Pain during nonsuicidal self-injury: An investigation of the sensory and affective components of pain and injury severity in daily life
This study of 51 women with nonsuicidal self-injury (NSSI) disorder reveals that pain during real-life NSSI episodes is generally mild, often appraised as pleasant, decreases shortly after the event, and increases with injury severity, suggesting that pain serves a functionally meaningful role in maintaining the behavior rather than acting solely as a barrier.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Pain is usually a warning system. When you touch a hot stove or step on a sharp stone, your body sends an urgent signal to your brain: stop, pull away, protect yourself. This sensation is meant to keep you safe from further harm. But for some people, the body's reaction to injury works differently. There is a behavior known as nonsuicidal self-injury, where individuals deliberately hurt their own bodies without intending to end their lives. For decades, scientists have wondered how this works. If pain is supposed to be a barrier that stops us from hurting ourselves, why do these individuals continue? Is the pain simply missing, or is it being felt but interpreted in a strange way? Understanding this difference is crucial, because if the pain is not just a barrier but actually part of the reason the behavior continues, then the way we help these people needs to change.
A team of researchers from Germany and the United States set out to answer this question by watching what happens in real life, rather than in a laboratory. They recruited fifty-one women who had a specific diagnosis related to repetitive self-injury. These women agreed to carry smartphones for fifteen days. Whenever they engaged in self-injury, they were asked to immediately open an app and describe what happened. They were then prompted three more times over the next thirty minutes to report on how they felt. This method allowed the researchers to capture the exact moment of injury and the minutes that followed, tracking both how strong the pain felt and how the person felt about that pain.
The results revealed a picture that is more complex than simple numbness. When the women reported on their injuries, the pain was generally mild. On a scale where zero is no pain and ten is the worst imaginable pain, the average rating was quite low. In fact, about eighteen percent of the time, the women reported feeling absolutely no pain at all during the act. However, pain was not absent in every case. Most of the time, they felt some level of discomfort, but it rarely reached high levels. Even when the injuries were severe—such as deep cuts that damaged tissue or caused significant bleeding—the reported pain remained surprisingly low. The researchers found that the more severe the injury, the higher the pain rating tended to be, but even the most serious injuries were not rated as excruciating.
What was perhaps the most surprising finding was how the women felt about the pain they were experiencing. The researchers asked them to rate whether the pain felt pleasant or unpleasant. On average, the pain was rated as pleasant. This does not mean the women enjoyed the physical sensation of being cut or burned in the way one might enjoy a warm bath. Instead, the pain seemed to serve a purpose. It felt relieving, calming, or useful in that moment. The study showed that this pleasant feeling did not change much over the thirty minutes following the injury, even as the actual intensity of the pain slowly faded.
The study also looked at how pain changed over time. The researchers found that the intensity of the pain dropped significantly in the minutes immediately after the injury. This suggests that the act of self-injury might trigger a process that reduces pain quickly, perhaps as a way to cope with overwhelming emotions. However, the feeling of the pain being pleasant or useful remained steady. This distinction is vital. It suggests that for these individuals, the pain is not just a hurdle they have to overcome to hurt themselves. Instead, the pain itself, or the way it is felt, might be a necessary part of the behavior. It provides a strong, clear sensation that can interrupt difficult thoughts or emotions, and the relief that follows can feel rewarding.
These findings challenge the old idea that people who self-injure simply do not feel pain. Instead, they feel it, but they feel it differently. The pain is often mild, it fades quickly, and it is often experienced as something positive or helpful in the context of their emotional state. This changes how we might understand the behavior. If the pain is not just a barrier but a functional part of the process, then treatment needs to address not just the urge to hurt oneself, but also the meaning the person attaches to that pain. By understanding that the pain can feel pleasant or relieving, doctors and therapists can better help these individuals find other ways to achieve that same sense of relief without causing harm. The study confirms that the human experience of pain is not just a biological signal, but a complex feeling that can be shaped by our emotions and our needs.
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