
The Dire Mental Health Effects...
By: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYBy: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert
with USCRI’s Refugee Health Services in Arlington, VA
Self-Injury/Harm Awareness Day is internationally recognized on March 1st with the rest of the month of March dedicated to raising awareness, dispelling myths, and offering support for this highly stigmatized and often misunderstood topic.
Over the years, multiple terms have been used to describe self-injury or self-harming behaviors, including self-cutting, self-wounding, self-mutilation, and deliberate self-harm. As a growing worldwide clinical and public health concern, non-suicidal self-injury (NSSI) is the term most often used in the United States and is now a new diagnosis in the Diagnostic and Statistical Manual of Menal Disorders (DSM-5). NSSI is defined as the direct and deliberate destruction of one’s own bodily tissue in the absence of the intent to die and for reasons not socially sanctioned (Lurigio et al., 2023). Although NSSI occurs in the absence of the intent to die, it is now recognized as a stronger risk factor for suicide than having a history of suicide attempts (Bettis et al., 2020).
Although prevalence rates vary by population, the prevalence rate for NSSI among community samples worldwide is between 7.5-22%, with the estimated lifetime prevalence of NSSI among adults and adolescents being between 4.8-17% and around 18%, respectively (Esposito et al., 2023; Lurigio et al., 2023; Moloney et al., 2024; Xiao et al., 2022). The average age of onset for NSSI is between 12 and 15 years, with 90% of youth beginning this behavior during their pre-adolescent or adolescent years (Lurigio et al., 2023). Across all populations, the most common types of NSSI are self-cutting with a knife, razor, or other sharp object, head banging, burning, and hitting with the most common sites of injury being on the extremities (arms and legs) and stomach. For more detailed information about self-harm, including symptoms, motivations or reasons, consequences, and ethnic variations, please read Self-Harm Awareness Month 2024.
Risk Factors
Self-harm or NSSI is the outcome of a complex interplay of biological, genetic, psychiatric, psychological, social, economic, and cultural factors that transcend race and economic boundaries. While self-harm affects individuals across all demographics, immigrants and refugees are at a heightened risk due to their unique experiences of trauma, forced displacement, acculturative stress, and social marginalization (Byrow et al., 2020; Klonsky et al., 2014; Gargiulo et al., 2020). The following are more general, as well as refugee-specific, risk factors for NSSI among adolescents and adults:
Understanding the risk factors for NSSI is key to informing the development and implementation of effective prevention measures and interventions and services to address self-harm.
Functions and Reasons for Self-Harm
Self-harm or NSSI serves various social, psychological, and emotional functions. Individuals who self-harm have intrapersonal or interpersonal vulnerabilities that typically limit their ability to adaptively respond to challenges and stressful life events, and so they may utilize self-injury or other dysfunctional behaviors as coping mechanisms to regulate their emotional, cognitive, or social experiences (Lurigio et al., 2023). Therefore, NSSI seems to serve both intrapersonal (e.g., emotion regulation or self-punishment) and interpersonal (e.g., fitting in or letting others know the extent of emotional pain) functions (Lurigio et al., 2023). Much of the research suggests that NSSI is physiologically and psychologically maintained as an effective, although maladaptive, emotion and cognitive regulation strategy. Among migrants and refugees, it can be understood as both an individual coping mechanism and a response to social and structural stressors (Klonsky et al., 2014).
Migrants and refugees often experience overwhelming emotions such as fear, sadness, and helplessness due to past trauma, forced displacement, and ongoing uncertainty. Self-harm can serve as a means of emotion regulation, providing temporary relief from overwhelming distress (Taylor et al., 2018). Research suggests that NSSI triggers the release of endogenous opiates in response to tissue damage, which can produce a calming effect and momentarily alleviate emotional pain (Hooley & Franklin, 2018; Lurigio et al., 2023).
For many individuals who have difficulty verbalizing their emotions, self-harm becomes a physical manifestation of psychological distress. Migrants and refugees who lack access to mental health support or who come from cultural backgrounds that stigmatize open emotional expression may use self-injury to externalize their internal suffering (Bevione et al., 2024).
Forced migration often involves a loss of control over one’s life, including decisions about where to live, work, or seek asylum. In such situations, self-harm may provide a sense of control over one’s body when external circumstances feel uncontrollable (Hatzenbuehler et al., 2017). This is particularly relevant for immigrants and refugees placed in detention centers or camps, with squalid and crowded conditions, where autonomy and basic freedoms are severely restricted. Self-harm can serve as an expression of agency and manifest as a form of resistance against the destructive effects of oppression by reclaiming ownership of one’s body or emotions and asserting a measure of control over one’s own life (Aitchison & Essex, 2022; LaGuardia-LoBianco, 2019; Lurigio et al., 2023).
Many refugees who have experienced war, violence, torture, or sexual assault during the migration process will experience symptoms of PTSD (Gargiulo et al., 2020). Self-injury may serve as a means of coping with or reducing PTSD symptoms, such as intrusive thoughts, flashbacks, or dissociation. Some individuals experiencing dissociative symptoms report using self-harm to “ground” themselves in reality (Taylor et al., 2018).
Although self-harm is often a private act, in some cases it can function as a form of communication. Refugees and immigrants who feel isolated and unheard may engage in self-injury as an indirect way of expressing their needs, especially if they believe that openly seeking mental health support is not an option due to stigma or other fears (Byrow et al., 2020).
Many immigrants and refugees struggle with feelings of guilt and shame, whether due to past traumas, survivor’s guilt, or difficulties adjusting to a new culture. Self-harm can be an expression of self-punishment, particularly among those who internalize negative beliefs about themselves (Bevione et al., 2024). Discrimination and xenophobia in host countries can exacerbate these feelings, reinforcing self-destructive behaviors.
Prevention and Intervention Strategies
To effectively address self-harm in migrant and refugee populations, a comprehensive and culturally sensitive approach is necessary:
Mental health professionals should be trained to understand the unique experiences of displaced populations. Providing therapy in an individual’s native language and incorporating cultural beliefs into treatment can increase engagement and effectiveness (Gargiulo et al., 2020).
Mental health programs should adopt trauma-informed care principles, recognizing that many migrants and refugees have histories of severe trauma. This includes fostering a sense of safety, building trust, and empowering individuals in their treatment process (Hatzenbuehler et al., 2017).
Community organizations and NGOs can play a crucial role in addressing self-harm by providing culturally sensitive counseling, peer support groups, and safe spaces where migrants and refugees can seek help without fear of stigma (Bevione et al., 2024).
Educational campaigns can help break the stigma surrounding mental health in migrant communities. Training religious leaders, teachers, and social workers to recognize signs of self-harm and provide support can also improve early intervention efforts.
Governments and international organizations should work toward policies that improve mental health access for displaced populations. This includes expanding mental health coverage for asylum seekers, funding culturally-responsive prevention programs, screening and assessment initiatives, and interventions, and ensuring that detention centers and refugee camps uphold human rights and provide adequate medical care and psychological support services (Byrow et al., 2020).
For Self-Injury/Harm Awareness Day and Month, it is essential to highlight the hidden struggles of migrant and refugee populations who turn to self-harm as a coping mechanism for their unique challenges. By understanding the risk factors and underlying psychological functions of self-injury, healthcare professionals, policymakers, and community organizations can work together to create a more supportive and compassionate system that fosters healing and resilience.
For resources or information about USCRI’s Refugee Health Services program for refugees, please visit: https://refugees.org/behavioral-health-support-program/ . If you are an immigrant or refugee experiencing sadness, anger, anxiety, fear, difficulties sleeping or functioning, or any other form of distress, call USCRI’s Wellness Helpline at 800-615-6514 for counseling and support.
If you or someone you know is thinking about suicide or would like emotional support, call or text 988, the Suicide and Crisis Lifeline that is available 24/7. If you or someone you know is having a life-threatening emergency, please call 911 or go to your nearest hospital emergency room.
References
Aitchison, G., & Essex, R. (2024). Self-harm in immigration detention: Political, not (just) medical. Journal of Medical Ethics, 50(11), 786–793. https://doi.org/10.1136/jme-2022-108366
Baralla, F., Ventura, M., Negay, N., Di Napoli, A., Petrelli, A., Mirisola, C., & Sarchiapone, M. (2021). Clinical correlates of deliberate self-harm among migrant trauma-affected subgroups. Frontiers in Psychiatry, 12, 529361. https://doi.org/10.3389/fpsyt.2021.529361
Bettis, A. H., Liu, R. T., Walsh, B. W., & Klonsky, E. D. (2020). Treatments for self-injurious thoughts and behaviors in youth: Progress and challenges. Evidence-Based Practice in Child and Adolescent Mental Health, 5(3), 354–364. https://doi.org/10.1080/23794925.2020.1806759
Bevione, F., Panero, M., Abbate-Daga, G., Cossu, G., Giovanni Carta, M., & Preti, A. (2024). Risk of suicide and suicidal behavior in refugees: a meta-review of current systematic reviews and meta-analyses. Journal of Psychiatric Research, 177, 287-298. https://doi.org/10.1016/j.jpsychires.2024.07.024
Byrow, Y., Pajak, R., Specker, P., & Nickerson, A. (2020). Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: a systematic review. Clinical Psychology Review, 75, 101812. https://doi.org/10.1016/j.cpr.2019.101812
Esposito, C., Dragone, M., Affuso, G., Amodeo, A. L., & Bacchini, D. (2023). Prevalence of engagement and frequency of non-suicidal self-injury behaviors in adolescence: an investigation of the longitudinal course and the role of temperamental effortful control. European Child & Adolescent Psychiatry 32, 2399–2414. https://doi.org/10.1007/s00787-022-02083-7
Gargiulo, A., Tessitore, F., Le Grottaglie, F., & Margherita, G. (2021). Self‐harming behaviours of asylum seekers and refugees in Europe: a systematic review. International Journal of Psychology, 56(2), 189-198. https://doi.org/10.1002/ijop.12697
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/AJPH.2012.301069
Hooley, J. M., & Franklin, J. C. (2018). Why do people hurt themselves? A new conceptual model of NSSI. Clinical Psychological Science, 6(3), 428-451. https://doi.org/10.1177/2167702617745641
Jacobson, C., Hill, R., Pettit, J., & Grozeva, D. (2015). The association of interpersonal and intrapersonal emotional experiences with non-suicidal self-injury in young adults. Archives of Suicide Research, 19(4). https://doi.org/10.1080/13811118.2015.1004492
Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: What we know, and what we need to know. Canadian Journal of Psychiatry, 59(11), 565-568. https://doi.org/10.1177/070674371405901101
LaGuardia-LoBianco, A. W. (2019). Understanding self-injury through body shame and internalized oppression. Philosophy, Psychiatry, & Psychology, 26(4), 295–313. https://doi.org/10.1353/ppp.2019.0045
Lurigio, A. J., Nesi, D., & Meyers, S. M. (2023). Nonsuicidal self-injury among young adults and adolescents: Historical, cultural and clinical understandings. Social Work in Mental Health, 22(1), 122–148. https://doi.org/10.1080/15332985.2023.2264434
Meisler, S., Sleman, S., Orgler, M., Tossman, I., & Hamdan, S. (2023). Examining thew relationship between non-suicidal self-injury and mental health among female Arab minority students: the role of identity conflict and acculturation stress. Frontiers in Psychiatry, 14, 1247175. https://doi.org/10.3389/fpsyt.2023.1247175
Moloney, F., Amini, J., Sinyor, M., Schaffer, A., Lanctôt, K. L., & Mitchell, R. H. (2024). Sex differences in the global prevalence of nonsuicidal self-injury in adolescents: a meta-analysis. JAMA Network Open, 7(6), e2415436. https://doi.org/10.1001/jamanetworkopen.2024.15436
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227, 759–769. https://doi.org/10.1016/j.jad.2017.11.073
Xiao, Q., Song, X., Huang, L., Hou, D., & Huang, X. (2022). Global prevalence and characteristics of non-suicidal self-injury between 2010 and 2021 among a non-clinical sample of adolescents: a meta-analysis. Frontiers in Psychiatry, 13, 912441. https://doi.org/10.3389/fpsyt.2022.912441
By: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYBy: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORYBy: Rosalind Ghafar Rogers, PhD, LMHC, Clinical Behavioral Health Subject Matter Expert with USCRI’s Refugee Health Services in Arlington, VA...
READ FULL STORY