Non-Suicidal Self-Injury: How to Cope with It and Provide Support – Dr. Stephen P. Lewis, Ph.D.

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Non-suicidal self-injury, or NSSI for short, refers to the intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned. 

Common examples include cutting, burning, scratching, banging or hitting. While this is indeed a heavy topic to talk about, NSSI is far more common than most people realize. 

Statistics show that about 14% to 24% of teens have reported causing self-injury at least once, and about a quarter of those have done it many times. 

Similar rates of self-injury have been found amongst college students. In later adulthood, the occurrence of self-injury seems to be somewhat less prevalent, with about 1 in 20, or approximately 4% of adults indicating they have done self-injury. 

Moreover, though it is more common than most people would think, there is still a lot of negative bias towards NSSI. As with any topic that bears a stigma, the stigma against NSSI usually arises from lack of awareness, lack of education, lack of perception, and the nature and complications of the topic.

Therefore, we have invited to The IPS Podcast, Dr. Stephen Lewis, associate professor of the Department of Psychology at the University of Guelph, and invited member of the International Society for the Study of Self-Injury (ISSS), where he currently sits on the Executive Board, to provide more in-depth information on what precisely non-suicidal self-injury is and how to stop self-harm.

Not only is Dr. Stephen Lewis a professional researcher on NSSI and can therefore talk intelligently about the subject, but he himself has personal experience with NSSI as well. 

Therefore, he also understands emotionally the pain and struggle of people who do self-harm.

It’s clear that NSSI is a grossly misunderstood topic. And it shows in many ways. Far too many people don’t know the main reason why someone causes self-injuries, and thus, they fail to take NSSI seriously and don’t know how to stop self-harm and provide support.

Self-harm is hardly as simple as it has been shown to be in popular media. It isn’t always a cry for attention or self-punishment.

In fact, it rarely is. By a wide margin, NSSI most commonly functions to (temporarily) alleviate overwhelming negative emotions.

This misconception that self-harm is done to gain attention is not only terribly incorrect, but it can even be dangerous.

It could, first of all, lead people to not take NSSI seriously because they don’t understand that the person who causes self-harm is going through intense emotional pain.

Thus, people will fail to provide support.

But also, there is a growing body of literature that suggests that NSSI may be an especially crucial risk factor in suicidal behavior.

While Dr. Lewis will talk more thoroughly about this in the interview, you should remember that, if you are having suicidal thoughts, there are people who greatly care to listen and be there for you—even though that’s hard to believe.

The suicide crisis line warmly welcomes anyone willing to have a chat. ‘Here’ you will find a list of suicide crisis lines that you can call; there should be one in your country.

Also, if you are struggling with suicidal thoughts, or if you know someone who does self-harm, have a listen to the interview on The IPS Podcast that we did with Mark Henick, suicide survivor and mental health advocate.

He shares his personal experience with suicide, how to be there for someone suffering from suicidal thoughts, and how to help yourself if you are struggling with these thoughts.

While in this interview Dr. Lewis gives in-depth insights into why people cause self-harm and provides tips and advice on how to help someone, as well to those who do self-harm, for anyone looking to learn even more about NSSI, Dr. Lewis is also the co-founder and co-director of Self-Injury Outreach & Support, an international outreach initiative providing current information and resources to individuals who inflict self-injury as well as their families, friends, teachers, and the health professionals who work with them.

The emotional and physical scars of people who do self-harm are real, and it is therefore not only important but also necessary to take NSSI far more seriously.

Stigma is a risk factor leading to negative mental health outcomes, as people often don’t dare to talk about their struggle for fear of not being taken seriously or not being understood.

This interview with Dr. Stephen Lewis will hopefully help educate and provide better information on self-harm and how to stop self-harm for those who are looking to understand it.

Likewise, this interview is very much aimed for those who do self-harm. It provides pieces of advice and insights from a man who not only knows about the topic and can talk intelligently about it, but who also wears the scars himself.

Websites:

  • Self-Injury Outreach and Support (Directed by Dr. Stephen Lewis and Dr Nancy Heath, our team consists of undergraduate and graduate students at both the University of Guelph and McGill University dedicated to developing and providing information and helpful resources about self-injury.)
  • – List of Suicide Crisis Lines 


Videos:

  • The Skeletons in My Closet | Stephen Lewis | TEDxGuelphU (Dr. Lewis tells the story of his own life, which eventually brought him to researching Non-Suicidal Self-Injury (NSSI) professionally. This intense and personal story gives insight into the internal struggles of someone who has dealt with self-injury and gives hope to those who may be struggling with the battle themselves.)


Books

  • Nonsuicidal Self-Injury, in the series Advances in Psychotherapy, Evidence Based Practice (Nonsuicidal self-injury (NSSI) is a baffling, troubling, and hard to treat phenomenon that has increased markedly in recent years. Key issues in diagnosing and treating NSSI adequately include differentiating it from attempted suicide and other mental disorders, as well as understanding the motivations for self-injury and the context in which it occurs.)
  • – Freedom from Selfharm: Overcoming Self-Injury with Skills from DBT and Other Treatments (Self-injury can be as addictive as any drug, and the secrecy and shame many sufferers feel about this behavior can keep them feeling trapped. But if you’re ready to replace self-harm with a set of healthy coping skills, this compassionate and practical book can help.)
  • – Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones (Subtle scars disappearing up a shirt sleeve, unexplained bruises, burn marks. As many as one out of every four young people engage in non-suicidal self-injury, defined as the deliberate destruction of body tissue without suicidal intent. Parents who uncover this alarming behavior are gripped by uncertainty and flooded with questions–why is my child doing this? Is this a suicide attempt? What did I do wrong? What can I do to stop it? And yet basic educational resources for parents with self-injuring children are sorely lacking.)
  • – The IPS Academy 00:000:50
  • – Intro 0:5004:47
  • – What is non-suicidal self-injury (NSSI)? 04:4707:37
  • – Understanding why someone self-harms 07:3710:54
  • – The relationship between NSSI and suicidal thoughts and behavior 10:5414:31
  • – Important information about NSSI and suicide 14:3115:44
  • – The most common methods used to self-harm 15:4416:42
  • – The age group with the highest percentage of self-harm 16:4219:57
  • – The IPS Academy 18:3919:57
  • – Why NSSI is addictive 19:5723:00
  • – Why people choose self-injury as a coping strategy 23:0025:25
  • – Dr. Lewis’s personal experience with NSSI 25:2528:30
  • – Advice from Dr. Lewis to anyone who self-harms 28:3032:09
  • – Essential things that helped Dr. Lewis to stop self-harm 32:0934:25
  • – How parents, teachers, and friends can help someone who self-harms 34:2539:10
  • – Resources to learn more about NSSI 39:1040:55
  • – How to live with and accept your scars 40:5543:14
  • – Dealing with people who stare at your scars 43:1445:55
  • – Interesting discoveries Dr. Lewis recently found in his research 45:5548:39
  • – A few last words from Dr. Lewis about NSSI 48:3950:57
  • – The final question 50:5751:18
  • – End 51:1852:40
  • – The IPS Academy 52:4054:05

The transcription is, for the most part, AI-transcribed and is currently 85% accurate. We are still weeding out some minor errors.

The IPS Academy
Before we go on to the interview, have you already taken a look at The IPS Academy? The IPS Academy provides online courses from some of the best instructors out there on mental health, personal development, lifestyle, nutrition, mindfulness improving your life quality, etc. Each course we offer has been made in collaboration with an instructor who has also been a guest here on The IPS podcast. Have a look to see if there’s a course to your liking. Read the full course descriptions and check out the thousands of positive reviews from students who have taken the course by going to TheIPSProject.com/academy. Or check the description of this episode to find the link. With that, let’s dig into the interview.

Dr. Stephen Lewis
I sort of view it as a bit of an iceberg in the sense that self-injury is what we see above the surface, and there’s a far greater story below the surface. I’ve had some bad experiences with disclosure where people didn’t react in the most helpful ways, but I’ve also had many where I got really compassionate and just validating accepting responses where there’s no judgment, there’s no pressure to you have to stop now. We get where you are, and it’s okay to be where you are, and I think that initial step, that being vulnerable is so important.

Jellis Vaes
This is Episode 18 with Dr. Stephen Lewis.

Welcome everyone, to a brand new episode here on The IPS Podcast. Thank you for tuning in and for being here. In this episode, we have invited Dr. Stephen Lewis, Associated Professor of the Department of Psychology at the University of Guelph, to talk about an extremely misunderstood topic non-suicidal self-injury, or in short, NSSI. Dr. Lewis has not only developed a keen knowledge of NSSI through professional research, but also understands it through his own personal experience, making him the perfect guest to talk about this subject. He is also the co-founder and Co-Director of Self Injury Outreach and Support, an international outreach initiative providing information and resources to individuals who cause self-injury, as well as support for their families, friends, teachers and health professionals. Just like many of the topics we address on this podcast, NSSI still has a lot of stigma attached to it, perhaps even more than some of the other issues we have talked about in the past. NSSI is, however, a lot more common than you might expect to demonstrate. Statistics show that about 14% to 24% of teens report having caused self-injury at least once, and about a quarter of those more frequently. Similar rates have been noted amongst colleague students, making Edisai a reality for about one-fifth of the younger population.

While the numbers drop somewhat in later adulthood, with about one in 20 indicating that they have engaged in self-injury, they remain quite shockingly high. To be honest, considering how little NSSI is talked about, some of the stigma around NSSI is to the fact that many still believe it is a means to elicit attention, even though various studies indicate that this is hardly ever the case. As Dr. Lewis will explain, that NSSI is still seen as a way to get attention makes it painfully clear how misunderstood the issue is to any listeners who engages in self-harm. I sincerely hope this episode with Dr. Stephen Lewis can serve as a means of support and a reminder that you’re not alone.

For more info on the Self-Injury Outreach Initiative, go to sioutreach.org and that’s all written together. So again sioutreach.org. Or check out the show notes located in the description of this episode to find the link. Any other resources mentioned in the episode can as well be found there now, if you can’t find the show notes that way, you can also go directly to ipsproject.com podcast and search for Stephen Lewis. Now, without further ado, let’s dive into this interview with Dr. Stephen Lewis about non suicidal self-injury.

Jellis Vaes
Stephen, welcome to the show here and many thanks for taking the time.

Dr. Stephen Lewis
My pleasure, glad to be here.

Jellis Vaes
I want to talk with you here about a topic that does bear quite a stigma, non-suicidal self-injury or in short, NSSI. Now, as with many topics that bear a stigma, this stigma is often, it comes often out of a lack of knowledge and understanding, leading to a whole lot of myths and misconceptions, as I believe is very much the case here as well with non-suicidal self-injury. Therefore, I’m very happy and appreciate a lot to have you, Stephen, and yeah, for taking the time to provide a better understanding of this topic that is grossly misunderstood by many people self-injury.

Dr. Stephen Lewis
Yeah, I mean, it is definitely quite misunderstood. Unfortunately, as you noted, it has a number of consequences because of that.

Jellis Vaes
Let me start this interview off with a rather simple sounding but important question to clarify here. At the start. How would you explain to someone what non suicidal self injury is?

Dr. Stephen Lewis
Sure, I think this is an important area to increase knowledge in and I think part of that, as you said, is sort of starting out by talking about what it is we’re talking about here. And what self-injury is or NSSI involves is when people intentionally hurt their own bodies in ways that I guess bring about immediate body tissue damage. And common methods that people might use are things like cutting or burning or hitting. Those aren’t the only methods, but they are the more commonly reported ones. There’s many, many other ways that people may do this. Important here is that the intent behind it. So the reason why they’re doing it, it isn’t about wanting to die by suicide. And that’s why we have the non-suicidal part of the non-suicidal self-injury definition. So there’s a whole host of reasons that people may do it. It’s not about suicide. With that said, however, we do know from recent research that’s been done in the field that self-injury does elevate the risk for suicide. So notwithstanding the fact that this is, as you pointed out from in the intro, grossly misunderstood, and it absolutely is, and part of it is the reasons people have and the misconception around why people do it.

Dr. Stephen Lewis
But it’s also a concern, I think, that we have to take very seriously just in light of what this involves, how common it is, what it associates with. And that includes, as I mentioned, suicide.

Jellis Vaes
So a few things that you just said right now we’re going to come back to in a few minutes. So there are so many myths and misconceptions around NSSI. Let’s therefore already start by clearing some of those up here in the beginning for listeners right now who have never have done self-injury but are trying to understand it. What are the reasons why someone would self-harm?

Dr. Stephen Lewis
Sure. So I think this is a really important area that we’re talking about then. And the most commonly reported reason that people give for self-injury is that they say that it’s used to cope. They say that it’s used to provide relief from what seems to be very extremely painful emotional experiences. So it might be high levels of anxiety, depression, sadness, anger, frustration, high levels of distress. And what they say is that many people say is that when they self-injure, that serves as a means to get relief from those really intolerable states of emotion. So it’s not about, as we’ve heard in many cases, attention seeking. Indeed, that’s not one of the reasons at all. For the most part, it’s really about coping and trying to find a way to manage what is otherwise incredibly painful and incredibly difficult experiences that people may have. Another reason related to some of this is that some people might use it as a means to express anger, self-criticism, or even self-hatred in some cases. So I’ve heard, and I can even think of some of my own personal experiences, that sometimes self-injury can be used to sort of express this sense of anger toward the self or to even punish oneself.

And some people even say that they dislike themselves so much that self-injury is often used as a means to punish themselves because they think they may desert pain. So a lot of this really centers around really, really painful emotional experiences and it’s used then to try and find and it’s often used because it’s the only way people have in that moment at their disposal to manage the pain. Certainly, if they had another way to express it, to regulate it and to extinguish that pain in the moment, they would do it. But for many people, self-injury is really all they know.

Jellis Vaes
And this says so much, right? Like for people who’ve never or don’t know much about self-harm, a lot would think that it’s mainly done for attention seeking. But that’s the last reason actually why people do it. So says enough. How many people actually misunderstand self-harm?

Dr. Stephen Lewis
Yeah, I think what I would say to anyone who sees us as attention seeking is my question would be attention for what? And what I mean by that is that it may be that they’re trying to tell you something, they’re trying to express something that maybe they can’t say on words. And sometimes actions can’t speak louder than words, I think. And to that end, they may be trying to communicate something like the intensity and the amount of pain that they’re going through. And for many people, it’s hard to express how they feel in general, let alone then for people who may self-injure. So they may be trying to tell you something. And it’s also not attention seeking, I would say as well, because most people go through great lengths to hide it from everyone.

Jellis Vaes
So while non-suicidal self-injury is typically used as a coping strategy to regulate emotional pain, not ending one’s life, as you pointed out, and you were already mentioning this in the beginning, but is there, however, a relationship between NSSI and suicidal thoughts and behaviors like it increases or potentially could increase suicide?

Dr. Stephen Lewis
Right. So it may seem a bit sort of, I guess, paradoxical in the sense that we’re calling it non-suicidal self-injury. Yet we know from evidence, from research conducted especially over the past several years that there is indeed a relation here. And so I’ll try and unpackage that as best I can. And as you can probably appreciate, just even when we’re thinking of some of the reasons that I was mentioning for self-injury, there’s a lot of emotional pain that goes along with it. And for some people they also experience depression. They might have an anxiety disorder, they might have a history of trauma, they might have an eating disorder. There could be any other multitude of sort of co-occurring difficulties or at times a mental illness that may also be present. And we know that with any of those experiences, especially if they are persisting over time, this may bring about feelings of hopelessness and a sense that maybe there’s nothing that people can do to sort of get rid of whatever it is that they’re experiencing in terms of the intensity of their suffering or their pain. And given that we know that some people who self-injure, especially if they self-injure on a more recurrent basis, may start to think about suicide, so it’s not uncommon for people who self-injure to think about suicide.

And just by virtue of that relative to someone who does not self-injure, they’re going to be at a higher risk for suicide. And some recent evidence in our field has indicated that individuals who self-injure, if we were to control for some of the other factors which we know that might elevate suicide risk, say, for example, depression and depressive symptoms. If we sort of take those out of the equation and we look at sort of what might be the unique role in terms of maybe trying to explain an outcome related to suicidal thinking or behavior, that self-injury does uniquely and strongly predict some of those outcomes long term. So what that means is that although it may be initially done for non suicidal reasons, over time, if someone does not receive support, does not get maybe helped in terms of finding ways to otherwise express their emotions or to cope with these intense feelings they may have. In other words, to find an alternative to self-injury that over time they are going to be at higher risk. It’s not to say that all people who self-injure will attempt suicide, most will not.

But it is something we have to take quite seriously because we do know that that relation does exist. We do know that self-injury does elevate the risk for suicide. So to view it as a fad or as not serious or any of these other things that we might often hear in terms of why self-injury is done, what it really means, it’s not that serious. It is and in many ways it’s because it’s a real indicator of distress and pain and those kinds of emotions, those kinds of feelings in of themselves can also elevate suicide risk. So if someone’s going on for a long time and feeling alone, really struggling and over time they may look for a more permanent, unfortunately, and tragically solution to obtain relief from their feelings and what’s going on for them.

Jellis Vaes
That makes a lot of sense, actually, and good to know. Just to possibly draw even more out of this, is there anything else about NSSI and suicide you feel listeners could benefit from? To know.

Dr. Stephen Lewis
I mean, I would hope that listeners would if they if they hadn’t already by knowing that there is that relation there. It’s to view self-injury as a really important concern and really, I think, warrants a compassionate understanding because of a stigma and to take it seriously, to not dismiss it as something that someone’s just doing for attention or just because or whatever other reason that may come up for some people that if you know someone who is struggling, that we have to take it seriously. We have to make sure that they feel validated, supported and heard. And it’s important that we then find ways to assist in that person’s path to finding their own path in terms of their own sort of building of resilience and strength, which I think resides in everyone who may struggle. With this, whether they see it or not, that we have to take it seriously, and we have to make sure that they get the support they need.

Jellis Vaes
Yes, exactly. The following two questions I have for you Stephen are mainly for listeners to become more aware what to pay attention to and to whom in order to support those who self-harm. So first of all, you already said a little bit about that in beginning as well. But what are the most common methods someone would use to self-injure?

Dr. Stephen Lewis
Sure, there’s a multitude of different methods that people might use but by far the more common ones that we see in research, in therapeutic settings and so forth is that people tend to engage in cutting or related to that maybe scratching of the skin and those kinds of behaviors. Other people might engage in self-burning and other people may engage in self-hitting. Those would be the top three or four sort of methods that we tend to see consistently across various contexts.

Jellis Vaes
And second on that, when looking at the statistics, which age group has the highest percentage of self-harm? And again, this is mainly asked to provide insights to listeners about who is more prone to do this.

Dr. Stephen Lewis
Well, I think I would say from the outset that anyone of any age may self-injure. We’ve had some people who take part in our studies who say they started to self-injure at five and six. We’ve had some people who say we run a nonprofit and we collect stories from people across the globe in terms of trying to provide messages of hope and inspiration for those who may feel like as though they’re presently struggling. We’ve had people disclose to us that they didn’t start until they were after 50. So this notion that it’s only limited to one age group would be incorrect. Anyone may self-injure from any walk of life. That being said, we do tend to see the highest rates being adolescents and emerging adulthood. So about 1213 to about 24 years of age, that sort of collective two groups, that’s where we see the highest rates and there we’re going to see rates of up to one in five will report having done it at least one time.

Jellis Vaes
What are the reasons actually why this age group has a much higher percentage compared to others?

Dr. Stephen Lewis
It’s a really good question and there’s probably a whole host of reasons. It’s not just one or two things in part that may be where there’s a lot of distress and finding ways to regulate and express emotions which we often see sort of evolving and manifesting in adolescents. So that’s certainly one part of it. It’s been argued too that many of today’s young people are experiencing a lot more distress and stressors than previous generations. So just by virtue of being in a world now where maybe there is more distress, more pressure and so forth that that age group is perhaps more vulnerable to finding ways that may work for them in the short term in terms of coping but may have consequences in the long term.

The IPS Academy
Before we continue with the interview, I just like to take a moment to mention if you feel that you’ve gained some insights and lessons from this interview and you’re curious to see what else we offer at The IPS Project, I recommend that you check out The IPS Academy, where we offer online courses taught by guests here on The IPS Podcast. Learn more about essential life topics such as mental health, relationships, the minds and the body and brain through fun and interactive courses. Simply go to theipsproject.com/academy or check the description of this episode to find the link. Each course has a few lessons to try for free so you can get a taste of what the course is like. We have countless reviews from other students so you can see what others think. And there is a 30-day money-back guarantee. If you end up not liking the course again, check them out at theipsproject.com/academy or by clicking on the link in the description of this episode. Having said that, let’s return back to the interview.

Jellis Vaes
To understand NSSI even better, for people who have never self-injured, it can be hard to understand how someone could keep doing this, often over periods of years. And even for people who self-injure, it can be confusing too, why it’s so addictive. Could you explain a bit more on the research that’s been done and what we currently know, what causes NSI to be so addictive?

Dr. Stephen Lewis
Right, so I’m not sure I would sort of frame it within the context of addiction per se, but okay, I totally see sort of where you’re coming from. And to your point, though, we have a lot of people who’ve taken part in some of our projects who do talk about it as an addiction in the sense that it’s something they might go to and turn to over and over again in times of distress. So basically what we know from research is that and we’ve done this in some of our own work as well, if you ask people, for example, how they were feeling prior to the time they self-injured, let’s say we were to give them like a rating scale of, say, one to seven. One is no distress, seven is high levels of distress, and many of them would probably record like a five, six or seven prior to self-injury. Interestingly. What we see is that if you give them the same kind of rating scale after, and they’re reporting now on how they feel after having hurt themselves, we see a significant decrease. So what that means is that many people are then experiencing a psychological reduction in the emotional experience they have that may have contributed to the self-injury.

So they’re self-injuring because it’s actually reducing their own level of distress. That’s not to say that I would ever condone this or advocate this as a means to cope. I wouldn’t because of the consequences and the pain that’s associated with it. But I think that offers a glimpse of understanding, perhaps in terms of why it may be used. And also we have now from recent work and I think we’re still in the process of understanding this in a deeper and better way. But there is evidence too, that there’s something going on physiologically as well. So we sort of have these psychological sort of emotional mechanisms, these physiological mechanisms, all of which are helping us to really understand that people do self-injure not just for any reason, but for particular reasons. And it often has to do with that emotional regulation we talked about earlier.

Jellis Vaes
Is it true that it also releases dopamine?

Dr. Stephen Lewis
There is some evidence that would point to certain neurotransmitters like, say, serotonin, for example. I’ve heard dopamine in the past, other work which suggests things like Endogenous, opioids or endorphins might be involved. So again, we don’t have sort of an entire or comprehensive understanding of some of the neurobiology or physiology that’s going on. But we are seeing evidence coming out that these mechanisms are in fact relevant. So it’s not just that people are doing it, but there’s something going on again psychologically, physiologically, that’s in some way sort of reinforcing the behavior.

Jellis Vaes
All right, interesting. So I’m quite curious actually about the following question. Now, I had trouble forming this question, so I hope it will be clear. So there are many non-injurious ways to regulate emotions, for example, exercising alcohol, et cetera. What leads a person to choose NSSI? Like how do people know or discover this is a way to regulate their emotions?

Dr. Stephen Lewis
I think it’s an excellent question. It’s one that is asked actually quite frequently by a lot of people. Say people who work with adolescents, for example, in schools, parents will ask this and so forth. There’s been a little bit of work on this and interestingly, many young people who self-injure say they don’t know where they came up with it. They say they just did it. And so it’s hard to sort of disentangle what that kind of means. There is other evidence and reports that people may hear about it, say through knowing someone who does it. So if we have two, for example, adolescents in school who are both struggling with their own mental health, if one of them is self-injuring and then the other one isn’t, the one who isn’t may find out the one who self-injuring is. And then they may try it themselves, because they now know that this might be used for a certain purpose. That happens sometimes. But again, many people self-injure and don’t tell anyone. So I wouldn’t say that that sort of is always happening either. People have suggested that maybe the media or social media plays a role, but I would be, I think, reluctant to sort of paint a sort of a picture that sort of frames the media and social media as all bad. Our research indicates that it actually serves a real purpose for a lot of people so, I mean, this may not be answering your question directly, but that’s in part because there is no sort of singular answer for that. It’s likely a multitude of different things. It can also be that if we were to compare, say, this generation to prior generations, self-injury is something that’s simply more talked about, it’s more known about. So that increased awareness may in itself be part of the reason why we see this happening in those age groups and perhaps more than prior generations.

Jellis Vaes
So with these questions answered, I think many listeners will have a much better understanding of NSSI. I’d like to move, if you don’t mind, of course, Stephen, to your personal story with NSSI. Is that okay?

Dr. Stephen Lewis
That’s okay, yes.

Jellis Vaes
So you’re not alone a researcher on this topic, but you’re also someone who has personal experience with NSSI. Do you still remember the first time you self-harmed? Like how what were you and how come you started with it?

Dr. Stephen Lewis
Yeah, for me, the first time I ever did it, I was 15. And much like what I’ve mentioned, for many young people, it’s hard to sort of recollect exactly why I did it when I did it. So for me, it was sort of something that I was struggling with a lot of internal distress, depression, some past trauma, and a lot of things that I really was keeping inside for a very long time. And in many ways I sort of say that I just kind of did it when I did it because it kind of made sense to me at the time because I felt so desperate to find a way to express everything that was going on inside and just let it out. So I did it for the first time at 15, and then I really didn’t do it much for the next couple of years until I was in university. And at that point I started doing it a lot to the point where I was doing it on a daily basis. So again, it’s hard to explain to you or sort of give you a reason as to why exactly I initially did it or even why I started to do it on a more repeated basis in university.

Jellis Vaes
But for me sorry to interrupt, by the way, but do you have any idea why you did it more when you were in university?

Dr. Stephen Lewis
I think for me, when I was in university, I was experiencing multiple bouts of depression. I was reliving a lot of very difficult past experiences in terms of being bullied. I was abused when I was nine. And those things, much like when I was 15, I really wasn’t talking about them, I wasn’t processing them. I don’t think I fully realized the impact they had had on me. And for the longest time then, I’m in many ways keeping everything inside. There’s no real way for it to come out. And so in really a point of just desperation in some ways. I wanted a way to try and release it and even to obtain temporary reprieve from the anguish that I was going through at the time. And so I kept doing it for those reasons and I did it for quite a while in university as a result.

Jellis Vaes
Thank you for sharing that, Stephen. It’s not easy to share such a personal story. I myself actually have personal experience with self-harm too. It’s something I used to do for many years. And actually in your profound Teddy’s talk about NSSI, which I will link in the show notes for everyone to find, you said something that I recognize so well. You said, when you feel alone in the world, when you hate yourself, it’s hard to ask for help, let alone accept it. For those who are listening with self-harm, what are some pieces of advice you could give to them to stop self-harming and seek support?

Dr. Stephen Lewis
Yeah, that’s really important. And thank you as well for sharing your experience just now as well. What I would, I think, want to build on that and say, and it relates to this and something I think about quite a bit is part of it is allowing yourself to be vulnerable. And part of that is that willingness, even if it’s just a little bit, because it may not be sort of a fully embraced willingness, and I get that, but that willingness to allow yourself to be vulnerable, to ask someone for support, it’s okay at that point to not be ready to stop. Many people aren’t ready to stop right away. And in many ways, if they could, they would.

But in my experience, there is much power in that vulnerable moment. It may not be noticeable at that time, but in retrospect, I’ve recognized that in my moment of need, in my moment of being vulnerable, in my moment of asking for help and then again, as you articulated, to allow myself to accept that help, which for the longest time it’s like I thought I didn’t deserve it in some ways. I think what I’ve learned is that I was deserving of it. And not in a braggadocious or like super sort of conceited kind of way, but just in the sense that we’re people who have value and for many people who struggle with self-injury, there’s a sense of not feeling like you have much or in terms of who you are, what you have to offer. And I would really argue strongly against that. And that in that moment of vulnerability, in many ways that can be a turning point, I think. And we can find on our own personal journeys and no one’s path will look the same, nor should it, because we’re all unique people. But you can find things in which you can identify where you have strengths and aspects of resilience that can be harnessed, where you can find meaning. And it doesn’t. Have to be as it was for me, going on to study this and try and work in the field. It could be anything at all.

But it’s important to allow yourself, I think, to be open to that, to take it. If you have a bad experience with someone who maybe didn’t react in the way you wanted to, not generalize that across all people. Some people, unfortunately, don’t get it, but many people do. And I’ve had some bad experiences with disclosure where people didn’t react in the most helpful ways. But I’ve also had many where I got really compassionate and just validating accepting responses where there’s no judgment, there’s no pressure to you have to stop now. We get where you are, and it’s okay to be where you are. And I think that initial step, that being vulnerable is so important.

Jellis Vaes
What were a few essential things for you that helped you greatly self-harm during those times to stop with self-harm?

Dr. Stephen Lewis
Yeah, I think for me, I would think probably for many people, there’s probably going to be some setbacks along the way. It’s not sort of just like this linear progression to I’m doing it to a point where I’m not doing it. There’s going to be some setbacks along the way, and I think that’s okay, that’s totally normal. But what worked for me, sort of as I was on my own sort of journey and path, was a lot of writing. I found through journaling, through poetry, through writing anything. Whenever I felt things, I just put it on paper or put it on my computer. And that sort of served as a vessel and a vehicle to express all these things that I would never otherwise express, but just through self-injury. So I sort of started to let my writing do the expression of emotion. I also started to run. I played Ultimate Frisbee. I did a lot of exercise that really helped. And then the other part of it, two parts would be being more open with some of my friends, being again, coming back to that vulnerability, that willingness to reach out, to talk, to let things out. And coupled with that, also seeking professional help, which for many people, for me, that was immensely helpful.

Jellis Vaes
Is there actually anything in particular that helped you to be more open about this?

Dr. Stephen Lewis
I think part of it was the reaction that some people gave me in the sense that it was non-judgmental, it was accepting, it was compassionate, it wasn’t pity. It was just recognizing that I was suffering and I was struggling. And in some ways that sort of told me, you know what, it’s okay. It’s okay to feel this. It’s valid what you’re feeling, and maybe you don’t have to feel this forever.

Jellis Vaes
Yes. It’s always good to know that everyone is fighting a battle that no one knows anything about. Like everyone is going through something.

Dr. Stephen Lewis
Absolutely.

Jellis Vaes
Let’s switch roles now, for any parent teacher, friend, boyfriend, girlfriend, family member, et cetera, who knows someone in their life who self-harms, what are some of the best pieces of advice you could give to them so they could provide helpful support to that person?

Dr. Stephen Lewis
Right. I mean, I think there’s a couple of things. I think first and foremost, it would be learning more about self-injury, I think, through building your own foundation of understanding that allows us, I think, to be better equipped in terms of having what’s for many concerned parents and other loved ones, these are not easy conversations to have. And in no means would I ever try and sugarcoat it as such. But it’s building that foundational knowledge and then that I think helps to get a better sense of things like well, why might this person who I love or who I’m really concerned about, why might they be hurting themselves? And if we start to sort of see self-injury as sort of this manifestation or indication of distress and pain and therefore understanding that people who are doing this are doing this because of what’s going on in their lives. I sort of view it as a bit of an iceberg in the sense that self-injury is what we see above the surface, and there’s a far greater story below the surface. But if we see the self-injury as that indication of someone’s pain, that I think also allows us to have a more compassionate initial view of what might be going on in that regard, I would say it’s finding a time to approach that individual, to talk to them, to be aware of our own potential reactions, to be present with that individual and really try and generally understand what their experience is without judgment, without jumping to conclusions and without necessarily jumping in to try and fix the problem.

And what I mean by that is that sometimes, even with the best of intentions, people may come in and say well, what do we do to make you stop? And what the person may actually need in that moment is to really just hear I see you’re really struggling right now and I’m here for you. And because many people may not be ready quite to stop self-injuring, the prospect of stopping sort of cold turkey is incredibly scary because it’s sort of like well, what do they do instead? But if we can approach these situations with a sense of compassion and a real genuine willingness and we sort of call this in the field like a respectful curiosity. And what I mean by that is just a question like can you help me understand your experience or what’s going on for you? And in framing it that way, I think we’re allowing people to share their experience, their story, because it’s devoid of assumption or sort of speculation as to why they’re doing it. And it’s just a real genuine desire to understand what the person is going through and just listening and attending to their emotional needs in that moment.

I think part of it too is a recognition that these conversations are not just one off events. It might be a conversation that occurs over time and that initial conversation may be brief, the person may not be ready. But I think it’s a recognition that coming in that maybe I can let them know that I am here, that I will check back in. And that sort of continued offering of support can also go a really long way. Part of that too is knowing maybe where to get resources as well. Whether they be online resources, books, professional help, whatever it may be in one’s area, but that’s another part of it. So that way too, those can be offered as a means of also offering one’s support because it shouldn’t also be on the one person who’s checking in and asking and trying to understand that they’re now responsible for fixing the problem. Because these are complex concerns that likely often warrant really sort of complex responses in the sense that it’s not just one thing that’s going to happen that’s going to fix everything, but it’s going to be sort of multiple different things that work together that can really make a big difference.

But that initial response is so important as I mentioned before. So again, compassionate, open, wanting to understand the other person’s experience, sort of recognizing and being patient in the moments and really attending to the person’s emotional well being and needs.

Jellis Vaes
Yeah, this is such good advice and it’s so powerful to just sit down and listen with the intent to try to understand someone. Is there actually any resource like any book or videos or anything for any parent or so to understand this topic better?

Dr. Stephen Lewis
Absolutely. We’ve developed our own on our website, sioutreach.org. Resources for concerned parents and Families, on things like how to have these conversations, how to better understand what your child might be going through. We have resources for concerned friends, for concerned romantic partners, for schools, even for professionals. And even sometimes it’s the person who’s self injuring who can even share those resources with their professional if they think maybe they may not fully understand what self injury is or what they may need. So I think we certainly have our own. There’s some really good books out there as well for different people. There’s a book called, I think, Freedom from Selfharm: Overcoming Self-Injury with Skills from DBT and Other Treatments, which is for anyone who may struggle with self injury, but also those who care about them in terms of talking about what can you do in your role as a care provider for that person you’re concerned about in terms of offering support for them. There’s a new book too called Healing Self-Injury: A Compassionate Guide for Parents and Other Loved Ones by Janice Whitlock and Elizabeth Lloyd Richardson and this is a compassionate guide for parents in terms of them and their role in terms of helping their child. So there’s some really, really great resources out there online, again in book form. And it’s just a matter of ensuring that people who are out there who may benefit from these are aware of them.

Jellis Vaes
Right. So everything that you just recommended, I will link that up in the show notes for everyone to find. Now, self-injury doesn’t alone leave psychological wounds within. It also leaves physical wounds. Self-injury is something many people carry dor the rest of their lives, with rhem wherever they go. And often a deep sense of shame is attached to these scars. How, over the years, have you learned to live with these scars? Were there any quotes, videos, words from others or thoughts from yourself that allowed you to accept them?

Dr. Stephen Lewis
Yeah, I think I’m glad you’re asking this question because in many ways it’s one of those things that many people don’t necessarily think of unless they’ve had the experience. Because for many things, I couldn’t tell if I were to see someone walking down the streets where they’ve ever had a depressive episode at any point in their life because there’s no visibility to depression, whereas self-injury is different. And to your point of people may have permanent scarring, that comes from their self-injury. And for many people we know from some of the research we’ve been doing in this area now that there is an immense shame that comes with that because it sort of, for some people, it serves as a reminder for what they’ve gone through. Equally, though, we see many people talk about how over time, through being more self-compassionate, through being more accepting of themselves, and through recognizing, I think, that self-injury for them served a purpose at a certain time in their life. It allowed people to navigate through a traumatic experience or to persevere through depression or eating disorder, whatever it may be. And many people and this is something that I can resonate with because it’s happened.

For me, it’s sort of like I’ve come to now view my scars in a more accepting way with compassion toward myself and my own experiences. And I view them as symbolic of my own fortitude for having built resilience to have gotten through an incredibly painful part of my life. So I don’t see them and look at them with regret or with shame anymore. I see them as an indicator and a symbol of strength. If anything.

Jellis Vaes
In your TEDx Talk, you also mentioned this, but the looks from other people when they notice those scars on your bodies, most of the time, not a pleasant response. It might range from shock to disgust. Now, always hiding these scars is something that is quite impossible for many. I mean, there will be a moment that’s going to the beach or possibly even wearing a t-shirt where scars will reveal out of your own experience, what has been the most inappropriate way. Someone once asked about your scars and how instead would you have liked that person in an appropriate way to have asked you about them. So in other words, what should people know before asking about the scars of someone?

Dr. Stephen Lewis
Well, I think if people have a deeper understanding of what may underlie self-injury, I would hope that that would lead to a recognition that first of all, maybe I shouldn’t even ask because the person may not want to talk about it, they may not be ready to talk about it. It may not be the best or appropriate context to talk about it because I’ve had people ask me things at a party or at a bus stop where that’s the last place I ever want to have a conversation, let alone with the person who would have asked. So I think part of it is recognizing that just because you notice it doesn’t mean you have to say anything too. If people were to ask, I think it would be important to ensure that the context is appropriate. So obviously not in public or any other sort of context like that. It would be important to, I think, have a recognition or a sense of the relationship between the two people. If it’s someone you don’t really know or you don’t know at all, I don’t think I would be asking personally because it’s probably not appropriate and it might be very off putting and upsetting for them.

But if they were to ask it’s then finding a time where you can actually have that conversation. And I think I would frame it more in terms of I’ve noticed this and I’m concerned about you, or I really care for you, I’m just wondering if you’d like to talk and if you don’t that’s okay. But more just gently checking in without sort of this expectation that the person is going to necessarily just divulge everything because they may not be ready and they may not want to. And I think that’s perfectly okay.

Jellis Vaes
Yeah. And I mean this personally has happened to me too, that people in very public places all of a sudden asked about my scars that I had. And I think it’s really good for people to understand that there is a lot of shame attached to those scars. So yeah, it could be great to be a bit more empathetic to them. Stephen, I just have three more questions for you before we round up this interview. What have been some recent interesting or helpful discoveries you’ve found in your research about NSSI?

Dr. Stephen Lewis
One thing that our research has really been trying to focus on there’s a couple of things. One thing is an understanding of what recovery means. I think in many ways a major focus of people when they think about recovery is just on stopping the behavior without a fuller recognition of everything else that may go along with that. Part of it is, I think, a recognition that self-injury doesn’t just stop in a sense that you do it one day, you don’t the next. It’s going to take time, it’s going to take patience, it’s likely going to take a few kicks to the can, so to speak, in a sense that as I mentioned earlier, there might be setbacks along the way. I think if people know that as they’re sort of working on their own journeys, that’s a good thing to know in terms of having realistic expectations about what to expect over the course of one’s own path. I think related to that is in our work too, is in doing that, really trying to share that with clinicians and researchers in terms of trying to broaden our understanding of recovery, to also include things that we just talked about, including scarring, which I feel hasn’t been as given the attention I think it deserves in our field.

So that’s some other work we’re trying to do. The other part is really trying to give voice to people who have lived experience because they have an important story to share, I think. And some of our work on understanding things like stigma and self-injury has really underscored that there’s a real need and desire amongst individuals who have lived experience with self-injury to hear from other people, to hear from other people who’ve been there because to hear other people’s experiences and to get those messages of hope that you can do it, this does not define you and you can overcome this. You can find meaning through this. Those are powerful messages and there’s a real desire for people to have access to those stories. So that’s one of the things we’re really trying to work on right now, is to understand people’s experiences with things like stigma. But through that, then finding ways to offer hope and to combat the stigma by way of having people with experience talk about when they are ready. Of course, their own experience. Because that can have a real sort of resonating and powerful effect on different audiences.

Jellis Vaes
The last question here, Stephen do you feel like there’s anything else you’d like to touch upon that we did not cover or is there like any question you’d hoped I asked but didn’t?

Dr. Stephen Lewis
I think you touched on sort of all the big questions. I think the one thing I’d want to leave in terms of a message would be for anyone who is currently struggling and who may currently feel voiceless or alone or as though maybe not deserving of support or help or hope to counter that and to say that you are and to say that you are deserving. And as bad as it may seem, as dark as it may seem, and it can seem pretty dark sometimes, and I get that it can get better, and it does get better. And it comes back to that willingness to be vulnerable, that willingness to reach out and to find your own unique journey forward and to find meaning and that we’re deserving of that. And I think that’s a message that it may seem very trite and simple, but I think it’s one that ton of people need to hear.

Jellis Vaes
Yeah, very true. Stephen, this has been amazing to do. You’re honestly an incredible inspiration that I personally look up to. It’s been a real honor to do this interview. Before we finish this interview off, there is one final end question I have for you that I ask all my guests. But before I ask that question, what is the best place for people to connect with you or to have a look at the work that you’re doing?

Dr. Stephen Lewis
I would say through our website there you would find all of the resources I mentioned earlier in the interview. You would find information linking to me and even my research lab and all of my information as well.

Jellis Vaes
And which website is that?

Dr. Stephen Lewis
The website is www.sioutreach.org.

Jellis Vaes
Got it. So I will link that up in Show Notes for everyone to find. So the final question that I have for you, and you can take your time with this, of course, but from everything that you have seen, experienced, lived and learn in your life, what is the one thing you know to be true?

Dr. Stephen Lewis
That we can find strength, meaning and purpose, even in our most vulnerable moments.

Jellis Vaes
Stephen, thank you once again for doing this interview and talking about this most important topic. It’s been a real pleasure, honestly.

Dr. Stephen Lewis
It’s been an absolute pleasure for me as well, and thank you so much for having me.

Jellis Vaes
And that concludes this conversation with Dr. Stephen Lewis on NSSI. I sincerely hope it provided you with some helpful insights about non-suicidal self-injury. For more info about NSSI, check out the website that Dr. Stephen Lewis co-founded sioutreach.org, and that’s all spelled together. So again, sioutreach.org as it can help you to get support and understand this topic even better, you can find the link to the website in the Show Notes, which are located in the description of this episode. There you can also find the book recommendations, Dr. Lewis, TEDx Talk, which I highly recommend, and other resources we talked about in this interview. Now, if you can’t find them in the description of this episode, you can also go directly to theipsproject.com/podcast and search for Stephen Lewis. With that, thank you again for tuning in and for spending some time with Dr. Stephen Lewis and me. I hope to see you again in another episode, another journey here on the IPS podcast. Until then, this is your host, Jellis Vaes signing off.

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