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

Manga are comics or graphic novels originating from Japan. Not only do manga reveal and reinforce cultural values, beliefs, and norms, particularly in Japan, but they can also be used as a teaching tool and source of information. Manga and other comics can be used in medicine to learn and teach about illness and to build empathy. They also have the power to shape public understanding of mental health issues, even nonsuicidal self-injury (NSSI).

In this episode, Dr. Yukari Seko explains how self-injury and the characters who engage in the behavior are portrayed in Japanese manga. She also discusses the importance of manga within Japanese culture. Below is a reference (with a link) to her research paper along with a breakdown of common genres of manga and, based on her study, just how many characters within each genre engage in self-injury and self-harm:

GENRES OF MANGA (& the number of characters depicted who self-injure, based on Dr. Seko's study):

1.  shōjo: comics for girls 18 and younger (written for girls, by girls) - depicted 10 characters who self-injure

2.  shōnen: comics for boys  18 and younger (written for boys, by boys, about boys) - depicted 0 characters

3.  seinen: comics for young males age 18-30 - depicted 6 characters, portrayed as menhera (a derivation of "mental health-er," a person with mental instability or "mentally vulnerable damsels in distress")

4.  josei: comics for young females 18-30 - depicted 1 character

5.  Boy's Love: a subgenre of josei manga featuring erotic relationships between male characters - depicted 1 character

6.  seijen:  comics for grownups - depicted 0 characters

7.  redicomi: "Lady's Comic" for adult women - depicted 0 characters

8. slice-of-life: genre that features realistic depictions of everyday life.

Seko, Y., & Kikuchi, M. (2021). Self-injury in Japanese manga: A content analysis. Journal of Medical Humanities, 42(3), 355-369. 

Seko, Y., & Kikuchi, M. (2022). Mentally ill and cute as hell: Menhera girls and portrayals of self-injury in Japanese popular culture. Frontiers in Communication, 7.

To learn more about Dr. Seko and her work at Ryerson University, visit https://www.ryerson.ca/procom/people/yukari-seko/. 

To learn more about graphic medicine and novels referenced in this episode, see Williams, I. C. M. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38(1), 21-27. 

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."

Many parents understandably want their child to stop self-injuring immediately, but cessation of self-injury is often a process and recurrence of episodes of self-injury can be expected, even when in therapy. In this episode, Dr. Jessica Garisch provides insight for parents about expectations for therapy and helping their child stop engaging in self-injury and self-harm. For instance, what do you do if your child does not seem to be putting forth effort in therapy? And if you are worried that your child may not be safe enough to go to camp or on vacation, should you keep them home?

To learn more about Dr. Garisch and her work at Victoria University of Wellington, visit https://people.wgtn.ac.nz/jessica.garisch. To learn more about the Youth Wellbeing Study and its research team, visit https://youthwellbeingstudy.wordpress.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."

Why is it important to talk about nonsuicidal self-injury among LGBTQ individuals? Just how prevalent is self-injury among those who identify as LGBTQ? And are there differences in rates of self-injury among sexual minority individuals (e.g., Lesbian, Gay, and Bisexual) compared to those that are Transgender or Gender Diverse?  In this episode, Dr. Lindsay Taliaferro discusses risk and protective factors for engaging in self-injury among LGBTQ individuals. She also tackles the intersectionality of race, sexual minority status, and gender diversity among those who self-injure and self-harm. Below are links to some of her research and the resources referenced in this episode:

Rogers, M. L., & Taliaferro, L. A. (2020). Self-injurious thoughts and behaviors among sexual and gender minority youth: A systematic review of recent research. Current Sexual Health Reports, 12, 335–350.

Taliaferro, L. A., McMorris, B. J., Rider, G. N., & Eisenberg, M. E. (2019). Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of Suicide Research, 23(2), 203-221.

Taliaferro, L. A., McMorris, B. J., & Eisenberg, M. E. (2018). Connections that moderate risk of non-suicidal self-injury among transgender and gender non-conforming youth. Psychiatry Research, 268, 65-67.

GLSEN's National School Climate Survey (2019).

Hatch Youth - the Montrose Center in Houston: https://www.montrosecenter.org/hatch-youth/

The Trevor Project: https://www.thetrevorproject.org/

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."

When is it appropriate for someone who engages in nonsuicidal self-injury (NSSI) to be admitted to an acute psychiatric inpatient program? And how realistic is it to expect no self-injury or self-harm to occur at all while in the hospital? How should hospital staff respond and intervene when someone engages in self-injury while on an inpatient unit? In this episode, Dr. Jason Washburn addresses these questions and discusses how hospital staff can foster empathy and compassion for individuals who self-injure while respecting their autonomy and also keeping them safe.

Learn more about Dr. Washburn and his work here. Below are links to some of his work, including his books as editor and new research. To learn more about AMITA Health and its treatment for self-injury, click here. 

Washburn, J. J. (2014). Self-injury: Simple answers to complex questions. Hoffman Estates, IL: Alexian Brothers Press.

Washburn, J. J. (2019). Nonsuicidal self-injury: Advances in research and practice . New York: Routledge.

Slesinger, N. C., Hayes, N. A., & Washburn, J. J. (2021). Understanding predictors of change in a day treatment setting for non-suicidal self-injury. Psychology and Psychotherapy: Theory, Research, and Practice, 94, 517–535.

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."

In this episode, Lexy details her experience of engaging in nonsuicidal self-injury (NSSI) and the stigma she has encountered as a result of self-injury and self-harm. Lexy is the current Student Representative of the International Society for the Study of Self-Injury (ISSS) and a PhD candidate working in the area of self-injury stigma. She is currently working on multiple projects looking at how self-injury stigma is experienced and how it is portrayed in the media. She has recently published a paper outlining how researchers can better understand self-injury stigma: Stigma and nonsuicidal self-injury: Application of a conceptual framework (Staniland, Hasking, Boyes, & Lewis, 2021)

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

BIG NEWS! The Psychology of Self-Injury podcast has been rated #5 by Feedspot in their "Top 15 Clinical Psychology Podcasts You Must Follow in 2021." Click here to see the full Top 15 list. 

When we talk about nonsuicidal self-injury (NSSI) in this podcast, we are typically referring to the most common forms of NSSI. But what about rarer, more significant forms of self-harm and self-harming behaviors that do not fit neatly within the typical definition of NSSI, like ingesting foreign objects to intentionally cause internal injury? And how do these forms of  “Atypical Severe Self-Injury” differ in function and severity from more common forms of self-injury? In this episode, Dr. Barry Walsh details 3 specific forms of Atypical, Severe Self-Injury, explains their unique functions, and shares clinical guidelines for treating those who engage in Atypical, Severe Self-Injury.

Learn more about Dr. Walsh and his work at Open Sky Community Services by visiting www.openskycs.org . Below are links to some of his research and publications referenced in this episode:

Walsh, B. W. (2014). Treating self-injury: A practical guide (2nd ed.). New York: Guilford. 

Walsh, B. W. (2019). Atypical, severe self-injury: How to understand and treat it. In J. J. Washburn (Ed.), Nonsuicidal self-injury: Advances in research and practice . New York: Routledge.

Atypical and severe nonsuicidal self-injury as an indicator of severe psychopathology: Findings from a sample of high-risk community mental health clients (Hom et al., 2018)

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

How do we assess self-injury differently than 20-30 years ago? Rather than asking someone to remember how they were thinking and feeling when they last self-injured days, weeks, and even months ago, advances in technology allow researchers and clinicians to monitor self-injury and self-harm in real time, as it occurs. In this episode, Dr. Glenn Kiekens discusses the advantages of adapting real-time monitoring (also known as experience sampling or ecological momentary assessment [EMA]) in researching nonsuicidal self-injury as well as the ethical concerns to consider when doing research in real time. 

Learn more about Dr. Kiekens and his work in the Center for Contextual Psychiatry at KU Leuven by clicking here. Follow Dr. Kiekens on Twitter @GKiekens. Below are links to some of his research and the resources referenced in this episode:

Opening the black box of daily life in non-suicidal self-injury research: With great opportunity comes great responsibility (preprint available at https://psyarxiv.com/yp86x)

Fluctuations in affective states and self-efficacy to resist non-suicidal self-injury as real-time predictors of non-suicidal self-injurious thoughts and behaviors (2020)

Consensus statement on ethical & safety practices for conducting digital monitoring studies with people at risk of suicide and related behaviors (Nock et al., 2020)

Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults (Nock, Prinstein, & Sterba, 2009)

Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-Injury (Armey, Crowther, & Miller, 2011)

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

A lot of therapies address the context in which nonsuicidal self-injury (NSSI) and self-harm may occur, but only a few treatments have been designed to address NSSI specifically. In this episode, we dive into one of these treatments: Treatment for Self-Injurious Behaviors (T-SIB). Dr. Peggy Andover, its lead developer, walks us through the 9 sessions of T-SIB, including the personalized modules of sessions 7 & 8.

Learn more about Dr. Andover and her work in the Mood and Behaviors Lab at https://www.fordham.edu/info/23638/mood_and_behaviors_lab and reach her at [email protected]. Follow her on Twitter @DrPeggyAndover. Below are links to some of her research and the resources referenced in this episode:

Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults (2020)

An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial (2017)

Development of an intervention for nonsuicidal self-injury in young adults: An open pilot trial (2015)

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

How many psychologists have lived experience of nonsuicidal self-injury (NSSI)? What biases should mental health professionals with and without a history of self-injury keep in mind when treating or supervising someone who has lived experience? In this episode, Dr. Victor shares preliminary data that she has just begun analyzing regarding the prevalence rates of mental health difficulties and self-injury among psychologists and psychology graduate students. She provides guidance about how mental health professionals can provide appropriate care to therapy clients and supervision to trainees who have lived experience of self-injury and self-harm. She also discusses how individuals with lived experience can be involved in research and teaching.

Learn more about Dr. Victor and her work in the Tracking Risk Over Time Lab (TRTL) at https://www.depts.ttu.edu/psy/people/svictor/ and her website at https://www.sarahevictor.com/. Follow her on Twitter @sarahevictor. Below are links to some of her research and the resources referenced in this episode:

Psychologists with lived experience of non-suicidal self-injury: Priorities, obstacles, and recommendations for inclusion (click here for the free version of the author's manuscript)

LiveThroughThis.org

Strategy for Patient-Oriented Research (Canadian Institutes of Health Research)

Patient-Centered Outcomes Research Institute (PCORI)

ClinicalTrials.gov

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

In this episode, Malika details her experience of disclosing her self-injury to her parents as a teenager, seeking treatment, and how she decided to start Selfharmerproblems Instagram and YouTube pages. 

Follow her on Instagram and YouTube, and visit her new website at www.selfharmerproblems.org. To watch all her YouTube videos about her lived experience of self-harm, click here. 

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