Self-injury remains a stigmatized topic, even amongst some mental health professionals (e.g., Andersson, 2024). It can be viewed as “manipulative” or simply attention-seeking (Tien Shan, 2024). It can also be seen as repulsive, or just plain vexing to family members or helping professionals not used to encountering it. Chances are, like most stigmatized occurrences, it is the lack of understanding that fuels stereotyping and negative reactions (APA, 2024).

It is not without consequence. People who self-injure and have encountered finger-wagging, accusations of manipulation, or some other form of revolt are less likely to report their self-injuring tendencies. On one end of the consequences, they do not discover more constructive means of managing emotional turmoil, accruing shame over their constantly defaced body parts, yielding more emotional turmoil and more proneness to self-injury. On the other end, while nonsuicidal self-injury (NSSI) is not about death, it is possible someone may go too far.

Anyone who has spent much time working with those who self-injure probably realizes it is no spontaneous development to coax others to give them what they want. Nor is it some foreshadowing of suicide. Most people who self-injure, while some have a suicide attempt history, aren’t injuring in the hopes of demise. As counterintuitive as it may sound, NSSI might thought of as an approach to self-preservation or communication.

Some people self-injure as a last resort. For example, I’ve encountered people who are so depressed they say they’re numb, and self-injury makes them feel something. One man told me when he saw his blood run, it reminded him he was alive. Others who dissociate, such as having out-of-body experiences, flashbacks, or derealized states might injure to ground themselves. Still others, such as those with borderline personality disorder (BPD) might self-injure as a form of........

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