Nonsuicidal Self-Injury (NSSI): The Silent Pain of Adolescents
Humans are naturally driven to seek pleasure and avoid pain. Yet many adolescents intentionally harm their own bodies, not to die, but to cope with overwhelming emotions. This behavior is known as nonsuicidal self-injury (NSSI), defined as deliberate, repetitive harm to one’s body without the intention of suicide.
Over the past two decades, NSSI has grown into a widespread yet silent crisis among teenagers, often hidden behind long sleeves and quiet suffering.
Self-Harm Is Not New – It Has Long Existed in Human History
Self-injury has been documented for thousands of years across different civilizations.
Examples from history and culture
In Oedipus Rex (5th century BCE), Sophocles described Oedipus injuring himself out of shame and despair.
Vincent van Gogh harmed himself multiple times and wrote, “As long as I keep my hand in the fire, let me see her.”
Sylvia Plath vividly explored themes of self-harm in her poem The Other.
These examples show that NSSI is not a modern trend, it is a human reaction to emotional pain that predates contemporary society.
Why Do Adolescents Intentionally Hurt Themselves?
NSSI typically begins around age 10, peaks between ages 13-22, and gradually declines after age 23.
Research shows:
19.5% of children and adolescents worldwide have self-harmed.
27.4% of middle school students in Mainland China report NSSI history.
These numbers highlight how common and urgent this issue truly is.
What teenagers say about why they self-harm
“It hurts, but it feels good.”
“It distracts me from sadness.”
“I want someone to notice and help me.”
“I need to punish myself.”
“It calms emotions that are too strong.”
“It shows what I can’t say out loud.”
“At least I can control something.”
From these statements, we can categorize the reasons into two main groups.
Two Core Reasons Behind NSSI
1. Emotion Regulation
Many teens self-injure to relieve emotional overload, guilt, shame, sadness, anger, fear, and anxiety.
Physical pain may temporarily:
reduce emotional intensity
bring a sense of “relief”
provide a momentary feeling of control
Some even describe it as an “addiction” to the sensation because the relief becomes reinforcing.
2. Communication & Relationship Signaling
Other teens seasking for help
wanting attention or care
signaling emotional suffering
protesting stressful or unfair situations
Unfortunately, NSSI sometimes “works” teachers may give breaks, parents pay more attention, or responsibilities decrease — unintentionally reinforcing the behavior.
How Dangerous Is Nonsuicidal Self-Injury?
Although NSSI is not performed with the intent to die, it carries serious risks.
Physical risks
infections and scarring
accidental severe wounds
disease transmission from shared tools
Psychological risks
shame, withdrawal, and social isolation
increased suicidal thoughts
dependency on self-harm as an emotional escape
escalation to more frequent or severe behavior
The emotional relief NSSI provides is temporary but the consequences can be long-lasting.
What Causes NSSI? A Complex Interaction of Factors
There is no single cause. NSSI usually results from a combination of biological, psychological, and environmental influences.
1. Biological factors
poor impulse control
altered pain perception
reward-system dysregulation
genetic predispositions to emotional sensitivity
2. Psychological and personality factors
unstable or impulsive personality traits
poor emotion-regulation skills
difficulty solving problems
inability to verbalize emotional pain
→ For these teens, self-harm becomes the only “tool” they know to cope.
3. Environmental and social factors
childhood trauma or abuse
emotional neglect
academic and performance pressure
parental absence or long-term separation
social media influence and contagion effects
Research consistently shows that emotional deprivation within the family is one of the strongest predictors of NSSI.
How Is NSSI Treated? A Comprehensive, Multi-Level Approach
Treating NSSI requires collaboration between families, mental health professionals, and support systems.
1. Professional assessment
A thorough evaluation identifies:
triggers
psychological conditions
frequency, tools, patterns
immediate safety concerns
2. Psychotherapy (Most effective treatments)
Trị liệu hành vi biện chứng (DBT) gold standard for NSSI
Trị liệu Nhận thức - Hành vi (Cognitive Behavioral Therapy)
Acceptance and emotion-regulation therapies
These therapies teach:
distress tolerance
emotional regulation
communication skills
replacing self-harm with healthier coping strategies
3. Medication
There is no medication specifically for NSSI.
However, treating underlying conditions such as:
trầm cảm
bipolar disorder
severe anxiety
can significantly reduce self-harm urges.
4. Social and family support
emotionally safe home environment
understanding, nonjudgmental caregivers
healthy peer networks
reducing stress and conflict
Supportive relationships are one of the strongest protective factors against NSSI.
How Can Teens Help Themselves? Practical Skills
A. Regulating emotions
learn personal triggers
identify early warning signs
practice emotional labeling
remove or discard self-harm tools
B. Surviving emotional crises
STOP and pause
step back from the situation
observe feelings without acting impulsively
ask: “What action can make this better, not worse?”
C. Preventing relapse
rapy
proper wound care
consistent the
building a long-term safety plan
strengthening emotional skills
How to Prevent NSSI, A Community-Level Responsibility
NSSI prevention requires collaboration across:
schools
families
healthcare systems
communities
media
Effective prevention strategies include:
mental health education and awareness
early emotional screening
teaching emotion-regulation skills
building self-acceptance
expanding access to counseling
professional training for teachers and parents
promoting healthy media guidelines
Creating environments where adolescents feel seen, understood, and supported is the foundation of prevention.
Understanding NSSI Helps Us Protect the Mental Health of the Next Generation
Nonsuicidal self-injury is not attention-seeking behavior it is a distress signal.
It reflects pain that words cannot express, and it calls for compassionate, informed intervention.
With the right support, adolescents can learn healthier ways to cope, regain control, and build emotional resilience.
No young person should feel they must hurt themselves to be heard.
