by bullying were more likely to injure themselves, and that
depression intensified this association. Similarly, a 2015
study in the Journal of Consulting and Clinical Psychology by
Matteo Giletta, PhD, and colleagues found that of 565 Chinese
adolescents who reported depressive symptoms at baseline,
those who also reported greater peer victimization were more
likely at the end of three years to self-injure than those who
reported less peer harassment.
Those who self-injure also are more prone to depression,
hopelessness and dissociation, research also finds. Thus,
researchers are studying the role of emotion dysregulation —
difficulty discriminating between emotional states or knowing
how to cope with or extricate oneself from negative emotional
states — and finding a strong link with self-injury.
Research also finds that NSSI is a strong predictor of later
suicide attempts. In a 2013 study reported in the Journal of
Adolescent Health, Whitlock, Muehlenkamp and colleagues
followed 1,466 students at five American colleges over three
years. Students who self-injured at the beginning and did not
report suicidal thoughts, plans or actions at the time, but who
went on to engage in 20 or more self-injuring behaviors, were 3. 4
times more likely to have attempted suicide by the study’s end.
Other risk factors are under the microscope as well. These
include self-injurers’ ability to endure pain, low feelings of self-worth (see article, page 59), tendency to objectify the body,
and risk factors that overlap with those of other conditions like
Muehlenkamp is examining body objectification as
an important potential factor in the development and
maintenance of NSSI. The notion holds that when people
see their own body as an object — the result of internalized
cultural and familial pressures — it’s easier to distance
themselves psychologically from their bodies and hence to
A 2013 study by Muehlenkamp and colleagues in Suicide
and Life-Threatening Behavior supports this hypothesis. Males
and females with poor body regard who also scored high on
emotion dysregulation were more likely to self-injure than
people with poor emotion regulation but normal body regard.
The findings suggest a potentially significant commonality
between NSSI and eating disorders, which are present in as
many as 55 percent of those who self-injure, Muehlenkamp
“Body objectification, body devaluation and a lack
of internal bodily awareness are also prevalent in that
population,” she says.
Muehlenkamp also hopes to study the mindfulness
component of dialectical behavior therapy, which she feels
might help NSSI sufferers address their body image problems
gently and gradually.
“To become more mindful means you have to become more
in tune with your body, more connected to it, more integrated
with it,” she says. Such body awareness may potentially
undermine one’s tendency to objectify the body, hence
reducing the risk for self-injury, she posits.
— Tori DeAngelis
Using a technique called pain offset relief conditioning, those
scientists also found that if you paired the pain with a stimulus,
over time, people would react more favorably to the pain because
they had learned to associate it with pain relief. For example,
when researchers shocked rats and then presented them with a
pleasant odor, over time, the rats began seeking out the smell.
Testing this paradigm with various types of shocks and
physiological measures, Franklin continued to find powerful
pain-offset relief effects in all of his participants, self-injurers
and controls alike. People who self-injure may unwittingly be
tapping into this mechanism, Franklin surmises. The first time
they hurt themselves, they experience unpleasant pain. But
when they keep doing it and experience pain relief, they begin
to associate cutting or other forms of self-injury with relief, and
they return for more.
“That is contrary to what a lot of people assumed and what
a lot of treatments focus on,” Franklin says. “People, including
myself, were thinking there was something unique about these
folks” — that if they were injuring themselves repeatedly, they
must perceive or experience pain differently from others.
“But that doesn’t appear to be the case at all,” he says. “It
looks like it’s this natural phenomenon that [people who self-injure] happen to be tapping into.”
The next research question may seem obvious: If anyone
can experience pain relief by inflicting pain on themselves, why
don’t more of us do it? To ask the question a different way, why
do self-injurers harm themselves instead of opting for healthier
or more pleasant ways of relieving emotional pain, such as
watching a movie, meeting a friend or going to a yoga class?
As Franklin was pondering this question in light of possible
benefits to the self-injurer, Hooley and her team wondered
about psychological explanations. She already knew that self-injurers would endure physical pain for longer, but why?
Was this increased pain endurance linked to some of the