Discussing NSSI: Language Counts

The language we use to talk about people and the behaviours they engage in is powerful. Language is the medium we use to communicate our understanding of the world, to establish social structures, define cultures, and establish meaning to phenomena and people. Language shapes the way we view the world and our place in it. The language that is commonly used when talking about NSSI and people with lived experience of NSSI is often derogatory, can perpetuate myths and foster stigma, and can make people with lived experience feel even more misunderstood and isolated.

Conversely, adopting a ‘respectful curiosity’ and being conscious of using respectful language can opened the way for helpful conversations and encourage support seeking.

Take home points:

·   Always be respectful when talking about NSSI, or people with a lived experience of NSSI

·   Poorly-considered language can exacerbate stigma among people who already feel highly stigmatised

·   Avoid language that defines a person by their behaviour (e.g., “cutter”; “self-injurer”)

·   Avoid language that is value-laden (e.g., good/bad), or propagates stigma (e.g., attention-seeking)

·   Use of appropriate language can foster open communication and facilitate support-seeking

Recommended reading:

1.           Lewis, (2017). I cut therefore I am? Avoiding labels in the context of self-injury. Medical Humanities.

2.           Hasking, P., Lewis, S.P., & Boyes, M. (2019). When language is maladaptive: Recommendations for discussing self-injury. Journal of Public Mental Health, 18, 148-152.

3.           Hasking, P., & Boyes, M. (2018). Cutting words: A commentary on language and stigma in the context of non-suicidal self-injury. Journal of Nervous and Mental Disease, 206, 829-833.

NSSI and Suicide

The relationship between NSSI and suicidal thoughts and behaviours is complex. Although NSSI is not engaged with conscious suicidal intent, it is the most reliable predictor of later suicidal behaviour. People who have a history of NSSI are between 3-5 times more likely to report later ideation or attempt.

Take home points:

·   A history of NSSI is associated with increased risk of later suicidal thoughts and behaviours.

·   However predictive accuracy is relatively weak.

·   More frequent NSSI, and use of a variety of methods, are associated with increased risk of attempt, among people with a history of NSSI.

·   Suicidal intent can fluctuate over time; risk assessment and ongoing monitoring of intent among people who self-injure may be warranted.

Recommended reading:

1. Hamza, Stewart, & Willoughby. (2012). Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clinical Psychology Review, 32, 482-495.

2. Victor and Klonsky (2014). Correlates of suicide attempts among self-injurers: A meta-analysis. Clinical Psychology Review, 34, 282-297.

3. Kiekens et al., (2018). The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviours. J Affective Disorders, 239, 171-179.

4. Whitlock et al. (2013). Nonsuicidal self-injury as a gateway to suicide in young adults. J Adolescent Health, 52, 486-492.

5. Ribeiro et al., (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46, 225-236.