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NSSI and Body Image: Where the Truth is hard to Digest

In today’s world, where distorted reality has become a trend, body image issues are also growing at a breakneck pace. According to a survey, 85% of the people dealing with body image issues are teenage girls. Body image refers to the multifaceted psychological experience of embodiment, which includes perceptions and estimations of the individual's body size and physical appearance, feelings and thoughts associated with the body and physical appearance (Cañabate, 2018). Because of this, their self-esteem crumbles because of the set beauty standards. Attitudes towards the body have been largely overlooked as a potential risk factor for adolescent Non-Suicidal Self-Injury (NSSI), defined as the destruction of body tissue without suicidal intent and for non-socially sanctioned purposes despite theorising that a negative body image may play a critical role in the development of this behaviour (Brausch, 2012). This phenomenon has been included in the DSM-5 as a condition under study, and its prevalence is rising in adolescent non-clinical and clinical populations, such as participants with eating disorders. NSSI rates have been reported between 13.6% and 42.1% for restricting anorexia nervosa (between 27.8% and 68.1% for purging anorexia nervosa), between 26% and 55.2% for bulimia nervosa, 26.2% for eating disorders not otherwise specified, and 19.8% for binge eating disorder (Cañabate, 2018).

Moreover, more often than not, an eating disorder makes it all the worse for everyone. More than one-third of patients with eating disorders report NSSI. Moreover, negative attitudes and feelings toward the body, body dissatisfaction, and body image disturbances have been linked to NSSI in community and clinical samples (Cañabate, 2018).

  • Cognitive Behavioural Therapy: According to the cognitive-behavioural paradigm, people who participate in NSSI frequently have flawed thought patterns and maladaptive behaviours that contribute to negative perceptions of their bodies and self-harm. Cognitive distortions such as selective conceptualisation (focusing on perceived imperfections while overlooking positive aspects), overgeneralising (comprehending isolated incidents as widespread structures), and stereotypical thinking (viewing situations in black-and-white terms) all contribute to deformed perceptions of the body. For example, someone may regard a little flaw as significant, resulting in great discontent and distress. These cognitive distortions feed the desire to use NSSI as a coping method to relieve emotional discomfort or to punish themselves for perceived shortcomings. Self-injury temporarily relieves bad feelings by acting as a diversion or numbing agent. However, it promotes negative self-beliefs and contributes to the cycle of self-harm.

  • Attachment Theory: Attachment theory proposes that early interactions with carers impact people's perspectives of themselves and others. Insecure attachment patterns, such as anxious or avoidant ties, are linked to challenges with emotion management, self-esteem, and interpersonal interactions. Individuals with a sense of inadequacy may acquire an adverse view of their bodies due to feeling unwanted, rejected, or invalidated in infancy. For example, someone who went through inconsistent parenting or emotional neglect may internalise sentiments of unworthiness or inadequacy, resulting in low self-evaluation and body dissatisfaction. Without stable attachment figures, NSSI might be used to find solace, relieve emotional suffering, or exert dominance.

  • Sociocultural Theory: Sociocultural elements such as societal norms, multimedia influences, and peer interactions all substantially impact body image and self-worth. Western society, in particular, encourages restricted beauty ideals defined by thinness, muscularity, and youth. Individuals who fail to meet these criteria may face social rejection, unfair treatment, or internalised stigma, which can lead to feelings of inadequacy and body shame. For example, exposure to idealised beauty ideals in media might worsen body dissatisfaction and drive comparing processes. Adolescents and young adults, in particular, are susceptible to the effects of peer groups and social media, where appearance-related comments and feedback can affect self-esteem and body image beliefs.

  • Comorbidities: Underlying psychological problems, such as depression, anxiety, trauma, or identity challenges, frequently coexist with NSSI and body image disorders. Negative emotions like shame, remorse, rage, or loneliness can lead to self-injury as people try to regulate or escape unpleasant feelings. NSSI is a maladaptive coping method for dealing with emotional discomfort, managing stress, and exerting authority over one's body and psyche. However, the respite produced by NSSI is very momentary and is frequently followed by thoughts of guilt, shame, or worsened negative emotions, reinforcing the cycle of self-harm. Individuals may become locked in a cycle of increased self-injury as they seek to find other strategies to cope with misery.

Finally, the complex relationship between NSSI and body image highlights the fundamental psychological challenges that individuals experience while managing their sense of self and psychological well-being. By applying cognitive-behavioural theory, attachment theory, and sociocultural influences, we understand the fundamental mechanisms driving self-harming behaviours in reaction to negative body image. Effective therapy techniques must address the interaction of cognitive deformations, emotional management deficits, and interpersonal relationships while also encouraging compassion for oneself, acceptance, and resilience. Mental health specialists may help people recover and discover themselves by teaching them how to confront negative ideas, establish healthier coping mechanisms, and cultivate a more compassionate relationship with their bodies.

  1. Muehlenkamp, J. J., & Brausch, A. M. (2012). Body image as a mediator of non-suicidal self-injury in adolescents. Journal of Adolescence, 35(1), 1-9.

  2. Pérez, S., Marco, J. H., & Cañabate, M. (2018). Non-suicidal self-injury in patients with eating disorders: prevalence, forms, functions, and body image correlates. Comprehensive Psychiatry, 84, 32-38.

  3. Black, E. B., Garratt, M., Beccaria, G., Mildred, H., & Kwan, M. (2019). Body image as a predictor of nonsuicidal self-injury in women: A longitudinal study. Comprehensive Psychiatry, pp. 88, 83–89.

  4. Duggan, J. M., Toste, J. R., & Heath, N. L. (2013). An examination of the relationship between body image factors and non-suicidal self-injury in young adults: The mediating influence of emotion dysregulation. Psychiatry Research, 206(2-3), pp. 256-264.

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