Anywhere between 17% and 38% of adolescents and young adults engage in behaviors of nonsuicidal self-injury, defined as “the deliberate, self-inflicted damage of body tissue without suicidal intent.” These behaviors, which might include cutting, scratching, head-banging, and burning, sometimes help people cope with negative emotions or even serve to keep them from attempting actual suicide, but they can also pose real harms.
A recent study in Clinical Psychological Science explores the role that online groups and e-communities can play in reducing the harm posed by nonsuicidal self-injury and in contributing to more effective treatments of this behavior. To speak about self-injury and how online communities might help, Emma Preston, an APS member and graduate student at the University of Southern California, joined APS’s Ludmila Nunes.
[00:00:13.350] – Ludmila Nunes
Estimates suggest that between 17% and 38% of adolescents and young adults engage in nonsuicidal self injury, defined as deliberate self inflicted damage of body tissue without suicidal intent. These behaviors, which include, for example, cutting, can be used to cope with negative emotions, which makes their cessation difficult. Despite how pervasive nonsuicidal self injury is, no effective treatments appear to be available. A reconceptualization of the treatment approaches to non suicidal self injury focused on preventing harm might help to minimize its negative effects. This is under the cortex. I am Ludmila Nunes with the Association for Psychological Science. To speak about how online groups or ecommunities may reduce the harm posed by self injury, I have with me APS member and graduate student at the University of Southern California, Emma Preston. Emma Preston, coauthored with Amy West, a professor of clinical pediatrics and psychology at the Children’s Hospital Of Los Angeles and the University Of Southern California. An article published in Clinical Psychological Science that reviewed how non suicidal self injury ecommunities, that is, online groups that share experiences with non suicidal self injury and other contents about self injury may inform harm reduction interventions.
[00:01:54.190] – Ludmila Nunes
Welcome to Under the Cortex. Thank you for joining me today.
[00:01:56.350] – Emma Preston
Thank you so much for having me. I’m really excited to be here to chat with you.
[00:02:02.280] – Ludmila Nunes
I was going to ask you to start by explaining what is actually non suicidal self injury.
[00:02:09.550] – Emma Preston
Sure. So the textbook definition of non suicidal self injury is the deliberate self inflicted damage of bodily tissue without suicidal intent. And for purposes that aren’t socially or culturally sanctioned, think things like tattoos. But most of the time when we think about non suicidal self injury we think about things like cutting. This is usually done with a razor blade, often on the wrists or the upper thighs. But non suicidal self injury actually includes a wide, wide range of behaviors. Things like self scratching, head banging, burning. There’s actually quite a long list. And for a long time we thought that self injury was a feature of suicidal behavior. So something you do before you attempt a suicide. But what we’re actually starting to learn is that many, many people engage in these behaviors and they don’t want to die. There seems to be a phenomenon that’s completely independent from suicidal behavior. Sometimes they overlap. But non suicidal self injury seems to be an independent phenomenon.
[00:03:19.810] – Ludmila Nunes
So it’s not the idea that it signals suicide or that people engage in this type of behavior because they are depressed or desperate. This type of self injury, of bodily harm can actually have some benefits. Right?
[00:03:39.130] – Emma Preston
Yeah. This is really interesting. I think to me and a growing number of researchers. People engage in non suicidal self injury for all kinds of reasons. Some people engage in it because they’re depressed. Some people engage in it because they are thinking about suicide. But many people engage in it because it’s serving a purpose. So some really interesting research from Dr. Hooley and Dr. Franklin talked about this idea that the reason why so many people engage in non suicidal health injury is that it’s a very functional behavior. So they talk about the affect regulation piece, they talk about a communication piece, social belonging piece. There’s some really interesting research with people who have lived experience in self injury. And a lot of these people talk about how engaging in self injury helps protect them against suicidal behaviors. They explain that engaging in non suicidal self injury is like a protector. They hurt themselves so that they don’t kill themselves. And this is a really interesting clinical phenomenon because as a clinician, you don’t want someone to hurt themselves. But they’re saying I’m doing this so that I don’t kill myself. And that is a really challenging patient population to work with.
[00:05:04.570] – Ludmila Nunes
So are these behaviors well studied? Because your article is basically a review on the research of these type of behaviors and then you use that review to come up with ideas about how to create better treatments.
[00:05:24.610] – Emma Preston
Yeah. So nonsense of injury historically has been really difficult to study. For a long time we thought about non suicidal self injury as just a feature of suicide or a feature of borderline personality disorder. And it’s not been until recently that researchers have started to give a lot of undivided attention to non suicidal self injury. But the literature is still pretty murky. A lot of people lump all kinds of self injury in together when they study it. Self injury done with suicidal intent and non suicidal self injury. People use different words to describe non suicidal self injury, things like deliberate self harm. So I would say the field is definitely in an exciting stage right now. People are really starting to get attention to this behavior by itself. But historically we’ve looked at it in relationship to other things like suicide or borderline personality disorder.
[00:06:20.150] – Ludmila Nunes
What did you do in this article? What was your goal?
[00:06:23.650] – Emma Preston
So I started thinking about this article because I was really curious about kind of the disconnect between the prevalence of non suicidal self injury, people say between 1718 and the high 30% of people, particularly adolescents, will engage in this behavior and how few of them actually seek treatment. And for the folks who do seek treatment, there’s very little evidence based treatments available to you. I thought this was really interesting, very curious as to why this is the case. And so I dove into the literature just looking to see what people are saying. How are people thinking about self injury, nonsucile selfinjury? And pretty quickly I saw that the writings of people with lived experience who have lived experience in this behavior were very, very different than the way researchers were talking about this behavior. People with lived experience were talking a lot about non suicidal self injury like addiction, talking about being unable to stop the difficulties with complete cessation or they would even use the word obstinates. And then in the research literature, oftentimes nonsiccious self injury is measured as a dichotomous variable. So yes or no? That’s two very different ways of thinking about this behavior.
[00:07:46.930] – Emma Preston
So as I was going through the literature, I also started to see a lot of literature on self injury ecommunities. These are online groups dedicated to the sharing, the solicitation self injury information. And they exist all over the internet and researchers have dated them back to the 90s. So they’ve been around for a while. And on these platforms, people who are engaging in nonsucile self injury talk about their experiences. They ask for support, they support each other, they seek out information in a way that they’re not doing an in person clinical care or therapy. So I was curious what these platforms might be offering people and how we could use that information to inform our clinical care, to make it better, to make it more effective, more acceptable. And the thing that came out both in the writings of those with lived experience in self injury and in these non suicidal self injury communities was this idea of harm reduction and talking about the need for immediate lifesaving information for folks who cannot or do not want to stop their non suicidal self injury. And so in this paper, we explored kind of how these NSSI ecommunities might point to treatment targets, specifically harm reduction treatment targets for non suicidal self injury, and just explored what it would be like if we thought about harm reduction as a treatment for this behavior.
[00:09:19.990] – Ludmila Nunes
In your research for this article, did you uncover anything unexpected, novel, something that you were surprised by?
[00:09:29.470] – Emma Preston
I think this is such an interesting question. I was most surprised by how many people who engage in self injury use these online communities. I thought, oh sure, like maybe a couple hundred, couple thousand people might check them out, use them once in a while. But these communities first of all, they’re on Instagram, TikTok, Reddit, YouTube, wallpad LiveJournal. They’re everywhere. And they have thousands and thousands of not just members, but highly active members. So any time you go online, you have the opportunity to talk to several hundred, if not several thousand people who are all having the same experiences as you. And that was really surprising to me that this is not just like a few folks who are using these communities, but thousands and thousands of people are using them.
[00:10:24.670] – Ludmila Nunes
So we’re talking about how these communities can give some clues about harm reduction and this would include like wound care, how to properly cut oneself, all of these things. And one thing that keeps popping in my mind is would these communities also have some negative effects? Like, for example, motivating people to do self harm and providing just the fact that they’re providing information about it? Would that increase people who engage in non suicidal self injury.
[00:11:04.210] – Emma Preston
This is such a hot topic among researchers and you can find evidence for either side the pros and the cons of these non suicidal self injury communities. There’s some research that suggests that they can breed like a competitive I have to hurt myself worse than you atmosphere. But I would say a lot of research, particularly newer research, has shown that these communities are primarily a place of support for people. Sometimes searching for information about how to hurt yourself worse, but a lot of times searching for information about what to do after you’ve hurt yourself, how to clean a wound, can you use a blunt instrument? When do you have to go get medical care? And so I think as a field, we’ve barely dipped our toe into the data that’s in these communities. And so there’s still so much work that needs to be done to determine if they’re good or they’re bad. But I guess I would say that many people are using them. Thousands and thousands of people are using them. And so clearly they’re serving a purpose. It seems that the purpose is often community and support, but there definitely can be dark sides to using these communities as well.
[00:12:16.870] – Ludmila Nunes
It sounds from your research and your review that maybe if they are focused on these harm reduction and wound care, maybe they’re doing something positive.
[00:12:27.910] – Emma Preston
[00:12:30.610] – Ludmila Nunes
So in your article you mentioned ethical considerations about using these communities. And I’m sure those have to do a little bit with these possible negative effects, but maybe also regarding the identities of people as users of these communities.
[00:12:50.390] – Emma Preston
[00:12:51.160] – Ludmila Nunes
Do you want to elaborate a little bit more on those?
[00:12:54.250] – Emma Preston
Of course. So I’ll say that every research team handles this differently. I think we really need like a standardized set of principles as more and more researchers start looking at the data in these communities. Personally, our team and I think many other teams, oftentimes don’t publish the names of the ecommunities, so they will give kind of a brief description of the community, but they don’t actually give the community’s name to try and protect the anonymity of the users. In the same way, we’re doing some research right now where we’re actually looking at content in those communities and in the work that we publish, we don’t use direct quotes, again, trying to protect anonymity of users. But this is, I think, something that’s a real ethical question, particularly if you’re working with data from a community where users aren’t anonymous, it’s public, it’s free, it’s open online, but we really want to do right by the users in these communities. And so I think doing as much as we can to preserve their non limiting is really important as a field.
[00:14:07.750] – Ludmila Nunes
Yes, totally. And so what would you say are the practical implications of this research and this review?
[00:14:17.470] – Emma Preston
So I think our big takeaway, the hope that we have for this article is that we’ll inspire empirical research on harm reduction and nonsucile selfinjury. I think that this article makes quite a compelling case for why we need harm reduction treatments and the study of harm reduction in non suicidal self injury. And so I really hope that the next step is very rigorous ethical research that looks at how we could use harm reduction in a systematic way. I also think collaboration between computer science and clinical psychology and the study of these non suicidal self injury ecommunities is super exciting, particularly thinking about digital interventions and how we could maybe mimic what these ecommunities are providing in a digital intervention setting. It could be really interesting as well.
[00:15:13.390] – Ludmila Nunes
Yes, I agree. Very interesting research. Thank you for sharing it with us. This is Ludmila Nunes with APS and I’ve been speaking to Emma Preston from the University of Southern California and lead author in an article about how a focus on harm reduction may be promising to reconceptualize the treatment of non suicidal self injury. I’d like to thank you for joining me today.
[00:15:39.860] – Emma Preston
Thank you so much for having me.
[00:15:42.430] – Ludmila Nunes
If anyone is interested in reading this study or learning more, please visit our website. psychologicalscience.org.
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