The Neuroscience of Non-Suicidal Self Injury (NSSI) 🧠

The Brain Science of Self-Injury and the Healing Power of IFS Therapy (12min Read)

***Disclaimer: Today’s blog contains conversations about suicide, self-harm, self-injury, non-suicidal self-injury, anxiety, depression, and suicidal ideations. These conversations and related language choices may trigger some readers. Please proceed with caution and care. If you are experiencing emotional distress or are feeling suicidal, call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or visit suicidepreventionlifeline.org***

TL;DR Summary

• This blog explores Non-Suicidal Self-Injury (NSSI), its neurobiological basis, and how Internal Family Systems (IFS) therapy can help.

• NSSI differs from self-harm and suicide in intent and methods but often serves as a way to manage overwhelming emotions.

• Mental health issues, trauma, and emotional dysregulation are key risk factors for NSSI.

• NSSI is reinforced by neurochemicals like serotonin, endorphins, and dopamine, making it hard to break the cycle.

• IFS provides a compassionate approach to healing by understanding and working with the parts of yourself involved in NSSI.

• The SIRA Foundation supports those struggling with NSSI; consider donating to their cause.

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Welcome Back

Today we’re covering what can be a heavy topic for some, but needs to be addressed nonetheless!

Many of you might not know, but I sit on the board of a foundation called the SIRA Foundation!

SIRA stands for Self Injury Recovery & Awareness and is run by a very close friend of mine, Amanda Beausoleil.

SIRA is the largest peer support and recovery group for people struggling with Non-Suicidal Self Injury (NSSI) in the world!

Every week they host live support groups that help thousands of people.

SIRA's goal is to reach 500K people by 2026— including people who self-injure, their families, and health care providers.

This is the kind of goal I can get behind!

If you feel the same, there will be “Donate” buttons throughout today’s blog that look like this:

Alright, today, I’d like to shed some light on NSSI, the neuroscience behind it, and how IFS can aid in the recovery process.

Let’s dive in!

Understanding Non-Suicidal Self-Injury (NSSI)

Alright, so what is Non-Suicidal Self-Injury (NSSI)?

Great question, here’s the definition, the intentional infliction of harm on the body without suicidal intent.

This behavior, while deeply distressing for those who engage in it, often serves as a maladaptive coping mechanism for managing overwhelming emotions.

More on this later, but it’s important to understand that NSSI is not simply a "bad habit" it’s rooted in complex neurobiological mechanisms which I’ll go over shortly!

The Difference Between NSSI, Self-Harm, & Suicide

NSSI (Non-Suicidal Self-Injury), self-harm, and suicidal behaviors are often grouped together because they all involve harm to oneself.

I know that I grouped them together before starting to work with SIRA!

However, they differ significantly in their intent, methods, and outcomes.

Here’s What They Have in Common:

• All involve intentional harm to oneself, typically as a way to cope with overwhelming emotions or distress.

• They often coexist, meaning someone who engages in NSSI might also experience suicidal thoughts or behaviors.

• Each of these behaviors can be a response to trauma, mental health issues, or emotional pain, making them serious and deserving of attention and care.

  

Where They Differ:

• Intent: NSSI and self-harm are typically not about wanting to die. They’re ways to manage emotions, find relief, or express pain. Suicidal behaviors, on the other hand, involve a desire to end life.

• Lethality: NSSI usually involves methods that cause harm but aren’t life-threatening, like cutting or burning. Suicidal attempts, however, often involve more lethal methods.

• Frequency: NSSI tends to be repetitive and frequent, serving as an ongoing coping mechanism. Suicide attempts, while less frequent, are far more dangerous.

• Purpose: NSSI often functions as a way to regulate emotions, to feel something when numb, or to punish oneself. Suicidal actions aim to end life, driven by a desire to escape unbearable pain.

Understanding these distinctions is crucial.

While NSSI doesn’t involve a desire to die, it’s a significant indicator of distress and why any form of self-harm should be taken seriously, with careful assessment and support!

What Puts Someone at Risk for NSSI?

NSSI isn’t something that appears out of nowhere.

It’s often the result of a combination of personal, social, and environmental factors that make someone more vulnerable to using self-injury as a coping mechanism.

Conditions like depression, anxiety, borderline personality disorder, and substance abuse are closely linked to NSSI.

These mental health issues often involve intense emotional pain and difficulties in managing those emotions, which can lead to self-injury as a way to cope.

When emotions feel too big to handle, self-injury can seem like a way to regain control.

This difficulty in regulating emotions is a common thread among those who engage in NSSI.

Another common thread is a history of trauma, particularly childhood abuse or neglect.

These early experiences can leave deep emotional scars, making it harder to cope with stress and increasing the likelihood of turning to self-injury.

The wild thing about NSSI, and just about any other mental health challenge is that these risk factors don’t operate in isolation—they often interact, creating a complex web that can lead to NSSI.

Common Examples of NSSI

You might be curious what some examples of Non-Suicidal Self-Injury are.

It can take many forms. Some common examples include:

• Cutting or Carving the Skin: Using sharp objects like razors or knives to create cuts or markings on the skin.

• Burning: Applying heat from matches, lighters, or cigarettes to inflict burns.

• Hitting or Punching: Repeatedly hitting oneself or banging parts of the body against hard objects to create bruises or pain.

• Scratching or Picking at Skin: Intentionally scratching the skin to the point of bleeding or preventing wounds from healing.

• Hair Pulling (Trichotillomania): Pulling out one’s own hair, sometimes to the point of causing bald patches or pain.

• Interfering with Wound Healing: Picking at scabs or reopening wounds to prevent healing.

So, what’s the neuroscience behind this behavior?

The Hijacking of the Brain's Reward System

NSSI shares several similarities with substance addiction, particularly in how the brain's reward system becomes hijacked.

The release of serotonin, endorphins, and dopamine during self-injury mimics the neurochemical response seen in drug addiction.

This makes NSSI feel rewarding, even though it is harmful, reinforcing the behavior.

I know that can come as a surprise to you to hear, but it’s part of what makes recovery challenging!

In addition to this hijacking of the reward system overall, people who self-injure often have heightened sensitivity in brain regions associated with reward.

Which means their brain more readily associates self-injury with relief and pleasure.

Speaking of reward centers, some of the most powerful neurotransmitters we have are released when engaging in NSSI.

There are 3 big ones and each plays a role in the overall experience.

1. Serotonin: Often called the "calming neurotransmitter," serotonin helps reduce anxiety and impulsivity.

2. Endorphins: These natural painkillers produce a numbing effect, which can be incredibly soothing for someone in emotional pain. The rush of endorphins during self-injury provides temporary relief from both physical and psychological discomfort.

3. Dopamine: Known for its role in pleasure and reward, dopamine is released during self-injury, reinforcing the behavior similarly to how drugs can reinforce addiction.

   

This combination of neurotransmitter release creates a powerful feedback loop, making NSSI not just a physical act but a neurobiologically reinforced behavior that can be hard to break.

This may come as a surprise, but to those engaged in NSSI, it can actually feel "good” even though it can be damaging.

Structural & Functional Differences in the Brain

So, that’s neurochemicals, but what about higher level brain structures?

You’re probably not surprised, but research shows that people who engage in NSSI often exhibit distinct brain differences from those who don’t.

Let’s break them down!

Limbic System

This part of the brain, responsible for emotional processing, is more active in those who self-injure.

The heightened activity in regions like the amygdala may explain why emotions feel overwhelming and uncontrollable, leading to self-injury as a form of release.

Cortical Midline Structures

These areas, involved in self-processing and identity, are also more active in people who engage in NSSI.

This might contribute to the distorted self-image and intense self-criticism often reported by these people.

Emotion Regulation Circuits

There is also often reduced connectivity between the brain regions responsible for emotion generation and those involved in regulating these emotions.

This disconnect makes it difficult for individuals to manage intense feelings in healthy ways, leading them to rely on NSSI.

Pain Processing

Interestingly, the experience of pain in those who engage in NSSI is different from that of others.

Pain, which typically serves as a deterrent, can feel rewarding or relieving for someone who self-injures as I talked about earlier.

This paradoxical experience is due to altered pain and reward processing in the brain, where pain relief and emotional numbing become intertwined.

Wild, right?

Emotional Regulation and NSSI: The Role of IFS

Emotion dysregulation is a central feature of NSSI.

People who engage in self-injury often struggle to manage intense emotions, leading them to use self-harm as a way to cope.

Internal Family Systems (IFS) therapy offers a powerful framework for understanding and treating this behavior by addressing the underlying emotional struggles.

IFS: Befriending the Parts

If you’ve been reading my blog long, you know I’m trained in IFS Psychotherapy!

And that IFS views the mind as composed of different "Parts," each with its own thoughts, feelings, and motivations.

In the context of NSSI, Parts may drive the behavior as a way to protect the individual from overwhelming emotions.

These Parts are not enemies; they are simply trying to help in the only way they know how.

For example, I’ve had clients that have a Part of themself that feels immense shame.

This part believes that self-injury is the only way to make up for perceived failures in their lives.

In IFS, the goal is not to suppress this Part but to understand its intentions and offer it new, healthier strategies for coping!

This is at the heart of why I believe IFS is so powerful for NSSI.

It’s the first time a lot of these people are talking with a therapist or coach who doesn’t shame them for these Parts of themselves.

This compassionate inquiry with their Parts can help teach them how to love these Parts of themselves!

Instead of just talking about it, I’d like to give an actual IFS process you or someone you know struggling with NSSI can use.

Before I dive in though, people review this quick disclaimer!

***This blog is for informational purposes only and is not a substitute for professional therapy. If you are struggling with NSSI or any mental health issues, please seek help from a licensed therapist near you. Always prioritize your safety and well-being.***

A DIY IFS Protocol for NSSI

Ok, now that we’ve got the acronyms outta the way, on to the protocol.

The following IFS-based protocol can be used to explore and address the Parts of yourself involved in this behavior.

This approach is designed to help you build a compassionate relationship with these Parts and gradually shift towards healthier ways of coping.

Step 1: Establishing Safety and Self-Connection

Before diving into work with your Parts, it’s essential to ensure you’re in a safe, grounded space.

1. Find a Quiet Space: Choose a comfortable, quiet place where you won’t be interrupted.

2. Grounding Exercise: Take a few deep breaths. Focus on your body and the sensation of your feet on the ground. This helps you stay connected to the present moment.

3. Connect with Your Self: Bring your awareness to the part of you that feels calm, curious, and compassionate. This is your Self, the core of who you are. All Parts work should be done from your Self.

Step 2: Identifying the NSSI Part(s)

NSSI often involves multiple parts, each playing a different role. The goal here is to identify and understand these parts without judgment.

1. Notice the Urges: When you feel the urge to self-injure, take a moment to pause. Ask yourself, “What part of me is feeling this way?” “Where do I feel it in or around my body?”

2. Ask About Their Role: Gently ask this part what it’s trying to do for you. Common answers might include trying to reduce emotional pain, helping you feel in control, or expressing something that feels unmanageable.

3. Acknowledge the Part’s Positive Intention: Even if the behavior is harmful, acknowledge that this part is trying to help in its own way.

Step 3: Building a Relationship with the NSSI Part(s)

Once you’ve identified the part(s) involved in NSSI, the next step is to build a compassionate relationship with them.

1. Express Curiosity: Approach the part with curiosity, asking it why it feels the need to push you towards self-injury. What is it afraid will happen if it doesn’t?

2. Offer Compassion: Let the part know that you see it and understand that it’s trying to help. You can say something like, “I see that you’re in a lot of pain, and I’m here to listen.”

3. Invite Dialogue: Ask the part if it’s willing to share more about its fears and desires. Listen without judgment.

Step 4: Developing New Coping Strategies

As you work with your parts, it’s important to develop new ways of coping!

1. Explore Alternatives: With the help of your Self, brainstorm alternative ways to meet the needs that NSSI was addressing. For example, if NSSI was a way to feel in control, explore other methods of grounding or self-soothing.

2. Practice and Reinforce: Begin practicing these new coping strategies regularly. Reinforce them by acknowledging the positive changes in how you feel and behave.

3. Check-In Regularly: Make it a habit to check in with your parts, especially during times of stress. Ensure they feel heard and supported, which will reduce the likelihood of reverting to NSSI.

Step 6: Seek Support

While IFS can be incredibly powerful as a self-help tool, having external support can make a big difference in your healing journey.

• Therapeutic Support: If possible, consider working with an IFS-trained therapist or coach who can guide you through the process.

• Peer Support: Sharing your experiences with others who understand can provide additional comfort and insight. This is where the SIRA Foundation comes in!

Treating NSSI using IFS is about more than just stopping the behavior—it’s about understanding and healing the parts of yourself that have been driving it.

By approaching these parts with compassion and curiosity, you can begin to unburden them and develop healthier ways of coping with life’s challenges.

Remember, every part of you has a positive intention, and by working together, you can find peace and healing!

A Path to Healing

NSSI is a complex behavior with deep roots in our mind, brain and body.

However, it is not an insurmountable challenge.

I hope that by understanding the neuroscience behind self-injury and utilizing approaches like Internal Family Systems Psychotherapy, more people can develop healthier ways to cope with their emotions.

Please consider supporting the SIRA Foundation if you’ve made it this far, here’s where you can donate.

And as always, until next time… Live Heroically 🧠

Supporting Research

1. Favazza, A. R. (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease, 186(5), 259-268.

2. Klonsky, E. D., & Muehlenkamp, J. J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology, 63(11), 1045-1056.

3. Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339-363.

4. Plener, P. L., Schumacher, T. S., Munz, L. M., & Groschwitz, R. C. (2015). The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature. Borderline Personality Disorder and Emotion Dysregulation, 2(1), 2.

5. Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647.

6. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

7. Schwartz, R. C. (1995). Internal Family Systems Therapy. Guilford Press.

8. Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226-239.

9. Westlund Schreiner, M., Klimes-Dougan, B., Begnel, E. D., & Cullen, K. R. (2015). Conceptualizing the neurobiology of non-suicidal self-injury from the perspective of the Research Domain Criteria Project. Neuroscience and biobehavioral reviews, 57, 381–391. https://doi.org/10.1016/j.neubiorev.2015.09.011