Non-Suicidal Self-Injury (NSSI) Treatment in Sycamore and North Aurora IL
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If you are interested in counseling for Non-Suicidal Self-Injury (NSSI), call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
What is Non-Suicidal Self-Injury?NSSI is the intentional destruction of one's own body tissue without suicidal intent, typically for the purpose of distracting from or numbing emotional and psychiatric distress, regulating intense emotions, or self-punishment. Many people who engage in NSSI use more than one method. Common examples include cutting, burning, scratching, banging body parts, and hitting oneself. NSSI is associated with an increased risk of suicide, even when the behaviors themselves are non-suicidal in intent, making it important to address as soon as possible.
Once NSSI is used by an individual, it becomes easier to turn to that behavior when in distress, and an urge often develops. The performance of the self-injurious behavior provides a calming effect or feeling of relief, which reinforces the continued use of the behavior during distress. Many people describe starting these behaviors by only engaging in them occasionally, but often find that the behaviors have increased to daily or multiple times a day. People who engage in NSSI often struggle to tolerate uncomfortable emotions because they have reduced their thresholds for emotional intensity due to their unwillingness or inability to feel their uncomfortable emotions. People who engage in NSSI often feel shameful about the behaviors and may try to hide their cuts or scars from others, including from family members, partners, friends, and treatment providers. Who Engages in NSSI?NSSI occurs across all ages, genders, and backgrounds. It most commonly begins during early adolescence, with onset typically between ages 12 and 14, though it can begin earlier or later. Lifetime prevalence estimates suggest that approximately 17% of adolescents and 5-6% of adults have engaged in NSSI at some point (Swannell et al., 2014). NSSI is more commonly identified in females, but male and gender-diverse individuals also engage in these behaviors and may be underrepresented in research due to differences in help-seeking and clinical presentation.
NSSI is not limited to any one mental health condition. It frequently co-occurs with depression, anxiety disorders, trauma and PTSD, eating disorders, substance use, and emotion dysregulation associated with borderline personality features. However, NSSI can also occur in the absence of any other diagnosis. |
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How is NSSI Treated?
There is no single treatment that works for everyone who engages in NSSI, and effective treatment depends on the function the behavior is serving, any co-occurring conditions, the individual's age and developmental stage, and their treatment goals. OakHeart clinicians draw from several evidence-based approaches.
Dialectical Behavior Therapy (DBT) is the most well-researched treatment for NSSI and is considered first-line, particularly for individuals with frequent or chronic NSSI, emotion dysregulation, or co-occurring borderline personality features. DBT was originally developed by Marsha Linehan and combines acceptance and change strategies. Treatment typically involves four skill areas:
Cognitive Behavioral Therapy (CBT) can be helpful for individuals whose NSSI is more situational or is closely tied to specific thinking patterns, beliefs about emotions, or co-occurring conditions like depression or anxiety. CBT focuses on identifying and modifying the thoughts, emotions, and behaviors that maintain self-injury.
Acceptance and Commitment Therapy (ACT) can support clients in developing a different relationship with painful internal experiences and in moving toward values-based behavior even when distress is present.
Trauma-focused treatments may be indicated when NSSI is closely connected to past traumatic experiences. Trauma processing is typically introduced after the client has developed sufficient stabilization and emotion regulation skills, often using a DBT or DBT-informed framework first. See our PTSD and trauma pages for more on trauma-focused treatment.
Family-Based Treatment is often appropriate for adolescents who engage in NSSI. This may include parent coaching, family sessions, or formal family-based programs that involve caregivers in supporting their child's recovery.
Medication is not a first-line treatment for NSSI itself, and there are currently no FDA-approved medications specifically for NSSI. However, medication can be helpful when there is a co-occurring condition (e.g., depression, anxiety, ADHD, bipolar disorder) that is contributing to emotional distress. Decisions about medication should be made in consultation with a prescribing provider, and medication is generally most effective when combined with therapy.
Your clinician will work with you to determine the most appropriate starting point based on the function of the behavior, current frequency and severity, co-occurring concerns, and your goals for treatment.
Dialectical Behavior Therapy (DBT) is the most well-researched treatment for NSSI and is considered first-line, particularly for individuals with frequent or chronic NSSI, emotion dysregulation, or co-occurring borderline personality features. DBT was originally developed by Marsha Linehan and combines acceptance and change strategies. Treatment typically involves four skill areas:
- Mindfulness: building awareness of thoughts, emotions, and urges without immediately acting on them
- Distress Tolerance: skills for getting through crisis moments without engaging in self-injury or other harmful behaviors
- Emotion Regulation: identifying, understanding, and reducing the intensity of overwhelming emotions
- Interpersonal Effectiveness: asking for what you need, setting limits, and maintaining relationships under stress
Cognitive Behavioral Therapy (CBT) can be helpful for individuals whose NSSI is more situational or is closely tied to specific thinking patterns, beliefs about emotions, or co-occurring conditions like depression or anxiety. CBT focuses on identifying and modifying the thoughts, emotions, and behaviors that maintain self-injury.
Acceptance and Commitment Therapy (ACT) can support clients in developing a different relationship with painful internal experiences and in moving toward values-based behavior even when distress is present.
Trauma-focused treatments may be indicated when NSSI is closely connected to past traumatic experiences. Trauma processing is typically introduced after the client has developed sufficient stabilization and emotion regulation skills, often using a DBT or DBT-informed framework first. See our PTSD and trauma pages for more on trauma-focused treatment.
Family-Based Treatment is often appropriate for adolescents who engage in NSSI. This may include parent coaching, family sessions, or formal family-based programs that involve caregivers in supporting their child's recovery.
Medication is not a first-line treatment for NSSI itself, and there are currently no FDA-approved medications specifically for NSSI. However, medication can be helpful when there is a co-occurring condition (e.g., depression, anxiety, ADHD, bipolar disorder) that is contributing to emotional distress. Decisions about medication should be made in consultation with a prescribing provider, and medication is generally most effective when combined with therapy.
Your clinician will work with you to determine the most appropriate starting point based on the function of the behavior, current frequency and severity, co-occurring concerns, and your goals for treatment.
For Parents and Loved Ones
Discovering that someone you love is engaging in self-injury is frightening, and most parents and partners feel some combination of fear, confusion, anger, guilt, and grief. These reactions are understandable. How you respond, however, matters significantly, both for the immediate moment and for the longer-term recovery process.
What tends to help:
For parents of adolescents, your involvement in treatment is often important. A skilled clinician will help you find the right balance between respecting your adolescent's privacy and being meaningfully involved in their care.
What tends to help:
- Responding with calm rather than panic or anger, even when this is difficult. The person who engages in NSSI almost always feels intense shame about the behavior, and a panicked or angry response often increases that shame and reinforces secrecy.
- Acknowledging that the behavior is serving a purpose (typically emotion regulation), without endorsing the behavior itself
- Helping connect the individual to professional treatment rather than trying to manage the behavior on your own
- Asking what they need from you, rather than assuming
- Continuing to engage with the person about other parts of their life (school, interests, friendships) so the NSSI does not become the entire focus of the relationship
- Taking care of your own mental health, including seeking your own support if needed
For parents of adolescents, your involvement in treatment is often important. A skilled clinician will help you find the right balance between respecting your adolescent's privacy and being meaningfully involved in their care.
When to Seek Higher Levels of Care
Most NSSI can be effectively treated in outpatient therapy. However, there are situations where a higher level of care is warranted, including:
In these situations, options may include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), residential treatment, or psychiatric hospitalization for acute stabilization. Your OakHeart clinician can help assess the appropriate level of care and assist with referrals when needed.
- NSSI that is causing injuries requiring medical attention
- NSSI that has rapidly increased in frequency or severity
- Co-occurring suicidal thoughts, plans, or behaviors
- Inability to maintain safety between sessions
- Significant co-occurring conditions (e.g., severe eating disorder, active substance use, untreated psychosis) that complicate outpatient treatment
In these situations, options may include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), residential treatment, or psychiatric hospitalization for acute stabilization. Your OakHeart clinician can help assess the appropriate level of care and assist with referrals when needed.
Frequently Asked Questions
Is NSSI a suicide attempt? No. By definition, NSSI is engaged in without suicidal intent. However, NSSI and suicidal behavior can co-occur, and a history of NSSI is associated with an increased risk of future suicide attempts. A comprehensive clinical assessment includes evaluating both NSSI behaviors and any current or past suicidal ideation, plans, or attempts.
Will I have to go to the hospital if I tell my therapist I am self-injuring? For most clients, no. NSSI is typically treated in outpatient therapy, and hospitalization is generally reserved for situations involving acute suicide risk or medically serious injuries. Your clinician will discuss the limits of confidentiality with you at the start of treatment and will talk through any clinical concerns with you as they arise. Decisions about higher levels of care are made collaboratively whenever possible, and are based on safety, not on the presence of NSSI alone.
Can people stop on their own? Some individuals do stop without formal treatment, particularly when NSSI was brief and situational. However, when NSSI has become a primary coping strategy, it is generally very difficult to stop without addressing the underlying emotional regulation difficulties. Professional treatment significantly improves outcomes.
How long does treatment take? This varies widely depending on the duration and severity of the NSSI, the presence of co-occurring conditions, and individual factors.
What if I am not ready to stop? Ambivalence about stopping NSSI is common and is not a barrier to starting treatment. A clinician can help you explore the function of the behavior, what you might lose or gain by changing it, and what your own goals are, without requiring you to commit to immediate cessation as a precondition for treatment.
Will I have to go to the hospital if I tell my therapist I am self-injuring? For most clients, no. NSSI is typically treated in outpatient therapy, and hospitalization is generally reserved for situations involving acute suicide risk or medically serious injuries. Your clinician will discuss the limits of confidentiality with you at the start of treatment and will talk through any clinical concerns with you as they arise. Decisions about higher levels of care are made collaboratively whenever possible, and are based on safety, not on the presence of NSSI alone.
Can people stop on their own? Some individuals do stop without formal treatment, particularly when NSSI was brief and situational. However, when NSSI has become a primary coping strategy, it is generally very difficult to stop without addressing the underlying emotional regulation difficulties. Professional treatment significantly improves outcomes.
How long does treatment take? This varies widely depending on the duration and severity of the NSSI, the presence of co-occurring conditions, and individual factors.
What if I am not ready to stop? Ambivalence about stopping NSSI is common and is not a barrier to starting treatment. A clinician can help you explore the function of the behavior, what you might lose or gain by changing it, and what your own goals are, without requiring you to commit to immediate cessation as a precondition for treatment.
OakHeart NSSI Counselors, Psychologists, and Social Workers
Resources
General Information on NSSI
Crisis Support 988 Suicide and Crisis Lifeline: Call or text 988 Crisis Text Line: Text HOME to 741741
Education and Information Cornell Research Program on Self-Injury and Recovery (selfinjury.bctr.cornell.edu) International Society for the Study of Self-Injury (itriples.org) S.A.F.E. Alternatives (selfinjury.com)
Crisis Support 988 Suicide and Crisis Lifeline: Call or text 988 Crisis Text Line: Text HOME to 741741
Education and Information Cornell Research Program on Self-Injury and Recovery (selfinjury.bctr.cornell.edu) International Society for the Study of Self-Injury (itriples.org) S.A.F.E. Alternatives (selfinjury.com)
