1. Some notes on self-injury
Jessica Garisch
Tamsyn Gilbertson
Robyn Langlands
Angelique O’Connell
Lynne Russell
Marc Wilson
Emma Brown
Tahlia Kingi

2. So what are we talking about…?
Non-Suicidal Self-Injury (NSSI) is… (from the International Society for Study of Self-injury, 2007):
“…the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. It is also sometimes referred to as self-injurious behavior, non-suicidal self-directed violence, self-harm, or deliberate self-harm (although some of these terms, such as self harm, do not differentiate non-suicidal from suicidal intent).” “As such, NSSI is distinguished from suicidal behaviors involving an intent to die, drug overdoses, and socially-sanctioned behaviors performed for display or aesthetic purposes (e.g., piercings, tattoos). Although cutting is one of the most well-known NSSI behaviors, it can take many forms including but not limited to burning, scratching, self-bruising or breaking bones if undertaken with intent to injure oneself. Resulting injuries may be mild, moderate, or severe.”

3. Why do people do it…?

4. Why do people do it…?

5. Prevalence…
2,087 ED presentations across 4 regions over 12 months, 20% repeat presentations1
24% - Lifetime prevalence among community-based New Zealand adults2
48% of adolescents presenting to CAMHS reported SH at initial assessment3
20% of 9,000 secondary students reported SH in previous year4
31% of 1,700 secondary students thought of SH in previous month, 20% acted on it over 5 years5
 (conflation between SSI and NSSI)
1. Hatcher et al., 2009.
2. Nada-Raja et al., 2004.
3. Fortune et al., 2005.
4. Fortune et al., 2010.
5. Pryor & Jose, 02/04 to 09/09.

6. Prevalence… Sample N Measure # items Lifetime Prevalence
level PSYC students
285
Sansone et al’s (1998) SHI 22
78.9%/54.9%†
† r=.40 with suicidal behaviour

8. Prevalence… Sample N Measure # items Lifetime Prevalence
level PSYC students
285
Sansone et al’s (1998) SHI 22
78.9%/54.9%†
year-old School students
325
De Leo & Heller (2004) 1
14.8%
† r=.40 with suicidal behaviour

10. Prevalence… Sample N Measure # items Lifetime Prevalence
level PSYC students
285
Sansone et al’s (1998) SHI 22
78.9%/54.9%†
year-old School students
325
De Leo & Heller (2004) 1
14.8%
year-old School students
1,162
Lundh et al’s (2007) DSHI 14
48.7%
level PSYC students
593
43.7%
† r=.40 with suicidal behaviour

12. Prevalence… Sample N Measure # items Lifetime Prevalence
level PSYC students
285
Sansone et al’s (1998) SHI 22
78.9%/54.9%†
year-old School students
325
De Leo & Heller (2004) 1
14.8%
year-old School students
1,162
Lundh et al’s (2007) DSHI 14
48.7%
level PSYC students
593
43.7%
level PSYC students
722
Lundh et al’s (2007) DSHI (SV) 7
39.7%‡
† r=.40 with suicidal behaviour
‡ correlates .79 with the full 14-item DSHI

15. Why do those who self-injure, self-injure?

17. Interpersonal
Intrapersonal

18. Affect regulation was the most strongly endorsed function and, overall, intrapersonal functions were the most strongly endorsed.
ISAS subscale
Global
Mean (SD)
Most recent Mean (SD)
Affect regulation
4.62 (1.62)
4.57 (1.74)
Self-punishment
4.14 (1.91)
3.89 (2.15)
Marking distress
2.82 (2.00)
2.66 (1.96)
Anti-dissociation/ feeling generation
2.68 (2.16)
2.04 (2.25)
Anti-suicide
2.22 (1.98)
2.02 (2.27)
Self-care
1.49 (1.48)
1.34 (1.51)
Toughness
1.29 (1.53)
1.04 (1.54)
Interpersonal influence
1.18 (1.47)
0.92 (1.36)
Interpersonal boundaries
1.16 (1.51)
0.89 (1.50)
Sensation-seeking
0.77 (1.21)
0.52 (1.17)
Autonomy
0.77 (1.18)
0.60 (1.17)
Revenge
0.68 (1.26)
0.62 (1.37)
Peer-bonding
0.14 (0.56)
0.15 (0.81)

19. Myths of self-injury: All people who self-injure are suicidal
Self-injury is a female issue
Only adolescents hurt themselves
People who hurt themselves are mentally ill
People who hurt themselves have been abused
Supporting people who self-injure:
1. Avoid pejorative labels
2. Remember the myths!
3. Aim for low-key dispassionate demeanour and respectful curiosity – be professional!
4. Aim for a balance of appropriate level of concern that doesn’t alarm the person, condone the behaviour, but also provides support
5. Pass it on to the professionals – be clear of your own limits.

20. Useful resources
Excellent factsheets developed by the team from the Cornell Research Programme on Self-injurious behaviour in adolescents and young adults:
An information booklet written by an Australian psychologist for young people who self-injure:
An online power-point presentation for parents with children who are self-injuring:
A free, downloadable copy of 'Healing the Hurt Within' by Jan Sutton:
Our website:

21. Where next?
Towards understanding how NSSI starts, stops, and continues…
Year 9 and older
Longitudinal
Funded by the Health Research Council of New Zealand
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