Non-suicidal self-injury (NSSI) is becoming more common, especially among adolescents and young adults. A number of factors can increase the risk for NSSI in college students, including mental illness, substance use, high levels of external stress, and trouble regulating emotions in healthy ways. [1] This article will examine risk factors and warning signs of NSSI in college students.
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What is non-suicidal self-injury (NSSI)?
Non-suicidal self-injury involves deliberate acts of self-harm or self-injury. There are many different types of self-harm that can be categorized as NSSI, including cutting, biting, hitting, scratching, or pinching oneself. Usually, people engage in these behaviors when they are highly distressed or overwhelmed. Unlike a suicide attempt, people who engage in self-harm are not trying to kill themselves. Instead, most describe using NSSI as an outlet or coping strategy that temporarily helps to regulate difficult emotions. [1][2]Â
How common is NSSI in college students?
Non-suicidal self-injury rates have increased in recent years, especially among teens and young adults. It is difficult to determine exact rates of NSSI because research shows that most people who engage in deliberate self-harm do not seek professional help or treatment. The best estimates suggest that between 12 and 17% of college students engage in NSSI, although these rates may be higher in certain countries. [1]Â
There are also certain populations and groups that are more likely to self-harm. Research consistently shows that females engage in NSSI at much higher rates than males, and that white females may be more likely to self-harm than females of other races. Having a substance use or mental health disorder also increases the risk for NSSI, as do external factors like stress, family dysfunction, or bullying. [2][3]
Why do college students self-harm?
NSSI is an attempt to physically injure or harm oneself, but not in an attempt to commit suicide. Instead, most people who use deliberate self-harm describe that this has become a method of coping and regulating their mood, stress, and emotions. [1][2]Â
NSSI can prompt the release of endogenous opioids and other neurochemicals that temporarily relieve emotional or physical pain. For some, self-harm can become compulsive in ways that are similar to addiction and involve strong cravings and urges. [3]
Risk factors for NSSI in college students
A number of factors can increase the risk of NSSI in college students, including both internal and environmental factors. Internal factors like the presence of a mental illness, higher degrees of impulsivity, chronic health issues, and more difficulty regulating stress and emotions can contribute to NSSI risk. External and environmental factors like stress, family dysfunction, bullying, and exposure to self-harm in the media can also increase the risk for these behaviors. [1][2][3]
External stress
External stress can come from a number of different sources, including school, family or peer relationships, work, or other life circumstances. Research shows that many people who engage in NSSI report struggling with feeling overly stressed or overwhelmed by external demands and pressures. [1] Stress can trigger urges to engage in unhealthy coping strategies like NSSI, and can also reduce a person’s ability to resist these urges and impulses.
Mental health conditions
Mental health conditions are also a known risk factor for NSSI. Anxiety disorders, mood disorders, and eating and substance use disorders are all closely correlated to NSSI, and many individuals with these conditions rely on NSSI to cope with their symptoms. Even in individuals not diagnosed with mental illness, psychological distress often acts as a precursor to NSSI behaviors. [1][3]
Poor coping skills
Research suggests that adolescents and adults who engage in NSSI often struggle to regulate their emotions and cope with stress in healthy ways. [1] Instead, they are more likely to engage in impulsive behaviors like NSSI or substance use that temporarily make them feel better despite causing other problems for them.
Media and peer examples
Exposure to examples of self-harm in the media or peer groups is also believed to increase the risk for NSSI. Many adolescents are especially vulnerable to these kinds of exposures, particularly when they are glorified in the media. [1]Â
Physical health issues
Physical health issues and chronic illnesses can also increase the risk for NSSI. While chronic health issues are less common in young people, a statistically significant percentage of people who self-harm struggle with an illness or medical condition. [1] In these instances, it is likely that people are using NSSI as a way to cope with the physical and emotional pain and discomfort caused by an underlying condition or illness.
Warning signs and when to seek help
Engaging in deliberate self-harm or NSSI is a sign that a person is actively struggling with their mental health, and should always be considered a warning sign that professional help is needed. There may be physical signs of self-harm, including cuts, burns, or bite marks on a person’s arms or legs. In many cases, a person will hide the physical evidence of NSSI, and a worsening of their mental health will be the only warning sign.
Here are some warning signs of poor mental health: [4]
- Changes in mood or energy levels.
- Increased social withdrawal or isolation.
- Worsened attendance, organization, or productivity.
- Change in sleep or nutritional habits.
- Poor concentration, memory, or learning.
- Illogical or irrational thoughts.
- Increased emotional reactivity, irritability, or sensitivity.
- Appearing more stressed, anxious, or overwhelmed.
- Worsened hygiene or appearing disheveled.
Treatment options for non-suicidal self-injury
It is safe to assume that people who engage in NSSI are in need of some level of professional mental health treatment. According to research, NSSI is closely correlated with a variety of conditions, including mood, anxiety, psychotic, eating, and substance use disorders. Most people who engage in deliberate self-harm are struggling with active symptoms of one or more of these conditions, as well as high levels of emotional distress. [1][3]Â
There are certain treatments that are better suited for specific types of mental health conditions, but all involve behavioral therapy that can be provided in individual, group, or family sessions. A variety of different types of therapy may be used, but Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and family therapy are the most common. In treatment, people who self-harm can work on identifying triggers and stressors for NSSI and learn healthier methods of coping. In addition to therapy, some individuals will also benefit from antidepressants (such as SSRIs) and other medications to help manage symptoms of an underlying mental illness. [1]
