Nonsuicidal Self-Injury in Girls

Nonsuicidal Self-Injury in Girls: A Growing Concern
Posted on 03/01/2025
Girl Crying

Nonsuicidal Self-Injury in Girls: A Growing Concern

Steering Committee

March 1, 2025

Women's History Month provides an excellent opportunity to raise awareness about mental health issues affecting young girls and women. As we observe Women's History Month this March of 2025, it is crucial to address the mental health challenges facing girls and young women in the United States. One particularly concerning issue is the prevalence of nonsuicidal self-injury (NSSI) among young girls and adolescents.

While there has been interest in studying behaviors leading to acts of self-injury since the 1930’s, it is only in the last twenty years that it has been more intensely researched.1 NSSI has been known by many names – self-mutilation, self-harm, self-injurious behavior – the academic and research communities in the US recently agreed that NSSI is the preferred term.2 NSSI “is defined as deliberate, self-inflicted injury to oneself that occurs without suicidal intent and is not for socially or culturally sanctioned purposes.”3 Typical behaviors include biting oneself, burning oneself, carving, cutting, or scratching the skin, and hitting or punching oneself. Interest in studying and understanding NSSI has increased as its prevalence, especially high in girls and adolescents, has become apparent.4

Recent studies have revealed alarming rates of NSSI among female youth in the United States:

  1. Among preadolescents aged 9 to 10, the lifetime prevalence of NSSI was 9.1%.5
  2. Nearly 18% of high school students had engaged in at least one NSSI act in the past year.6
  3. Girls engage in NSSI at two to three times the rate of boys.7

Notably, there is a significant gender disparity in NSSI rates, particularly as girls enter adolescence. A recent meta-analysis found that NSSI was twice as prevalent among female adolescents compared to male adolescents in North America.8 This gender difference becomes particularly pronounced in the ninth grade, where 19% of girls reported engaging in NSSI compared to only 5% of boys.9 Early starters of NSSI – before age 10 – exhibit greater frequency of NSSI, use more diverse and dangerous methods, and are hospitalized more often.10

The percentages for all categories in the adolescent category show a slight increase from the past year, 2021, numbers. Unfortunately, due to methodological changes to the survey in 2021 it is difficult to compare the numbers to prior years.

While the reasons that girls engage in NSSI behaviors more often than boys are complex and numerous, there are some commonalities. Many girls use NSSI to cope with intense emotions or emotional pain they find difficult to manage. They use it to regulate those overwhelming emotions or to "feel something" when experiencing emotional numbness. Girls use NSSI to make life more manageable, provide relief, security, and a way to control intense feelings.11 Some girls engage in NSSI as a form of self-punishment, often stemming from feelings of low self-esteem or self-blame. Girls who are extremely self-critical may use NSSI to punish themselves out of anger or disgust to inflict pain they believe they deserve.12 Often NSSI is used by young girls to jar them back to the present moment if they have used disassociation as a defense mechanism due to experiencing trauma. The physical pain from the NSSI can help end the dissociative state and help them feel a sense of control.13

The reasons that girls may use NSSI as a maladaptive coping mechanism can vary as much as the girls themselves. They may use NSSI to deal with academic and societal pressures, problematic family dynamics, peer and social media influence, and even underlying mental health challenges. Understanding these factors is crucial for developing effective prevention and intervention strategies to because engaging in NSSI can have far-reaching consequences for girls' physical, emotional, and social well-being.

While NSSI is not intended to cause severe harm, it can result in scarring, infections, and other physical complications. In some cases, severe accidental injury may occur. NSSI can exacerbate existing mental health issues and contribute to the development of new ones. Girls engaging in NSSI may experience increased feelings of shame, guilt, and low self-esteem. That behavior can then become a cycle, with temporary relief followed by renewed distress, leading to further self-injury. NSSI can strain relationships with family and friends, leading to social isolation. Many girls who engage in NSSI report difficulties in parent-child relationships and strained communication with their families. The emotional distress and preoccupation with self-injury can interfere with concentration and academic achievement, potentially impacting girls' future educational and career opportunities. Early engagement in NSSI may predict the occurrence of mental disorders in late adolescence, with increased rates of depression, anxiety, and eating disorders. Additionally, a history of NSSI is associated with a significantly higher risk of future suicide attempts.14

As we celebrate the achievements of women throughout history, it's crucial to recognize the challenges facing today's girls and young women. Addressing NSSI requires a comprehensive approach that considers the unique experiences and pressures faced by girls in contemporary US society. Given the high prevalence of NSSI among preadolescents and adolescents, routine screening in primary care and school settings is crucial. More than 60% of preadolescents with NSSI had no history of psychiatric care, highlighting the importance of proactive identification.15

What can schools do?

Schools can implement awareness and prevention programs to educate students, teachers, and staff about NSSI, reducing stigma and promoting early intervention. These programs must include components specifically addressing challenges faced by girls. This may include addressing body image concerns, building resilience against societal pressures, and developing healthy coping mechanisms for managing stress and emotions. Interventions should focus on empowering girls by building self-esteem, assertiveness, and problem-solving skills. Teaching healthy coping mechanisms and stress management techniques can provide alternatives to self-injury. Education on responsible social media use and digital literacy can help girls navigate online spaces more safely and critically evaluate the content they encounter.

Women's History Month provides an excellent opportunity to raise awareness about mental health issues affecting girls and women. Using it as a platform to discuss mental health openly can help reduce the stigma surrounding issues like NSSI. This can encourage more girls to seek help and support when needed. By highlighting the stories of women who have overcome mental health challenges and made significant contributions to society, we can inspire hope and resilience. Recognizing the contributions of women to the field of mental health can inspire girls to perhaps even consider careers in the mental health professions.

Emphasizing the importance of self-care and mental wellness as part of celebrating women's achievements can help girls prioritize their mental health. As noted by the Substance Abuse and Mental Health Services Administration, dedicating time for oneself, getting adequate rest, exercising regularly, and seeking help when needed are crucial steps in maintaining positive mental health.16

Nonsuicidal self-injury among girls in the United States is a significant concern that requires immediate attention and action. By understanding the risk factors, impacts, and potential interventions for NSSI, we can work towards creating a supportive environment that promotes mental health and well-being for all girls. This involves not only addressing immediate mental health concerns but also tackling broader societal issues that contribute to the pressure and stress experienced by young girls. By providing the necessary resources, education, and support, we can help girls overcome challenges like NSSI and empower them to reach their full potential. As we honor the achievements of women throughout history, let us also commit to supporting the mental health of future generations of women. In doing so, we not only address a critical mental health issue but also pave the way for a future where all girls can thrive, contribute to society, and potentially become the celebrated women of tomorrow's history books.

References:

  1. Nonsuicidal Self-Injury: Diagnostic Challenges And Current Perspectives
  2. Nonsuicidal Self-Injury (NSSI)
  3. Nonsuicidal Self-Injury in Preadolescent Children: Who’s at Risk?
  4. Prevention of self-harm and suicide in young people up to the age of 25 in education settings
  5. Nonsuicidal Self-Injury in Preadolescents
  6. Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample
  7. Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 201
  8. Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015
  9. Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample
  10. Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents
  11. A Necessary Pain: A Literature Review of Young People’s Experiences of Self-Harm
  12. Correlates of suicide attempts among self-injurers: A meta-analysis
  13. The link between dissociation and both suicide attempts and non-suicidal self-injury: Meta-analyses
  14. Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Preadolescence
  15. Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample
  16. Celebrate Women’s History Month by Prioritizing Your Mental Health

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