MMN 038: Non-Suicidal Self-Injury – with Lori Vann

On this episode of the Make a Mental Note podcast, Lori Vann, a licensed professional counselor-supervisor, discusses the nature of non-suicidal self-injury, reasons why people engage in this practice, and how they can use more adaptive methods of dealing with distressing feelings. Give it a listen and find out why this episode is worthy of a mental note!

Lori Vann interview (click on Lori’s name to listen to interview)

Mental Notes:

* Non-suicidal self-injury (NSSI) was referred to as self-mutilation, self-abuse and self-harm in the past. It’s also been referred to as “cutting,” but NSSI can be much broader in practice.

* Lori addresses 17 different types of NSSI in her book, “A Caregiver’s Guide to Self-Injury.” (See link to book below.)

* People who engage in NSSI are not attempting to commit suicide. There must be intent to kill oneself in order to classify the action as suicide or a suicide attempt.

* There are different types of NSSI and oftentimes people will start with one method and try out different forms of NSSI. In some cases, elementary-aged children engage in NSSI. It may start off as picking or scratching themselves or hitting themselves or an object, which could result in broken bones. Burning (with chemicals or a heating element) is also possible and in extreme cases people remove body parts.

* NSSI appears to follow a progression in which people start off engaging in mild forms of self-harm and escalate to more serious forms. In this way, there are parallels between patterns of NSSI and addiction. People start off by experimenting with NSSI and – for some of them – it fulfills some function (e.g., emotional relief, rush, “high”) and for others not so much. There are 35+ reasons why people self-harm – it could be for a single reason or for multiple reasons. Addiction terminology such as “triggers” and “relapse” are used with people who are in counseling for NSSI. Many people who engage in this activity feel as though they are “hooked” to the behavior – similar to how people get “hooked” on drugs – and may develop a tolerance over the course of time, which results in having to cut deeper or go longer or somehow engage in a more intense form of the behavior.

* Some people who engage in NSSI lose control over their behavior – similar to how people with addiction lose control over their use of substances.

* For some people, NSSI is a preventative measure that is taken so as not to commit suicide.

* The primary reason that people engage in NSSI is because the emotional pain is so bad (and people don’t know what to do with/how to handle intense emotions) that they find physical pain an effective way of purging and escaping from the emotional pain. The physical pain is easier to cope with than the emotional pain.

* People who engage in these behaviors may have experienced trauma such as physical, sexual and/or emotional abuse (including bullying) as well as neglect. About 70% the clients in Lori’s outpatient practice have a history of emotional abuse. About 50% suffered from physical abuse while 30% experienced sexual abuse. Males, females and members of different racial groups engage in NSSI.

* People who were raised in families in which one or both parents were alcoholics are at higher risk of engaging in NSSI as it is more likely that they experienced some type of abuse in comparison to families with non-alcoholic parents. In addition, parents who abuse alcohol are role modeling inappropriate coping behavior to their children (i.e., “If you have a problem, seek a way of escaping from it.”).

* Many people who seek out help for NSSI are experiencing boundary issues. They don’t know how to be assertive or believe they don’t have certain rights (e.g., the right to make mistakes; the right to not be a people pleaser). Traumatic experiences – including divorce and death – can impact people in ways such that they look to ways of managing their emotional pain through NSSI.

* NSSI may serve a positive function in terms of emotional relief and/or a method of distraction from their feelings.

* Clients may view NSSI as their security blanket. It’s what they hold on to because it is something that’s worked for them in regulating their distressing emotions. Thus, it’s not a good idea to “rip away their blanket” by suggesting that they simply stop engaging in the behavior. That will actually increase the risk of suicide. Finding out how/why NSSI serves as a security blanket is important. In some cases, NSSI can be a control issue – “I can’t control the chaos in my world. I don’t get to call the shots, but what I do to my body – I have 100% control over that.”

* People who engage in NSSI can benefit by utilizing alternative strategies. For example, instead of taking things out on their own bodies, people could rip up a notebook, dig a hole in the back yard, exercise, knit, etc. – in other words, redirec physical energy that focuses on hands and arms into alternative activities. They might benefit from non-physical activities as well (e.g., placing a raisin in their mouths and experiencing the sensations of the raisin – feel/texture, taste – with the tongue; walking outside and focusing intently on something such as grass – it’s color, length, movement in the wind, etc.). Calling a friend or family member is also useful as well as trying to delay acting on their feelings/impulses to engage in NSSI.

* Identifying the trigger and coming with a game plan as to how to deal with the trigger in the future is important.

* People may experience relapses when they are trying to engage in non-NSSI/alternative behaviors. They may feel guilty and/or feel as though they disappointed or let down people when they relapse. Continuing to engage in self-care and using coping strategies will reduce the chances of engaging in NSSI in the future.

* Parents of adolescents that engage in NSSI can be enablers or disconnected or have their own issues that they’re dealing with, which serves to perpetuate NSSI.

* NSSI is a core component of some adolescents’ individual and social identity.

* Finding balance is important – bad stuff happens when people go to extreme with regard to their behavior.

* Self-injury – similar to eating disorders, promiscuity & addiction – are acting out behaviors/symptoms of underlying emotional issues.

* The “trifecta of self-care” – sleep, nutrition and exercise.

Mental Notes Takeaway:

* NSSI is a coping strategy that people use to deal with emotional distress. Their intention isn’t to commit suicide, but rather to find a way of releasing emotional pain.

Check It Out:

* Lori Vann’s e-mail address:

* Lori’s website:

* Lori’s Twitter handle: @lorivannlpcs

* Lori on YouTube channel: lorivannlpcs

* Lori’s list of upcoming training seminars:

* Lori’s books:

* A Caregiver’s Guide to Self-Injury (

* The Practitioner’s Guide to the Treatment of Self-Injury: Tips, Techniques, Activities, and Debates (



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