When language is maladaptive: recommendations for discussing self-injury

Publication Date17 Jun 2019
AuthorPenelope Hasking,Stephen P. Lewis,Mark E. Boyes
SubjectHealth & social care
When language is maladaptive:
recommendations for discussing self-injury
Penelope Hasking, Stephen P. Lewis and Mark E. Boyes
Purpose The purpose of this paper is to call on researchers and clinicians to carefully consider the
terminology used when d iscussing non-suicid al self-injury (NSSI ), and specifically the u se of the term
Design/methodology/approach Drawing on literature regarding stigma, language and self-injury to
support the argument that the term maladaptive is inappropriate to describe self-injury.
Findings Use of the term maladaptive conflates short-term effectiveness with long-term outcomes and
ignores context in which the behaviour occurs.
Social implications Use of the term maladaptive to describe self-injury can invalidate the person with a
history of NSSI, impacting stigma and potentially help-seeking. An alternate framing focussed on specific
coping strategies is offered.
Originality/value Language is a powerful medium of communication that has significant influence in how
society shapes ideas around mental health. In proposing a change in the way the authorstalk about
self-injury there is potential to significantly improve the wellbeing of people with lived experience of self-injury.
Keywords Coping, NSSI, Self-injury, Maladaptive
Paper type Viewpoint
Recently, attention has been drawn to the need to be mindful of the language used when talking
about people who self-injure, and ensure we adopt a de-stigmatizing and empathic approach
(Hasking and Boyes, 2018; Lewis, 2017). Similarly, we believe the language we use to describe
the behaviour itself is important. Defined as the intentional damage to ones body tissue without
intent to die, non-suicidal self-injury (NSSI), is a common and serious concern (International
Society for the Study of Self-Injury, 2018). Rates of NSSI in non-clinical samples are about
18 per cent among adolescents, 13 per cent among young adults and 5 per cent among adults
over 25 years of age (Swannell et al., 2014). More recent data suggest up to 18 per cent of
adolescents self-injured in the last 12 months (Monto et al., 2018). NSSI is associated with
numerous mental health difficulties (e.g. distress, anxiety, depressive symptoms; Klonsky, 2011;
Lewis and Heath, 2015), may result in residual scarring (Lewis, 2016; Lewis and Mehrabkhani,
2016), and a growing line of research highlights that NSSI confers risk for subsequent suicidal
thoughts and behaviours (Kiekens et al., 2018).
Although individuals may engage in NSSI for many reasons, the most commonly reported
function of the behaviour is to obtain relief from difficult, unwanted, or intense emotional
experiences (Klonsky, 2007; Taylor et al., 2018). For this reason, it is perhaps unsurprising that
NSSI has been conceptualized as a coping strategy (e.g. Brook and Willoughby, 2016;
Chapman et al., 2006). However, while recognizing NSSI as a form of coping is warranted,
defaulting to a position in which NSSI is conceptualized as a maladaptiveform of coping
presents several concerns.
In this commentary we call on researchers and clinicians to carefully consider the terminology used to
talk about NSSI. Of note, we advise people to avoid terminology that may increase the, already
significant, stigma experienced by people who self-injure (Lloyd et al., 2018; Mitten et al., 2016;
Rosenrot and Lewis, 2018). Language used to describe a behaviour confers values to that
Received 24 January 2019
Revised 11 March 2019
Accepted 13 March 2019
Penelope Hasking is based at
the School of Psychology,
Curtin University,
Bentley, Australia.
Stephen P. Lewis is based at
the University of Guelph,
Guelph, Canada.
Mark E. Boyes is based at the
Curtin University,
Bentley, Australia.
VOL. 18 NO. 2 2019, pp. 148-152, © Emerald Publishing Limited, ISSN 1746-5729 DOI 10.1108/JPMH-01-2019-0014

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