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relapse wishes keep clean These words are commonly used to describe the challenges associated with drug or alcohol withdrawal. But on online message boards like Reddit, these terms are frequently used by people who struggle with a different behavior: the urge to self-harm.

Earlier this year, a team led by Brenda Curtis, Ph.D., chief of the Technology and Translational Research Unit at the National Institute on Drug Abuse, conducted a quantitative analysis of online posts made by 500 people who discussed their experiences with a non-suicidal self. -injury (NSSI). They assessed how many of these individuals used phrases indicative of one of the 11 DSM-5 criteria for substance use disorders (SUDs), which the researchers had adapted to NSSI; for example, did online commenters talk about various unsuccessful efforts to stop self-harming, or that their self-harm affected their work or social life?

Photo: Brenda Curtis, Ph.D.

“Anything you can do to help destigmatize a disorder is valuable because people will be more open,” says Brenda Curtis, Ph.D.


Curtis’ team found that over 75% of individuals met at least two DSM-5 criteria, which would equate to mild SUD, while over 30% of individuals met criteria for moderate (4-5 criteria) or severe (6+). criteria) SUD.

The most common criteria described were having irresistible urges/desires and the need to increase the severity of self-harm to achieve the same effect.

Stephen Lewis, Ph.D., professor of psychology at the University of Guelph in Ontario, Canada, noted that while self-harm is different from addiction, there may be some similarities. “The main reason people self-harm is to get relief from intense emotional experiences like distress or sadness,” he told Psychiatric News. Alcohol and drugs can serve a similar function, but these substances are also frequently (and misused) used by people experiencing positive feelings.

Over time, with addiction to a substance, the substance “remains reinforcing regardless of what happens in an individual’s life,” said E. David Klonsky, Ph.D., professor of psychology at the University of British Columbia and a leading researcher on suicide and self-harm. “Most people with [nonsuicidal self-injury]Don’t feel like hurting yourself if they’re having a good day, though.”

Klonsky published a study exploring this in 2012. He and his colleagues administered craving questionnaires to 58 teenagers who were receiving psychiatric treatment for self-harm and/or substance use. They found that mean craving scores were much lower for self-injury than for any substance, and that self-injury, but not substance use, was desired only in negative contexts. These discrepancies persisted even among youth who had problems with both self-harm and substance use.

Do people who engage in non-suicidal self-injury share more similarities with people with other psychiatric disorders? In years past, such behavior was linked to borderline personality disorder, Klonsky noted, but in 2013 non-suicidal self-harm was introduced as a separate condition worth further study in the DSM-5. Given the connection between self-injury and negative emotions, some people have suggested that non-suicidal self-injury might be a depressive disorder. Klonsky, however, believes it fits better as part of a category of behavioral disorders, such as binge eating or hair pulling, in which people continually resort to a specific behavior to relieve stress or get gratification

So why do people who self-harm commonly use terms like “cleanse” and “relapse” to describe their experiences?

“The conversation about substance use, especially about recovery, is becoming mainstream,” Curtis said. As such, people may feel more comfortable describing their symptoms in these terms. “Anything you can do to help destigmatize a disorder is valuable, as people will be more open and will go see health professionals.”

Lewis, who has publicly shared her own struggles with non-suicidal self-harm, added that individuals can use language similar to that used to describe addiction to convey the seriousness of their behaviors. “These young people are telling us that this is not attention-seeking or a fad that they will outgrow; it’s not behavior that people can just stop cold turkey,” he said.

Doctors and therapists who work with people who engage in non-suicidal self-injury can use this information to their advantage, Lewis added. “I’m not saying we apply an SUD framework when we help people who self-harm, but if they describe their self-harm as an addiction, we should use similar language to validate their experience,” she said. “Remember that people who have self-harmed are experts in their own experience and we need to work with them to promote resilience and ultimately recovery.”

Curtis’ study was funded by the intramural research program of the National Institute on Drug Abuse. ■

Source: People who self-harm describe the behaviors as addictive

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