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Key points
- Like substance use disorders, self-harming is generally hidden and highly stigmatized.
- As with SUDs, the motivations underlying non-suicidal self-injury are diverse but often include a desire for reward or relief.
- People who self-harm often use language such as “getting clean,” “relapse,” or “recovery."
Approximately 17 percent of adolescents, 13 percent of young adults, and 6 percent of adults report a lifetime history of non-suicidal self-injury or the deliberate harming of one’s body tissue (most often via cutting, scratching, or burning) without intending to kill oneself. Although this type of behavior has become increasingly prevalent over the past two decades, not enough is known about the drivers and clinical features of self-harming behavior, and there is no standard therapy approach to treat it. In the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5), non-suicidal self-injury is identified as a condition for future study. However, new research by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) demonstrates the experiential commonalities between non-suicidal self-injury (NSSI) and substance use disorders (SUDs).
In the study, recently published in the Journal of Behavioral Addictions, a substantial majority of individuals who reported and discussed non-suicidal self-injury on the social media platform Reddit described their experience in terms impressively similar to those used in connection with substance use disorders. Researchers analyzed more than 350,000 posts and comments on “r/selfharm,” a Reddit subforum dedicated to discussion of self-harm, from 2010 to 2019. Those who posted often directly referred to their self-injuring activities as an “addiction,” citing cravings or urges to self-harm, as well as a progression of actions and escalating severity related to the phenomenon of tolerance—where increased intensity and/or frequency of self-harming behavior becomes necessary to achieve the desired effects. Individuals on the subforum also frequently used language and concepts common to addiction recovery and frequently used in 12-step programs, such as “getting clean,” “relapse,” or “recovery.”
Self-harming is generally hidden and highly stigmatized. As with SUDs, the motivations underlying non-suicidal self-injury are diverse but often include a desire for reward or relief—to feel “good,” to feel “better,” or at least to feel different. More specifically, many people engage in self-harming behaviors to relieve or cope with feelings of depression, anxiety, and stress, along with other uncomfortable mental-emotional states.
To explore the extent to which self-injury and substance use disorders are similar experientially, NIDA researchers explored the language that people use to talk about self-harm on Reddit, a social network of online discussion communities organized into hundreds of thousands of so-called “subreddits,” or forums dedicated to specific topics. Study investigators reviewed a dataset of 69,380 original posts and 290,524 comments from 38,484 Reddit users on the r/selfharm subforum, which describes itself as “a subreddit for self-harmers to relate to each other, ask questions, and build up a community.” From this dataset, the investigators analyzed posts from 500 random Reddit users who each had left at least 10 posts and comments with a total of at least 2,000 words on the subreddit.
Substance use disorders are diagnosed using the evidence-based criteria described in DSM-5. To examine the r/selfharm posts about non-suicidal self-injury for language correlating to features and symptoms of addiction the researchers then adapted 11 diagnostic criteria from DSM-5 used to diagnose substance use disorders and applied them to these posts.
SUD is diagnosed when at least two DSM-5 criteria are met. In this study, 77 percent of the individuals met at least two of the adapted DSM-5 substance use disorder criteria, as indicated by their posts. The most frequently observed criteria were urges or cravings (68 percent) and escalating severity or tolerance of self-harming activities (47 percent).
In general, individuals whose self-harming behavior took on addictive features were more also likely to disclose a psychiatric disorder—such as depression, anxiety, or an eating disorder—in their posts, used a wider range of methods for self-injury, and engaged in more frequent and dangerous self-harming activities (those that required medical attention). That said, reporting addiction-like self-harming behavior was not associated with suicidality.
NIDA researchers stress that their findings do not establish non-suicidal self-harm as an addiction and further studies are needed to investigate the similarities between addiction and non-suicidal self-harm, including those that involve direct engagement with this population.
However, this study contributes to a growing body of work that uses social media as a window into the subjective experiences of stigmatized at-risk populations, and its findings indicate that people who engage in non-suicidal self-harm may be more effectively supported and treated by adapting language and strategies used to diagnose and treat substance use disorders. Among the most important takeaways is that listening to and learning from the lived experiences of those who self-harm is essential to improving understanding and potential treatment.
Copyright 2022 Dan Mager, MSW
References
Reference: Himelein-Wachowiak M, Giorgi S, Kwarteng A, Destiny S, Chase S, Kenna Y, Elise B, Amanda D, Lyle U, and Brenda C. Getting “clean” from nonsuicidal self-injury: Addiction language and experiences on the subreddit r/selfharm. Journal of Behavioral Addictions. DOI: 10.1556/2006.2022.00005 (2022)
