Investigating the Functions and Psychological Correlates of Sexual Activity to Self-Injure (SASI) in Post-Secondary Students

For many young adults, the university years are a time of intense self-discovery, where social expectations often push toward exploring relationships and intimacy. Yet, for a small but significant number of students, these sexual experiences can become twisted into a mechanism for coping with deep emotional pain. Researchers have long studied non-suicidal self-injury, which includes behaviors like cutting or burning the skin to relieve overwhelming feelings without the intent to die. A newer, less understood concept is using sexual activity to harm oneself. This is not about consensual practices that involve pain for pleasure, nor is it about sexual assault; rather, it is when a person voluntarily engages in sexual situations specifically to inflict mental or physical pain on themselves, often to escape feelings of shame, anxiety, or emptiness. While this behavior has been observed in adolescents, it remains a mystery how it functions among college-aged students, a group navigating their own sexual identities while facing high levels of stress.

A team of researchers at the University of Edinburgh set out to fill this gap by asking 190 post-secondary students, aged 17 to 25, about their experiences. The study focused on understanding why students might use sex to hurt themselves and how this behavior connects to their mental health and past trauma. The researchers divided the participants into four groups: those who only engaged in non-suicidal self-injury, those who only used sexual activity to self-injure, those who did both, and a control group who did neither. They asked the students to complete anonymous surveys about their history of sexual and physical abuse, their levels of depression and anxiety, and their self-esteem. Crucially, they also asked the students to explain their motivations, looking to see if the behavior was driven by a desire for immediate physical pain or by a need to regulate difficult emotions.

The findings revealed a complex picture of distress and survival. The study found that students who engaged in this behavior were significantly more likely to do so for indirect reasons, such as managing overwhelming emotions, rather than for direct physical harm. However, the most striking discovery was the overwhelming link to past trauma. Every single student in the group who reported using only sexual activity to self-injure also reported a history of both sexual and physical abuse. In the group that engaged in both types of self-harm, more than 85 percent reported this same dual history of abuse. The data showed that a history of abuse was a powerful predictor of this behavior, even more so than other factors like anxiety. While depression also played a significant role in predicting who might engage in this behavior, anxiety and self-esteem did not show the same strong statistical connection when the researchers looked at the full picture.

Interestingly, the researchers found that students who used sexual activity to self-injure often did so alongside other forms of self-harm, suggesting that these behaviors often travel together. When the researchers looked at the specific motivations, they found that students who engaged in both types of self-harm were more likely to use sexual activity to regulate their emotions, whereas those who only used sexual activity were more likely to report direct physical harm. This suggests that the reasons behind the behavior can shift depending on whether a person is also using other methods to cope. The study also highlighted that non-binary students and those who identified as bisexual were overrepresented in the groups reporting self-harm, pointing to the unique pressures and stigma these groups may face.

Ultimately, this research suggests that for many university students, using sex to self-injure is a desperate attempt to manage the aftermath of severe trauma and deep emotional pain. The behavior appears to be a maladaptive coping strategy, often rooted in a history of abuse, rather than a simple act of risk-taking. The study concludes that understanding these behaviors requires looking beyond the surface to the history of trauma and the struggle with depression that often drives them. By recognizing that these actions are frequently linked to past abuse and emotional dysregulation, mental health professionals can better support students who are suffering in silence, offering them trauma-informed care that addresses the root causes of their pain rather than just the symptoms.