Getting “clean” from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm

Abstract

Background & Aims Previous studies have shown that nonsuicidal self-injury (NSSI) has addictive features, and an addiction model of NSSI has been considered. Addictive features have been associated with severity of NSSI and adverse psychological experiences. Yet, there is debate over the extent to which NSSI and substance use disorders (SUDs) are similar experientially. Methods To evaluate the extent that people who self-injure experience NSSI like an addiction, we coded the posts of users of the subreddit r/selfharm (n = 500) for each of 11 DSM-5 SUD criteria adapted to NSSI. Results A majority (76.8%) of users endorsed at least two adapted SUD criteria in their posts, indicative of mild, moderate, or severe addiction. The most frequently endorsed criteria were urges or cravings (67.6%), escalating severity or tolerance (46.7%), and NSSI that is particularly hazardous. User-level addictive features positively predicted number of methods used for NSSI, number of psychiatric disorders, and particularly hazardous NSSI, but not suicidality. We also observed frequent use of language and concepts common in SUD recovery circles like Alcoholics Anonymous. Discussion & Conclusion Our findings support previous work describing the addiction potential of NSSI and associating addictive features with clinical severity. These results suggest that NSSI and SUD may share experiential similarities, which has implications for the treatment of NSSI. We also contribute to a growing body of work that uses social media as a window into the subjective experiences of stigmatized populations.

Non-Suicidal Self-Injury and Emotional Dysregulation in Male and Female Young Adults: A Qualitative Study

“…Indeed, one study investigated one of the key symptoms of the addictive process, namely craving, and showed that this construct was more central for substance use disorder than for NSSI [30]. Furthermore, the use of terms referring to addictive behaviors by participants can be interpreted as a way of reducing the stigma around NSSI, while implying that recovery would be possible [31]. Further studies are needed to clarify the similarities and differences in process between addictive behaviors and NSSI.…”

Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample

“…In addition, craving for NSSI was significantly lower compared to drug craving and was typically reported in the context of negative emotions, while craving for drugs was reported in a wide variety of emotional states. However, we should also mention that when analyzing the internet posts of people who engaged in NSSI, the addiction potential of NSSI has been clearly demonstrated ( 43 ). The most indicative SUDs criterion was urge/craving in reference to NSSI.…”

“…The most indicative SUDs criterion was urge/craving in reference to NSSI. Moreover, the user-level addictive characteristics of NSSI are closely linked to more serious versatility and more associated psychiatric disorders ( 43 ). It is also worth noting that there are attempts to treat addiction-type experiences of NSSI as a behavioral addiction.…”

Picturing self‐harm: Investigating flash‐forward mental imagery as a proximal and modifiable driver of non‐suicidal self‐injury

“…Understanding the proximal and dynamic drivers of NSSI urge fluctuation is likely to aid the identification of novel intervention targets. NSSI episodes are triggered by negative affect (Kiekens et al, 2020) and are preceded by thoughts and urges that intensify over time (Himelein-Wachowiak et al, 2022;Miller et al, 2021), typically over a duration of approximately 30 min (Fitzpatrick et al, 2020). Interestingly, while urge intensity is a strong proximal predictor of NSSI behavior (Ammerman et al, 2017;Turner et al, 2019), negative affect (Kiekens et al, 2020) and persistent ideation do not appear to be strong predictors of behavior (Turner et al, 2019).…”