Non-Suicidal Self-Injury (NSSI)

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    • 00:02

      [MUSIC PLAYING][Non-Suicidal Self-Injury-- NSSI]

    • 00:11

      DR. JASON WASHBURN: My name is Jason Washburn,and I am a clinical psychologist and alsoa director of the Center for EvidenceBased Practice at Alexian Brothers Behavioral HealthHospital.[Jason J Washburn, PhD Director, Center for Evidence BasedPractice at Alexian Brothers Behavioral Health Hospital]In addition, I am the Director of Educationin Clinical Training for the PhD programin Clinical Psychology at Northwestern University,Feinberg School of Medicine.I have practiced with children, adolescents, and adultsfor over 15 years in multiple, different contexts-- includingthe community hospitals and in incarcerated environments.

    • 00:42

      DR. JASON WASHBURN [continued]: I am also a board-certified clinical childand adolescent psychologist.In this tutorial, we are going to be talkingabout non-suicidal self-injury.First, we are going to define what we meanby non-suicidal self-injury.[Definition of non suicidal self injury.] Second,we are going to talk about how non-suicidal self-injurydiffers from suicidal self-injury.

    • 01:02

      DR. JASON WASHBURN [continued]: [Difference between non suicidal and suicidal self injury].Finally, we are going to talk about why people engagein non-suicidal self-injury.[Why people engage in Non Suicidal Self Injury][What is non-suicidal self-injury?]So first, what do we mean by non-suicidal self-injury?Non-suicidal self-injury is somewhat of a clumsy term,but it is actually quite descriptive.What we mean by non-suicidal self-injuryis when somebody engages in a self-injurious behaviorwhere they will destroy some part of their body tissue,purposefully, for purposes which are not suicidal.

    • 01:35

      DR. JASON WASHBURN [continued]: They are hurting themselves in a way thatresults in either the tearing or the breakingof their skin, or bone, or some other part of their body.But they are not trying to kill themselves.Of note, non-suicidal self-injuryexcludes anything that is engaged in for sociallysanctioned reasons.

    • 01:57

      DR. JASON WASHBURN [continued]: What do we mean by that?Tattooing, piercing, other forms of body modificationin which somebody is altering their bodyfor purposes of beautification and not to actuallyhurt themselves.That does not qualify as non-suicidal self-injury.[What is suicidal self-injury?]Suicidal self-injury is more severe and usuallylife threatening.

    • 02:22

      DR. JASON WASHBURN [continued]: It will often involve things such as swallowing pills,jumping from heights, using something to strangle oneself.It can sometimes involve cutting behavior as well,but the cutting is usually going to bemuch more severe than you would seein non-suicidal self-injury.With non-suicidal self-injury, a lot of times, the cuttingdoesn't even need a Band-Aid.

    • 02:45

      DR. JASON WASHBURN [continued]: Sometimes it might need a Band-Aid.And more rarely, it's going to need medical intervention.Typically with suicidal self-injury,you are almost always going to need some sortof medical intervention.There is also another way that fundamentallynon-suicidal self-injury is differentthan suicidal self-injury.In short, there is no intention to die, in fact,the intention is to live-- to continue on, to cope,to do better than one is doing right now.

    • 03:15

      DR. JASON WASHBURN [continued]: With suicidal self-injury, the intentionis to make it all stop-- to die, to escape.Very, very different reasons that oneengages in non-suicidal self-injury.Because these two conditions are very different from each other,we believe is important to separate themand to be sure that one is talkingabout either suicidal self-injury injuryor non-suicidal self-injury.

    • 03:41

      DR. JASON WASHBURN [continued]: It is important to note, however,that non-suicidal self-injury-- even though it is engagedin for purposes that don't involve the wantingto die or suicide-- that non-suicidal self-injuryactually increases risk for suicidal self-injury.[What are the funcions of non-suicidal self-injury?]Non-suicidal self-injury is a very confusing and complexcondition.

    • 04:05

      DR. JASON WASHBURN [continued]: To a lot of people it doesn't make sensewhy somebody would hurt themselves on purpose.A lot of research over the last decadehas focused on understanding why people engagein non-suicidal self-injury.This research has really focused on whatwe refer to as the functions of non-suicidal self-injury.In other words, what is the purpose or functionof the self-injury for a given person?

    • 04:34

      DR. JASON WASHBURN [continued]: A lot of research has shown that non-suicidal self-injurytends to serve two purposes-- two over-arching purposes.Intrapersonal reasons, or reasonswithin the self, and then interpersonal reasons,or social reasons involving other people.

    • 04:55

      DR. JASON WASHBURN [continued]: One of the biggest reasons that peopleengage in non-suicidal self-injuryis affective regulation, which isan intrapersonal, or within self, reasonfor engaging in non-suicidal self-injury injury.[Intrapersonal functions Affective regulation]Self-injury actually regulates their emotions.It helps them to feel better.

    • 05:17

      DR. JASON WASHBURN [continued]: If they're feeling very upset, very distraught,non-suicidal self-injury will actuallydecrease their feelings, decreasetheir unwanted feelings and arousal.If they're feeling nothing, if they feel numb or empty inside,self-injury can help them to feel something.So the affective regulation functionof non-suicidal self-injury is critical.

    • 05:43

      DR. JASON WASHBURN [continued]: Our data show that approximately 70%of the people that we treat for non-suicidal self-injuryendorse the affective regulation function of this behavior.[Intrapersonal functions Suicide prevention]The anti-suicide function of non-suicidal self-injuryis one of the most common functions of the behavior.

    • 06:05

      DR. JASON WASHBURN [continued]: A lot of times non-suicidal self-injuryis used to help to cope with or preventthe onset of suicidal thoughts and feelings and behavior.So in many ways, non-suicidal self-injuryis a behavior people engage in to stay alive.[Intrapersonal functions Self punishment]The self punishment function of self-injuryinvolves expressing one's antipathy or hatred of oneselfor dislike of oneself directly through aggressingagainst oneself-- through hurting oneself.

    • 06:42

      DR. JASON WASHBURN [continued]: There's a theory of non-suicidal self-injury called the selfdeprecatory theory of self-injury, which basicallysays that the function of self-injuryis to express how much I don't like myself.In many ways, non-suicidal self-injuryis a direct representation of that inward hatred and dislike.

    • 07:06

      DR. JASON WASHBURN [continued]: Now, we've discussed the intrapersonal,within self functions, of non-suicidal self-injury.But if you ask most people, why does somebodycut themselves or hit their head against the wallwhen they're upset?Most people would say, it's because they want attention.This may be true.

    • 07:27

      DR. JASON WASHBURN [continued]: What we generally find, though, isthat most people engage in non-suicidal self-injuryfor those intrapersonal functionsthat we just discussed.That said, a good number of peoplealso engage in non-suicidal self-injuryfor interpersonal or social functions.[Interpersonal functions-- social functions]Somebody may engage in non-suicidal self-injuryto influence others-- to maybe get their attention,to maybe get them to do something that they want themto do, to maybe get them to change their mind on a decisionthat they've made.

    • 08:02

      DR. JASON WASHBURN [continued]: They also may do it to bond with somebody else--to show that they are a part of a group, for example.So while the majority of the functionsof non-suicidal self-injury involve thingswithin the self-- such as affective regulation, selfpunishment, or anti-suicide-- we do alsosee that there are social functionsto non-suicidal self-injury.

    • 08:28

      DR. JASON WASHBURN [continued]: [Treatment for non-suicidal self-injury]So understanding the functions of non-suicidal self-injuryare actually critical to the treatmentof non-suicidal self-injury.It also highlights the differencebetween the treatment for suicidal self-injury.In non-suicidal self-injury, you aregoing to be working on replacing non-suicidal self-injuryas a way to address the needs of the patientand instead replacing them with coping mechanismsand strategies that are healthierbut yet still address those functions.

    • 09:06

      DR. JASON WASHBURN [continued]: So for example, using relaxation techniques or usingmindfulness when one is upset, rather than engagingin non-suicidal self-injury.Another option is that patients canengage in grounding techniques to help them to feelmore connected with the world.

    • 09:28

      DR. JASON WASHBURN [continued]: We also see that a lot of times patientswill avoid their emotions or try to get awayfrom their emotions.So helping them to directly address and managetheir emotions and approach their emotionsand accept their emotions, rather thantrying to distract from them or to avoid themcan be very helpful.Unfortunately, there is no gold standard treatmentfor non-suicidal self-injury.

    • 09:53

      DR. JASON WASHBURN [continued]: There are some promising techniques, however.For example, emotion regulation group treatment--developed by Kim Gratz at the University of MississippiMedical Center-- is the only treatmentthat's been shown to be effective in specificallyaddressing non-suicidal self-injury.[Key Points Understanding non suicidal self injuryUnderstanding suicidal self injury --Intrapersonalfunctions Inter personal, social, funcions Treatmentfor non suicidal self injury]In this tutorial, you should have learned the definitionof non-suicidal self-injury.

    • 10:20

      DR. JASON WASHBURN [continued]: You should also have learned how to non-suicidal self-injuryis different from suicidal self-injury.Finally, you should have learned about the functionsof non-suicidal self-injury and how those functions areimportant for understanding how to treatnon-suicidal self-injury.[MUSIC PLAYING]

Non-Suicidal Self-Injury (NSSI)

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Non-suicidal self-injury (NSSI) is when a person engages in puposeful self-injurious behavior without the goal of suicide. This tutorial explores the functions of non-suicidal self-injury (i.e. as a coping strategy, a means of exerting influence over others, or a form of self-punishment), and some of the treatments available for a non-suicidal self-injury (NSSI) condition.

SAGE Video Tutorials
Non-Suicidal Self-Injury (NSSI)

Non-suicidal self-injury (NSSI) is when a person engages in puposeful self-injurious behavior without the goal of suicide. This tutorial explores the functions of non-suicidal self-injury (i.e. as a coping strategy, a means of exerting influence over others, or a form of self-punishment), and some of the treatments available for a non-suicidal self-injury (NSSI) condition.

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