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The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

The Psychology of Self-Injury: Exploring Self-Harm & Mental Health

Auteur(s): Nicholas J. Westers Psy.D. ABPP
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 Why do people self-injure? And what is the best way to respond when someone tells us they self-injure? Dr. Nicholas Westers, a clinical psychologist at Children's Health and Associate Professor at the University of Texas Southwestern Medical Center, collaborates with the International Society for the Study of Self-Injury (ISSS) to interview the leading experts in the field of self-injury and self-harm as well as individuals with lived experience of self-injury and parents and family members of those who have self-injured. This podcast is meant to be a resource for parents, professionals, and people with lived experience.2021 The Psychology of Self-Injury Hygiène et mode de vie sain Psychologie Psychologie et santé mentale Relations Science Sciences sociales
Épisodes
  • DSM Update: Nonsuicidal Self-Injury Disorder, or a Clinical Specifier?

    DSM Update: Nonsuicidal Self-Injury Disorder, or a Clinical Specifier?
    Aug 29 2025
    In this episode, four of the top experts in researching and treating nonsuicidal self-injury (NSSI) talk about the research behind NSSI Disorder, the evolution of how they now think about NSSI within the context of the DSM, and why they now advocate for an NSSI specifier rather than an NSSI Disorder in the DSM. They also delineate their proposed criteria for self-harm as a specifier and both the positive and negative consequences of doing so.Below are papers referenced in this episode:Lengel, G. J., Muehlenkamp, J. J., Zetterqvist, M., Ammerman, B. A., Brausch, A. M., & Washburn, J. J. (2025). Non-suicidal self-injury: proposal to shift designation from disorder to a clinical specifier. The Lancet Psychiatry. Online advanced publication.Shaffer, D., & Jacobson, C. (2009). Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. American Psychiatric Association, 1-21.Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75(2), 324–333.Brausch, A. (2019). Diagnostic classification of nonsuicidal self-injury. In J. J. Washburn (Ed.), Nonsuicidal self-injury: Advances in research and practice (pp. 71-87). Routledge.NONSUICIDAL SELF-INJURY SPECIFIER (PROPOSED CRITERIA):A. The specifier should be used when the nonsuicidal self-injury (NSSI) behavior is characterized by the following:The individual intentionally engages in NSSI behavior to inflict bodily damage or painThe individual's NSSI behavior is recent, such that it occurred at least once during the past monthThe individual’s NSSI behavior is repetitive, such that it occurred on about 5 or more days in an individual’s lifetimeNote: culturally specific NSSI behavior (e.g., piercings and tattoos) and harm that is habitual (e.g., scab picking, nail biting, and hair pulling) should not be considered to be NSSI unless the behavior is explicitly for the purposes of causing damage or pain to one’s body. The NSSI specifier can still be applied if the behavior occurs under the influence of substances, as long as the behavior meets the required features.Coding note: use code Z91.52 for individuals with a previous history of NSSI when all criteria except for recency are met (A2).Want to have a bigger role on the podcast?:Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at thepsychologyofselfinjury@gmail.comWant to be involved in research? Send us a message at thepsychologyofselfinjury@gmail.com and we will see if we can match you to an active study.Want to interact with us through comments and polls? You can on Spotify!Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."
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    1 h et 3 min
  • Help-Seeking for Self-Injury, with Nani Kim, RN

    Help-Seeking for Self-Injury, with Nani Kim, RN
    Jul 25 2025

    In this episode, Nani Kim, RN from the University of Texas at Austin talks all things help-seeking for nonsuicidal self-injury (NSSI). This includes common reasons people give for choosing to seek help for self-harm, common forms of help-seeking behavior for NSSI, how often individuals who self-injure seek help for their self-injury, why they choose to seek help, what types of help they receive, and what happens when they seek help for self-injury.

    Below are a few references from this episode:

    1. Kim, N., Young, C. C., Kim, B. R., Rew, L., & Westers, N. J. (in press). Help-seeking behaviors in adolescents and young adults who engage in nonsuicidal self-injury: An integrative review. Journal of Adolescent Health. Advance online publication (free to access through August 7, 2025).
    2. Nadler, A. (1987). Determinants of help seeking behaviour: The effects of helper’s similarity, task centrality and recipient’s self esteem. European Journal of Social Psychology, 17(1), 57-67.
    3. Mackesy, C. (2019). The boy, the mole, the fox and the horse: Inspiring conversations on hope, love and personal growth. HarperOne.

    Want to have a bigger role on the podcast?:

    1. Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.
    2. Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at thepsychologyofselfinjury@gmail.com
    3. Want to be involved in research? Send us a message at thepsychologyofselfinjury@gmail.com and we will see if we can match you to an active study.
    4. Want to interact with us through comments and polls? You can on Spotify!

    Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).

    The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."
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    48 min
  • Why Do People Self-Injure? Part 2, with Dr. Kirsty Hird

    Why Do People Self-Injure? Part 2, with Dr. Kirsty Hird
    Jun 27 2025
    Dr. Kirsty Hird, a Research Officer in the Youth Mental Health team at The Kids Research Institute Australia, adds to Episode 1 of The Psychology of Self-Injury podcast by explaining in depth and in layman's terms why people self-injure according to the six most common/popular theoretical models. Connect with Dr. Hird on LinkedIn here, view her staff profile here, and follow her on ResearchGate here. Below are two of her papers related to today's interview as well as a few other resources referenced in this episode:Hird, K., Hasking, P., & Boyes, M. (2023). A comparison of the theoretical models of NSSI. In E.E. Lloyd-Richardson, I. Baetens, & J. Whitlock (Eds.), The Oxford handbook of nonsuicidal self-injury (pp. 24-40). Oxford University Press.Hird, K., Hasking, P., & Boyes, M. (2022). Relationships between outcome expectancies and non-suicidal self-injury: Moderating roles of emotion regulation difficulties and self-efficacy to resist self-injury. Archives of Suicide Research, 26(4), 1688-1701.Gray, N., Uren, H., Pemberton, E., & Boyes, M. (2023). Profiling ambivalence in the context of nonsuicidal self-injury. Journal of Clinical Psychology, 79(8), 1699-1712.Ramsey, W. A., Berlin, K. S., Del Conte, G., Lightsey, O. R., Schimmel-Bristow, A., Marks, L. R., & Strohmer, D. C. (2021). Targeting self-criticism in the treatment of nonsuicidal self-injury in dialectical behavior therapy for adolescents: a randomized clinical trial. Child and Adolescent Mental Health, 26(4), 320-330.Gratz, K., & Tull, M. (2025). Acceptance-based emotion regulation therapy: A clinician’s guide to treating emotion dysregulation and self-destructive behaviors using an evidence-based therapy drawn from ACT and DBT. Harbinger Press.Below are links to the original 6 theoretical models discussed in this episode:Four Function Model - Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890.Experiential Avoidance Model - Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394.Emotional Cascade Model - Selby, E. A., & Joiner, T. E. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13(3), 219–229.Integrated Model - Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6(1), 339–363.Cognitive-Emotional Model - Hasking, P., Whitlock, J., Voon, D., & Rose, A. (2017). A cognitive-emotional model of NSSI: Using emotion regulation and cognitive processes to explain why people self-injure. Cognition and Emotion, 31(8), 1543–1556.Barriers and Benefits Model - Hooley, J. M., & Franklin, J. C. (2018). Why do people hurt themselves? A new conceptual model of nonsuicidal self-injury. Clinical Psychological Science, 6(3), 428–451.Want to have a bigger role on the podcast?:Should you or someone you know be interviewed on the podcast? We want to know! Please fill out this Google doc form, and we will be in touch with more details if it’s a good fit.Want to hear your question and have it answered on the podcast? Please send an audio clip of your question (60 seconds or less) to @DocWesters on Instagram or Twitter/X, or email us at thepsychologyofselfinjury@gmail.comWant to be involved in research? Send us a message at thepsychologyofselfinjury@gmail.com and we will see if we can match you to an active study.Want to interact with us through comments and polls? You can on Spotify!Follow Dr. Westers on Instagram and Twitter/X (@DocWesters). To join ISSS, visit itriples.org and follow ISSS on Facebook and Twitter/X (@ITripleS).The Psychology of Self-Injury podcast has been rated as one of the "10 Best Self Harm Podcasts" and "20 Best Clinical Psychology Podcasts" by Feedspot and one of the Top 100 Psychology Podcasts by Goodpods. It has also been featured in Audible's "Best Mental Health Podcasts to Defy Stigma and Begin to Heal."
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    43 min
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