Understanding self-harm … another new blog

Jason Washburn from the Centre for Evidence-Based Practice in Hoffman Estate, Illinois observed that over the last 20 years there has been a 400%+ increase in scholarly publications focusing on Non-Suicidal Self-Injury (NSSI) (Washburn et al., 2012). Despite this increase little real progress has been made in understanding why people, mostly young people, engage in “self-inflicted damage of body tissue that induces bleeding, bruising. or pain, but is absent of evidence for suicide intent and is not for purposes that are social sanctioned (e.g., tattooing, piercing)” (Washburn et al., p.1, citing Nock & Favazza, 2009). The explanations that have been generated from research are logical and many have high face validity, but the complexities of application mean that simple answers may be impossible. For example, it appears that females and males may self injure at different rates, for different reasons and in different ways (Whitlock, Muehlenkamp, Purington, et al., 2011). Sexuality as well as gender has a significant bearing on risk (Batejan, Jarvi, & Swenson, 2014).

What is also missing from the literature is any real indication about how best to address the needs of someone who is engaged in NSSI beyond what may be considered competent and caring clinical practice. Walsh (2012) outlines a stepped-care model that consists of – Step 1: the initial therapeutic response and assessment, Step 2: mainstream psychological and pharmacological interventions, Step 3: specific interventions based around trauma, anxiety, body image, and safety, and Step 4: Residential support and detailed case management. While these approaches make sense and have some appeal their utility is still far from proven. One of the difficulties is that ‘treatment’ of NSSI has, in the past, been incorporated into the treatment of other presentations and has not been the focus of attention. Over the last years it has been recognized that NSSI can be expressed outside of other major mental health presentations as a standalone behaviour, at least in psychiatric terms. Of course, NSSI is anything but a ‘standalone’ behaviour as it has its own social, interpersonal, and intrapsychic context and meaning.

The purpose of this blog is to report on the work we are starting on the Wellington campus of Massey University in New Zealand. Our focus is both academic and clinical. We aim to develop theory and conduct research which has direct applicability to practice. To achieve this we aim to engage with people who currently self-harm (both with and without suicidal intent) and work with service providers, clinical practitioners and service planners to find ways of meeting the needs of those who self-harm.

We will keep you informed of our progress. Please visit again.

Dr John Fitzgerald, Snr Lecturer in Clinical Psychology



Batejan, K. L., Jarvi, S. M., & Swenson, L. P. (2014). Sexual orientation and non-suicidal self-injury: A meta-analytic review. Archives of Suicide Research, 19, 131-150. doi:10.1080/13811118.2014.957450

Nock, M. K., & Favazza, A. R. (2009). Non-suicidal self-injury: Origins, assessment, and treatment. Washington, DC: American Psychological Association.

Walsh, B. W. (2012). Treating self-injury: A practical guide (2nd edn). NY: Guilford Press.

Washburn, J. J., Richardt, S. L., Styer, D. M., Gebhardt, M., Juzwin, K. R., Yourek, A., & Aldridge, D. (2012). Psychotherapeutic approaches to non-suicidal self-injury in adolescents. Child and adolescent psychiatry and mental health, 6(1), 1-8.

Whitlock, J., Muehlenkamp, J., Purington, A., Eckenrode, J., Barreira, P., Abrams, G. B., … Knox, K. (2011). Nonsuicidal self-injury in a college population: General trends and sex differences. Journal of American College Health, 59, 691–698. doi:10.1080/07448481.2010.529626

About John Fitzgerald

NZ Registered Clinical Psychologist and Snr Lecturer in Clinical Psychology at Massey University, Wellington, New Zealand
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