The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

In this episode, Spencer Ellison and Dr. Jennifer Muehlenkamp read a hypothetical case vignette of a client who engages in nonsuicidal self-injury (NSSI), has experienced suicidal thoughts or behaviors, or is experiencing significant depression. They then tell us how willing therapists are to treat each case (self-injury vs. suicide vs. depression), if therapists would accept them into their clinical practice, and if it depends on the therapists' (1) liability concerns, (2) comfort/skill confidence to treat self-harm, (3) attitude toward self-harm in general, and (4) attitude towards clients who self-harm.

Learn more about Dr. Muehlenkamp at her University of Wisconsin-Eau Claire faculty page here, and see her growing list of peer-reviewed publications on Google Scholar here. Learn more about Trinity Equestrian Center at www.trinity-ec.com. Below are a couple research studies referenced in this episode:

1. Levi-Belz, Y., Barzilay, S., Levy, D., & David, O. (2020). To treat or not to treat: The effect of hypothetical patients' suicidal severity on therapists' willingness to treat. Archives of Suicide Research, 24(3), 355-366.
2. Groth, T., & Boccio, D. E. (2019). Psychologists’ willingness to provide services to individuals at risk of suicide. Suicide and Life-Threatening Behavior, 49(5), 1241-1254.

Want to have a bigger role on the podcast?:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
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What is paramedical tattooing and scar camouflage and how is it different than other treatments for self-injury scars? Not everyone with lived experience of nonsuicidal self-injury (NSSI) wants or needs to address self-harm scars, but some may choose to reduce or get rid of them as part of their recovery journey. Elena from Illusions by Ink Studio (https://illusionsbyinkstudio.com/) walks us through her approach to paramedical tattooing for self-injury. Her client "H" joins the conversation, sharing her experience as someone with lived experience of NSSI and why she chose this type of tattooing for her self-injury scars.

Connect with Elena on Instagram @illusionsbyink_studio, on Facebook here, and on YouTube @Scarcamouflagetattoo. You can reach her at [email protected]. Below are a couple papers referenced in this episode:

1. Allroggen, M., Kleinrahm, R., Rau, T. A. D., Weninger, L., Ludolph, A. G., & Plener, P. L. (2014). Nonsuicidal self-injury and its relation to personality traits in medical students. The Journal of Nervous and Mental Disease, 202(4), 300-304.
2. Plener, P. L., Brunner, R., Fegert, J. M., Groschwitz, R. C., In-Albon, T., Kaess, M., Kapusta, N. D., Resch, F., & Becker, K. (2016). Treating nonsuicidal self-injury (NSSI) in adolescents: consensus based German guidelines. Child and Adolescent Psychiatry and Mental Health, 10(46).

Want to have a bigger role on the podcast?:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

In this episode, Ellie from the United Kingdom and National Health Service (NHS) shares her lived experience of atypical severe self-injury while participating in a psychiatric inpatient stay for an acute increase in severity of eating disorder symptoms. She discusses how she has used her experiences as a patient and recipient of mental healthcare in the UK to bring about systemic change, participate as a co-producer and research, and advocate for those with lived experience of nonsuicidal self-injury (NSSI) and self-harm.  While participating in our interview while in inpatient care, we invite her live-in care provider (i.e., carer), Shami, to join our conversation and offer her own insights.

Connect with Ellie on LinkedIn here and on Twitter/X @EllieWildbore or @elliewildbore.bsky.social.  Visit her blog at https://balancingontheborderline.home.blog/. Here are two links to Ellie being interviewed about lived experience research and her work on YouTube with the Mental Elf: https://youtu.be/HezHKYrF7zM and https://youtu.be/IA91M6fGaQo. Read the pre-print of her article referenced in this episode available for free here. Learn more about Atypical Severe Self-Injury by listening to our episode with Dr. Barry Walsh on the topic from Season 1 here. 

Want to have a bigger role on the podcast?:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

In this episode, Maryam Gholamrezaei, PhD, C.Psych, shares about her interviews with racially and ethnically diverse individuals who self-injure, including their responses to her question, “In your culture, what is the general response to people who engage in self-harming behaviors?” She also discusses gender differences in nonsuicidal self-injury (NSSI) among different ethnic groups and offers unique insights into how the geopolitical landscape of the Middle East may influence an individual's decision to self-harm.

Learn more about Dr. Gholamrezaei on her website at https://drmaryamgholamrezaei.ca/. Below are some publications written by Dr. Gholamrezaei as well as Dr. Westers' editorial:

1. Gholamrezaei, M., Heath, N. L., Pereira, L., De Stefano, J., & Böke, B. N. (2023). Nonsuicidal self-injury, mental health service use, and cultural perspectives among ethnically diverse university students. Canadian Journal of Community Mental Health, 42(1), 15-40.
2. Gholamrezaei, M., De Stefano, J., & Heath, N. L. (2017). Nonsuicidal self-injury across cultures and ethnic and racial minorities: A review. International Journal of Psychology, 52(4), 316–326.
3. Gholamrezaei, M., Heath, N., & Panaghi, L. (2016). Non-suicidal self-injury in a sample of university students in Tehran, Iran: prevalence, characteristics and risk factors. International Journal of Culture and Mental Health, 10(2), 136–149.
4. Westers, N. J. (2024). Cultural interpretations of nonsuicidal self-injury and suicide: Insights from around the world. Clinical Child Psychology and Psychiatry, 29(4), 1231-1235.

Want to have a bigger role on the podcast?:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Does the emotion someone experiences immediately preceding an episode of nonsuicidal self-injury (NSSI) influence how painful that episode of self-harm feels? In this episode, Michelle Hiner, MS, a Clinical Psychology PhD student in the Emotion and Psychopathology (EmP) Lab at Rutgers University in New Jersey talks about how individuals who self-harm after experiencing high arousal negative emotions (HANEs), like anger, experience pain differently than those who self-injure after experiencing low arousal negative emotions (LANEs), like sadness and dissociation. 

Connect with Michelle on LinkedIn here, and learn more about the Emotion and Psychopathology (EmP) Lab here. Below are some papers referenced in this episode:

1. Drummond, P. D. (1995). Noradrenaline increases hyperalgesia to heat in skin sensitized by capsaicin. Pain, 60(3), 311-315.
2. Wiercioch-Kuzianik, K., & Bąbel, P. (2019). Color hurts. The effect of color on pain perception. Pain Medicine,  20(10), 1955-1962.
3. Paul, E., Tsypes, A., Eidlitz, L., Ernhout, C., & Whitlock, J. (2015). Frequency and functions of non-suicidal self-injury: Associations with suicidal thoughts and behaviors. Psychiatry Research, 225(3), 276–282.

Want to have a bigger role on the podcast?:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Emotion Regulation Individual Therapy for Adolescents (ERITA) and its internet-delivered version (IERITA) is just one of a couple of treatments developed specifically to address nonsuicidal self-injury (NSSI) among adolescents. In this episode, Dr. Johan Bjureberg from the Karolinska Institute in Stockholm, Sweden walks us through in detail each of the 11 sessions of IERITA and IERITA's 6 parallel sessions for parents.

Learn more about Dr. Bjureberg's work here, and follow his research lab and their projects and publications at Emotion regulation, Self-injury, Suicide, and Intervention (ESSI) here. Below are links to his research on ERITA/IERITA referenced in this episode:

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

In this episode, host and producer of The Psychology of Self-Injury podcast, Dr. Nicholas Westers, shares his own thoughts about what we should consider when supporting friends, families, clients, and patients who engage in nonsuicidal self-injury (NSSI). This marks the first solo episode of the podcast, and Dr. Westers offers ways for listeners to have a bigger role on the podcast, including:

1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at [email protected]
3. Want to be involved in research? Send us a message at [email protected] and we will see if we can match you to an active study.
4. Want to interact with us through comments and polls? You can on Spotify!

Below are a couple papers related to this episode with Dr. Westers:

1. Westers, N. J., Rehfuss, M., Olson, L., & Biron, D. (2012). The role of forgiveness in adolescents who engage in nonsuicidal self-injury. The Journal of Nervous and Mental Disease, 200(6), 535-541.
2. Westers, N. J., & Tinsley, B. (2023). Nonsuicidal self-injury risk assessment, intervention, and guidance for first responders and medical settings. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 873–893). Oxford University Press.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

In this episode, Lotte Rubæk, MSc, who leads the Self-Injury Team in Child and Adolescent Psychiatry in the Capital Region of Denmark, talks about why interaction on image-based social media platforms like Instagram can be particularly appealing to young people who self-harm. She discusses the dynamics that can arise between users in the more closed social media networks, and she explains why she so publicly resigned from Meta's global expert panel on self-harm after serving on it for 3.5 years.

Connect with Lotte on LinkedIn here, and read The Guardian's article about her decision to resign from Meta here. Listen to her podcast, Selvskadens Psykologi, which means The Psychology of Self-Injury in Danish, here. Read about the U.S. Surgeon General's May 2023 advisory about the effects social media use has on youth mental health here, and read about his June 2024 call on Congress to require warning labels on social media platforms and their effects on young people’s lives here. 

Below are Lotte's two book chapters in the new Oxford Handbook of Nonsuicidal Self-Injury and a few additional papers related to social media and self-injury:

1. Rubæk, L., & Møhl, B. (2023). Direct and indirect self-injury. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 41-71). Oxford University Press.
2. Møhl, B., & Rubæk, L. (2023). Understanding the link between direct and indirect self-injurious behavior. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 680-701). Oxford University Press.
3. Westers, N. J., Lewis, S. P., Whitlock, J., Schatten, H. T., Ammerman, B., Andover, M. S., & Lloyd-Richardson, E. E.(2021). Media guidelines for the responsible reporting and depicting of non-suicidal self-injury. The British Journal of Psychiatry, 219(2), 415-418.
4. Zhu, L., Westers, N. J.,Horton, S. E., King, J. D., Diederich, A., Stewart, S. M., & Kennard, B. D. (2016). Frequency of exposure to and engagement in nonsuicidal self-injury among inpatient adolescents. Archives of Suicide Research, 20(4), 580-590.
5. Bridge, J. A., Greenhouse, J. B., Ruch, D., Stevens, J., Ackerman, J., Sheftall, A. H., Horowitz, L. M., Kelleher, K. J., & Campo, J. V. (2020). Association between the release of Netflix’s 13 Reasons Why and suicide rates in the United States: An interrupted time series analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 59(2), 236-243.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

Goodpods Top 100 Parents Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

Goodpods Top 100 Research Podcasts Listen now to The Psychology of Self-Injury: Exploring
Self-Harm & Mental Health podcast 

In this episode, Christina Robillard talks about how self-criticism can lead to increases in self-injury urges within the next two hours as well as the relationship between self-criticism and disordered eating. She explains how she and her team use ecological momentary assessment (EMA; see Season 1, Episode 11 with Dr. Glenn Kiekens) to assess self-criticism in real time.

Connect with Christina on LinkedIn here. See Christina's academic page at the University of Victoria here and her Google Scholar page here. Below are links to some of her papers as well as one about self-criticism and pain:

1. Robillard, C. L., Merrin, G. J., Legg, N. K., Ames, M. E., & Turner, B. J. (2024). Different self-damaging behaviours, similar motives? Testing measurement invariance of motives for nonsuicidal self-injury, disordered eating and substance misuse. British Journal of Clinical Psychology. Advance online publication.
2. Robillard, C. L., Legg, N. K., Ames, M. E.,  & Turner, B. J. (2022). Support for a transdiagnostic motivational model of self-damaging behaviors: Comparing the salience of motives for binge drinking, disordered eating, and nonsuicidal self-injury. Behavior Therapy, 53(6), 1219-1232.
3. Robillard, C. L., Chapman, A. L., & Turner, B. J. (2022). Learning from experience: Within- and between-person associations of the consequences, frequency, and versatility of nonsuicidal self-injury. Suicide and Life-Threatening Behavior, 52(5), 836-847.
4. Robillard, C. L., Turner, B. J., Ames, M. E., & Craig, S. G. (2021). Deliberate self-harm in adolescents during COVID-19: The roles of pandemic-related stress, emotion regulation difficulties, and social distancing. Psychiatry Research, 304, 114152.
5. Fox, K. R., O'Sullivan, I. M., Wang, S. B., & Hooley, J. M. (2019). Self-criticism impacts emotional responses to pain. Behavior Therapy, 50(2), 410-420.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.

Approximately 47% of transgender adults and 55.7% of transgender and non-binary youth report having engaged in nonsuicidal self-injury (NSSI) at some point in their life. In this episode, Thomas details his experience of self-harm beginning at age 12, how his self-injury evolved over time, and how it related to his gender dysphoria. He also discusses dissociation as a relatively constant function (i.e., reason) of his self-injury and what happened when he fully transitioned as a man.

Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot  and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."

If you or someone you know should be interviewed on the podcast, we want to know! Please fill out this form, and we will be in touch with more details if it’s a good fit.