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

What is the prevalence of self-injury among adults over age 40? And what differentiates those who report having stopped self-injuring from those who continue to self-injure? How do they differ from those under age 25 who self-injure, including related to suicidal thoughts and behaviors? In this episode, psychologist Dr. Sarah Swannell from Australia discusses the prevalence of self-injury and self-harm among individuals over age 40 and stigma around the behavior.

Learn more about Dr. Swannell and her work at https://sarahswannell.com.au/. Below are links to some of her research referenced in this episode: 

1. Martin, G., & Swannell, S. (2016). Non-suicidal self-injury in the over 40s: Results from a large national epidemiological survey. Epidemiology, 6(5), 266.
2. Martin, G., Swannell, S. V., Hazell, P. L., Harrison, J. E., & Taylor, A. W. (2010). Self-injury in Australia: a community survey. Medical Journal of Australia, 193(9), 506-510. (Australian National Epidemiological Study of Self-Injury [ANESSI])
3. Troya, M. I., Dikomitis, L., Babatunde, O. O., Bartlam, B., & Chew-Graham, C. A. (2019). Understanding self-harm in older adults: A qualitative study. EClinical Medicine, 12, 52-61.

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

Every screenwriter and film director is different and each has their own intentions and motivations, but what goes into the writing of characters who engage in self-injury and self-harm? How are such films inspired, and how do writers and directors choose to frame self-injury content? In this episode, screenwriter, director, and actress Christina Beck discusses her independent feature film "PERFECTION" and what inspired the characters and content of the film. This episode was recorded as a live virtual session held during the 17th annual ISSS Conference on June 24, 2022. 

To watch PERFECTION (for free), visit perfectionthemovie.wordpress.com and click on "Watch PERFECTION NOW!" Download the movie's free companion workbook here. Please note that some content in the film could be upsetting or triggering, including depictions of self-injury, substance use, and brief flashbacks that allude to sexual abuse. 

Christina is also a film professor at Loyola Marymount University in Los Angeles, CA. You can follow her on Twitter at @xtinabeck and Facebook at www.facebook.com/perfectionfilm.

To review the Media Guidelines for the Responsible Reporting and Depicting of Non-Suicidal Self-Injury published in the British Journal of Psychiatry, click here. You can also visit www.itriples.org/media-guidelines to read the original ISSS white paper and its accompanied infographic.

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

Does it matter where on the body someone cuts, whether on typically more visible sites such as the forearm and wrist, or in typically more concealed areas, such as the upper arm and torso? Is there a relationship between where someone cuts on their body and their likelihood of continuing to engage in the behavior? In this episode, Dr. Gardner discusses her research on the psychology of self-injury location and where on the body one chooses to self-injure as well as intrapersonal (emotional) reasons and interpersonal (social) reasons for engaging in self-injury and self-harm.

Learn more about Dr. Gardner and her work at https://www.uclan.ac.uk/academics/dr-kathryn-gardner, and follow her on Twitter @KathrynJGardner. Below are links to some of her research referenced in this episode: 

1. Gardner, K. J., Bickley, H., Turnbull, P., Kapur, N., Taylor, P., & Clements, C. (2020). The significance of site of cut in self-harm in young people. Journal of Affective Disorders, 266, 603-609.
2. Gardner, K. J., Paul, E., Selby, E. A., Klonsky, E. D., Mars, B. (2021). Intrapersonal and interpersonal functions as pathways to future self-harm repetition and suicide attempts. Frontiers in Psychology, 12, 688472. 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

Are there countries, races, or ethnicities with higher or lower rates of self-injury?  How prevalent is NSSI among indigenous peoples, and what role does culture play in the form, function, and meaning of self-injury?  In this episode, Dr. Marc Wilson from Te Herenga Waka Victoria University of Wellington in Aotearoa New Zealand shares about cross-cultural representations of self-injury and self-harm.  

Learn more about Dr. Wilson and his work at https://people.wgtn.ac.nz/Marc.Wilson. Below are links to some of the research referenced in this episode:

1. Sansone, R. A., Wiederman, M. W., & Sansone, L.A. (1998). The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. Journal of Clinical Psychology, 54(7), 973–983.
2. Sansone, R. A., & Sansone, L. A. (2010). Measuring self-harm behavior with the Self-Harm Inventory. Psychiatry (Edgmont), 7(4), 16-20.
3. Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253-263.
4. Monto, M. A., McRee, N., & Deryck, F. S. (2018). Nonsuicidal self-injury among a representative sample of US adolescents, 2015. American Journal of Public Health, 108, 1042-1048.
5. Favazza, A. R. (2011). Bodies under siege: Self-mutilation, nonsuicidal self-injury, and body modification in culture and psychiatry (3rd ed.). Baltimore, MD: Johns Hopkins University Press.
6. Wilson, M. S. (2024). Cross-cultural representations of nonsuicidal self-injury. In E. E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The handbook of nonsuicidal self-injury (pp. 167-186). Oxford University Press.
7. Westers, N. J. (2024). Cultural interpretations of nonsuicidal self-injury and suicide: Insights from around the world. Clinical Child Psychology and Psychiatry, 29(4). 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

According to a 2020 national survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), among 52.9 million adults with any mental illness in the United States, 46.2% received mental health services in the past year, which means more than half did not. Although there are known, effective treatments for mental disorders, the World Health Organization (WHO) reports that more than 75% of people in low- and middle-income countries receive no treatment.

In this episode, Mallory Dobias, MA, a Clinical Psychology PhD student at Stony Brook University in New York discusses an online, brief single-session intervention for nonsuicidal self-injury and self-harm, allowing for more accessible treatment options.

You can find Mallory's open access pre-print paper on PsyArXiv at https://psyarxiv.com/jprcg and its peer-reviewed final publication in the journal Behaviour Research and Therapy by clicking here. To find the pdf version of the intervention in Open Science Framework (OSF) visit https://osf.io/vguf4/. To find the project summary of Project SAVE (Stop Adolescent Violence Everywhere), visit www.schleiderlab.org/completed-projects.html.

Follow Mallory on Twitter at @MalloryDobias and learn more about her work with the Lab for Scalable Mental Health at www.schleiderlab.org/ and her work with the Fox Lab at Denver University at www.foxlabdu.com/. 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

The term "self-harm" is an umbrella term, encompassing a broad range of behaviors, under which is included substance abuse and misuse, suicide, nonsuicidal self-injury (NSSI), and even eating disorders. In this episode, Dr. Katie Gordon, a Licensed Clinical Psychologist in Fargo, North Dakota, discusses the prevalence of self-injury among individuals with eating disorders and the prevalence of eating disorders among those who self-injure. She explains the relationship between the two behaviors, including common risk factors. 

Learn more about Dr. Gordon and her work on her website at https://kathrynhgordon.com/. Follow her on Twitter and Instagram at @DrKathrynGordon. You can purchase her book The Suicidal Thoughts Workbook: CBT Skills to Reduce Emotional Pain, Increase Hope, and Prevent Suicide on Amazon here. 

Below are links to some of Dr. Gordon's research as well as resources referenced in this episode:

1. Kiekens, G., & Claes, L. (2020). Non-suicidal self-injury and eating disordered behaviors: An update on what we do and do not know. Current Psychiatry Reports, 22(68).
2. Fox, K. R., Wang, S. B., Boccagno, C., Haynos, A. F., Kleiman, E., & Hooley, J. M. (2019). Comparing self-harming intentions underlying eating disordered behaviors and NSSI: Evidence that distinctions are less clear than assumed. International Journal of Eating Disorders, 52(5), 564-575.
3. Smith, A. R., et al. (2013). Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research, 206(2-3), 246-255.
4. Gordon, K. H., Perez, M., & Joiner, T. E. (2002). The impact of racial stereotypes on eating disorder recognition. International Journal of Eating Disorders, 32(2), 219-224.

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

In this first episode of Season 2, Brittany details her experience of engaging in nonsuicidal self-injury (NSSI), how it started, and how she makes sense of self-injury and her faith in God. She explains two starkly different responses she received from church leaders and shares insights about how youth pastors in particular can provide supportive responses to students who engage in self-injury and self-harm. 

Follow Brittany on Instagram at @brittanytinsleywrites and read her blog at https://brittanytinsley.com/. 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Best 20 Clinical Psychology Podcasts" and by Welp Magazine in their "20 Best Injury Podcasts."

How can schools appropriately respond to students who engage in nonsuicidal self-injury (NSSI), whether the behavior occurs at home, on school grounds, or elsewhere? What protocols exist to support schools to better respond to students who self-injure? What role does liability play? In this episode, Dr. Nancy Heath of McGill University in Montreal, Canada explains how schools can support students who engage in self-injury and self-harm.

Learn more about Dr. Heath's work here, and learn more about her work with the Development and Intrapersonal Resilience (DAIR) Research Team here. Learn more about the International Consortium on Self-Injury in Educational Settings (ICSES) at http://icsesgroup.org/.

Self-injury Outreach & Support (SiOS) offers resources for schools here and a list of do's and don'ts here. Visit SiOS at http://sioutreach.org and follow them on Facebook (www.facebook.com/sioutreach) and Twitter (https://twitter.com/sioutreach).

Below are links to some of Dr. Heath's research as well as resources referenced in this episode:

1. Hasking, P. A., Bloom, E., Lewis, S. P., & Baetens, I. (2020). Developing a policy, and professional development for school staff, to address and respond to nonsuicidal self-injury in schools. International Perspectives in Psychology: Research, Practice, Consultation, 9(3), 176.
2. Berger, E., Hasking, P., & Reupert, A. (2015). Developing a policy to address nonsuicidal self-injury in schools. Journal of School Health, 85(9), 629-647.
3. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 1: understanding nonsuicidal self-injury and the importance of respectful curiosity in supporting youth who engage in self-injury. NASN School Nurse, 35(2), 92-98.
4. Lloyd-Richardson, E. E., Hasking, P., Lewis, S.P., Hamza, C., McAllister, M., Baetens, I., & Muehlenkamp, J. (2020). Addressing self-injury in schools, part 2: how school nurses can help with supporting assessment, ongoing care, and referral for treatment. NASN School Nurse, 35(2), 99-103.
5. Lewis, S. P., Heath, N. L., Hasking, P. A., Hamza, C. A., Bloom, E. L., Lloyd-Richardson, E. E., & Whitlock, J. (2019). Advocacy for improved response to self-injury in schools: A call to action for school psychologists. Psychological Services, 17(S1), 86–92.
6. De Riggi, M. E., Moumne, S., Heath, N. L., & Lewis, S. P. (2017). Non-suicidal self-injury in our schools: a review and research-informed guidelines for school mental health professionals. Canadian Journal of School Psychology, 32(2), 122-143.
7. Whitlock, J. L., Baetens, I., Lloyd-Richardson, E., Hasking, P., Hamza, C., Lewis, S., Franz, P., & Robinson, K. (2018). Helping schools support caregivers of youth who self-injure: Considerations and recommendations. School Psychology International, 39(3), 312-328.
8. Hasking, P. A., Heath, N. L., Kaess, M., Lewis, S. P., Plener, P. L., Walsh, B. W., .Whitlock, J., & Wilson, M. S. (2016). Position paper for guiding response to non-suicidal self-injury in schools. School Psychology International, 37(6), 644-663. Open access here.
9. Book: Self-Injury in Youth: The Essential Guide to Assessment and Intervention (2008) by Drs. Mary Nixon & Nancy Heath 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Top 15 Clinical Psychology Podcasts You Must Follow in 2021" and by Welp Magazine in their "20 Best Injury Podcasts of 2021."

Dialectical Behavior Therapy (DBT) has been lauded as an evidence-based treatment for addressing suicidal and nonsuicidal thoughts and behaviors.  In this episode, Dr. Jenny Hughes explains what DBT is, describes what "dialectical" means, and walks us through how each of the four modules of DBT can be used to address nonsuicidal self-injury and self-harm: (1) Emotion Regulation, (2) Distress Tolerance, (3) Interpersonal Effectiveness, and (4) Mindfulness. She also provides an update on the science behind DBT, including what aspects of the treatment are thought to be most effective in addressing self-injury. 

To learn more about DBT and opportunities for training in DBT as referenced in this episode, visit Behavioral Tech at https://behavioraltech.org/. Learn more about Dr. Hughes' work at the University of Texas Southwestern Medical Center here, and follow her on Twitter at @DrJennyHughes. Watch her 2018 TEDx talk on Resilience: Growth Through Struggle  at www.youtube.com/watch?v=Nr44v2__zrU. Below are links to some of her research on DBT among youth:

Editorial: Dialectical Behavior Therapy and the Function of Self-Injury (2021)

(1) Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial (2018)

(2) Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions (2019)

(3) Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators (2021).

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Top 15 Clinical Psychology Podcasts You Must Follow in 2021" and by Welp Magazine in their "20 Best Injury Podcasts of 2021."

If you’ve never engaged in self-injury or self-harm, then you may have never considered the anxieties related to something as seemingly simple as a routine doctor visit. In this episode, Brittany Tinsley explains what questions she asks herself prior to attending routine doctor visits in order to ease her anxiety about medical providers seeing her self-injury wounds and scars.  We take a unique peek into what doctor visits can be like for those who self-injure or have self-injured, as well as discuss tips on navigating those visits, whether as a treatment provider or someone with lived experience. 

Follow Brittany on Instagram at @brittanytinsleywrites and read her blog at https://brittanytinsley.com/. 

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

The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Top 15 Clinical Psychology Podcasts You Must Follow in 2021" and by Welp Magazine in their "20 Best Injury Podcasts of 2021."