations can far exceed their ability to cope. unfortunately this can and has led to suicide. Generally though self harming is used as a coping mechanism and I find that once we establish a non-judgmental .caring safe environment YP can move forward.”

Some people develop NSSI through observational learning; they learn it from somebody else or through the media. The chances of most people actually seeing another person self-injury are very slim, but in places such as psychiatric hospitals and prisons the odds are much higher. Since self-injury has become a part of the vernacular, part of society’s everyday knowledge, the incidence of NSSI, especially amongst teens, has exploded. Where once a self-injurer may been alone in their social group it’s common for teenagers to have friends who actively self-injure or have self-injured in the past.

Diane Sue, PhD. shares, ” I have found that many of those who persistently self-injure have underlying conditions, especially depression, anxiety and sometimes PTSD. Often there are few adults in their lives they can turn to for support.”

My research and experience has made me realize one thing that NSSI is not limited to any age group or gender. The experience of NSSI varies in different individuals. Chris White, Ed.D. says, ” Interestingly, I have observed a major change in who is engaging in this behavior over the past few years. For most of the 27 years I have been practicing, cutters were almost always women who had experienced fairly severe physical or sexual abuse as children and had begun cutting in their 20’s or 30’s. Now, I am seeing much younger girls, as well as some boys/young men, begin cutting in their early teens or even pre-adolescence, who do not have histories of trauma! Some even talk of having “cutter clubs” in their high schools where kids trade “tips” around this behavior.”

Basically the purpose is not killing or hurting oneself but it is due to lack of healthy strategies to deal with your pain. I researched and asked a lot of professionals from this field for help. From the studies and contributions from people working in this field I have tried to collaborate some strategies :

  • You need to find a healthy vent for your pain & problems.
  • It is fine to find strength from within you, but its destructive to accumulate the pain you are going through internally.There is a critical difference here, which we need to understand ; Being a person who is not talkative is amazing if you are happy with it, but if you are going through a phase where you need help, you need to gather the courage to seek it.
  • We need to understand the difference between positive & negative peer pressure. Just because someone, we consider as our style icon, is doing a certain thing, it is not necessary that we should follow them blindly. Sometimes it starts as a cool thing but stays with you forever, mutilating yourself becomes a habit which goes out of your hands.The origin of self-injury is often difficult to determine or understand. Many people are unable to remember where they first got the idea of hurting themselves, and when they actually began to self-injury.
  • If you know someone or a caretaker of a person going through this syndrome, you need to establish a non judgmental & caring atmosphere.
  • You need to be very vigilant for the early signs of injury. Ask questions and seek answers. People who self-injury usually begin by cutting themselves with a knife, razor blade, or other sharp object. From there the person tries other forms of self-injury, such as burning, hitting, etc., until they find their preferred method.
  •  If dissatisfied, bring in a person who could help. The best way you can help a person going through NSSI is connecting him to a therapist. You need an expert here because often there is a lot of underlying reason behind the NSSI behavior.
  • Allow the expression of emotions in a healthy way. Don’t bottle up inside. Often it is the fear or disturbing of expressing it which leads to self damaging path. Sometimes you also learn unhealthy way of showing your emotion, seek proper care if you are one of them in the form of a support group.
  • Don’t be scared of changes in life. Change is growth, though it is feared by most as it is also the unknown. It is being seen that the most cases of NSSI is being reported or observed in teens or mid twenties. It could be due the fact that in this phase of your life you go through a lot of changes.The best way to deal with it to be aware and ready for the new.
  • Feel the pain: Running away from your pain is never the solution.  NSSI is way for short lived relief. You need to live your feeling. There is a whole series on pain: Feel the pain, live the pain and relieve the pain which could help you with this step.
  • Do accept that there is no Shame in what you are doing. It is quite understandable that till now this was the only coping skill you had but realize one thing that it is not a healthy one. Deal with your feeling of shame and seek help.
  • For a primary self check examine your thoughts by asking yourself direct questions like; “What did you intend to accomplish through ___________?” , “What was the point to __________?”, “How did you expect people to react?”, “What did you expect to happen if you didn’t do it?”.

I would like to compare NSSI to an addiction to a depressant. You start with a feeling of euphoria, which fades away leaving you more depressed. You chase the “first time high”, sadly that is unattainable.

In the end I want to say that there are more ways of coping, you just need to look for it!
P.S. A special thanks to all those who took some time out and helped with this article.

Comments on: "Non Suicidal Self Injury, Please don’t refer as Self Mutilators ( Cutters)" (14)

  1. This really is such a commonly ignored aspect….loved reading it……acted like an eye opener…..we all are generally guilty of being judgmental about such people….and forming an opinion of a “psycho”, “insane” or “mad”….now i know what to do…n how to react.

  2. Dr.vk sharma said:

    Imformative to common people!

  3. Don Williams said:

    Very insightful …Omg…at best I assumed there were a few recreational self mutilators..borderline emotionally unhinged..folks..

    that this is an actual addiction for some is scary and eye opening…

    I hope they’re working on a cure this this obvious mental disease

    Thanks for Sharing…

  4. Greetings Naghma,

    I would like to take this opportunity to expand on the quote you used from my post to you on Linked In; The use of the term “self-mutilation” is an outdated one that was borne of ignorance and observation without investigation on the part of clinicians. They described what they saw, not what their patients’ intent was.

    Occurrences of self-mutilation do occur, many associated with Body Dysmorphic Disorder with accompanying psychosis. The intent of a person struggling with self-injury or self-harm is for affect regulation, not to disfigure their body. Most are ashamed of their scars and go to extreme lengths to hide them.

    Using the term “self-mutilation” is not only a misnomer, but also reinforces the belief amongst many in the self-injury peer support community that mental health practitioners don’t understand NSSI and therefore can be no help.

    Even Dr. Armando Favazza – one of the early leaders in modern NSSI research has discontinued the use of the antiquated “self-mutilation” – his letter stating so can be found on Deb Martinson’s website “Secret Shame”.

    As a therapist, I believe we need to use the language of our clients. To someone who struggles with NSSI, being labeled as a “self-mutilator” will only feed the negative core schema that underlies their difficulties and confirm that we do not understand them, nor wish to.

    in the spirit of understanding and to aid educating others, I ask that you remove “Self-Mutilation” from the title of this blog entry.

    • unwrappingminds said:

      Thank you so much Aaron for the insight and I totally understand the point you are coming from. My only reason for putting it there is, most of the people are not aware of the term NSSI and in need of help most of the time they search for self mutilators or a term similar to that. I would like them to have the access to information.

      • Could you then not replace the judgmental and inaccurate “self-mutilation”, “self-mutilators” with self-injury, self-injurers or self-harm, self-harmers?

        This may seem like a small thing to some in our professional community, but to a person who struggles with an addiction to self-injury, it is tantamount to being called a racial slur.

        As mental health clinicians, we need to exercise tact and sensitivity toward our clients and the general public. We would no longer even think to use the term “retard” to refer to someone with a developmental delay, nor should we use “self-mutilator” to refer to someone who self-injures, because both terms are hurtful, insensitive, and inaccurate.

  5. I would like to repost this blog. Please contact me at

    Thank you

  6. Those of who do so, or use to in my case, call it self harm, not NSSI. We dislike NSSI. We call each other cutters.
    It’s an informative artical and you did it well.

    • unwrappingminds said:

      Thank you for this insight because a person who actually has gone or going through it is the best judge of the terminology used.

  7. […] is posted by Naghma Khan, a Clinical & Addictions Psychologist in India, she writes the blog: The million dollar question you might ask is “Who am I & what am I doing writing this […]

  8. Serenity Pearls said:

    Your writing is very interesting and informational. This is one of the highly neglected topics. Most people who aren’t involved in it directly hardly understand, perhaps because our lack of empathy and that we can’t seem to relate to this sort of behavior.

    You have written that banging is a form of self-harm. I had read it in a research journal once that head-banging is a form of suicide. I found the concept particularly astounding since head-banging has literally become a norm in the music industry. Would you be kind enough to elaborate the relation between headbanging and self-harm/suicide?

    • unwrappingminds said:

      Thank you for the kind words. I will certainly post, what you asked for soon!

  9. […] Non Suicidal Self Injury/Self Mutilators ( Cutters) ( […]

  10. I am also a cutter. The terms I use (as well as all the other cutters I’ve met in halfway houses and hospitals) are:
    * cutting
    * self-mutilating

    As a cutter, I don’t use “self-injury”, because that can also refer to people who just bruise or scratch themselves and I feel that it is a less serious level of self-mutilation.

    I have never EVER used NSSI and have never had a psychologist, psychiatrist, counselor, nurse or doctor use it either. It’s way too clinical.

    It’s similar to my history with miscarriages. I had four losses in a row. Those of us with that experience are typically labeled with “recurrent pregnancy loss”, but the clinical term is “habitual aborter”. Clinical terms are way too… well… clinical.

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