Write On: Sharp Objects and Self-Injury (NSSI)

A few weeks back Sarah K. Stephens and I decided to collaborate on a project we are calling Write On. Sarah is a developmental psychologist with a Ph.D. from Penn State University. I think Sarah describes the intent of the project best:

Today my friend and Pandamoon Publishing colleague, Francis Sparks, and I are embarking on a partnership that will hopefully inform both of us as writers, and our readership as well. Each segment of Write On will focus on one particular topic of interest to us that we want to get right in our own literary work. There’s a lot we are hoping to cover, from mental health to coding to informing our writing from the masters of the craft, mainly because we both realize there is much to learn about life before trying to embody it in our writing. Francis and I will each take turns pursuing topics, depending on our own training and expertise, and today I am lucky enough to have the opportunity to answer Francis’s questions regarding Gillian Flynn’s novel Sharp Objects and the topic of self-injury, as it was featured in the book. Below you’ll find our discussion, as framed from Francis’s viewpoint and blog. I hope you come away from it informed, intrigued, and ready to write.

Sarah K. Stephens

Trigger Warning: This post will examine the condition of Non-Suicidal Self-Injury (NSSI; otherwise known as self-injury, self-harm, or cutting) and Suicide and its content may be triggering to some individuals.

Today I wanted to talk to you about self-injury and a book by Gillian Flynn called Sharp Objects, which depicts a person who is battling her history with self-injury.

First off can you get us on a level field as far as terminology goes, I’ve heard this condition referred to by many names. What is the best terminology to use?   

As is common in the field of psychology, many names have been attached over the years to the condition currently known as Non-Suicidal Self-Injury (NSSI), including deliberate or intentional self-injury, self-harm, self-injurious behavior, cutting, and self-mutilation. Similarly, outside of the scientific field, there are many terms used commonly to describe this condition, the most common of them being self-harm and/or cutting.

From the perspective of understanding the characteristics, predictors, and effective treatments for NSSI, an accurate term that encompasses the disorder is important, to ensure both that different research programs are examining the same phenomenon in their work and that the symptomatology of this condition is clearly described.

For example, simply referring to it as self-injury limits the clarity of our understanding of NSSI, as a similar phenomenon in behavioral symptoms, but distinct in motivation, occurs in individuals with developmental disabilities. The self-injury that occurs in developmentally disabled populations (e.g., individuals with autism) has its roots in different causal factors than the self-injury that occurs in typically-developing populations. Thus, referring to it as NSSI clarifies the condition actually being observed in a client. Likewise, since NSSI takes many forms, including cutting, burning, and skin picking, simply referring to it as ‘cutting’ limits our understanding of the condition as well.       

In Sharp Objects there are depictions of a woman with a history self-injury. Her particular self-injury is done by cutting. This got me thinking about the causes of cutting or self-injury and how it can manifest itself in individuals. Thank you for helping me better understand this condition.

The newest diagnostic manual used in the diagnosis of mental health disorders, the DSM 5, was released in May 2013 and this new edition added the diagnosis of NSSI as a separate diagnostic label. The criteria for someone being diagnosed with NSSI (which is described as 5 or more days of intentional self-inflicted damage to the surface of the body without suicidal intent within the past year) includes engaging in the NSSI:

  • to seek relief from a negative feeling or cognitive state
  • to resolve an interpersonal difficulty
  • or to induce a positive state

NSSI is also detailed in the DSM V as needing to be associated with interpersonal difficulty or negative feelings and thoughts, premeditation, and ruminating on (non-suicidal) self-injury.

Mainly, we think of NSSI as a faulty coping tool for the stressors an individual encounters, especially when they are experiencing other mental health concerns, such as depression. NSSI becomes their tool for reducing anxiety, sadness, and/or stress.  It can also become a tool for experiencing a physiological rush from natural pain-relievers that our body releases after injury, thus becoming a technique for triggering a ‘positive’ emotional experience when a person might otherwise feel numb or overwhelmingly angry or sad.    

Read the rest on Sarah’s Blog.

This is an exciting project and I look forward to seeing it grow.

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