Most of our understanding about non-suicidal self-injury comes from mainly white, western samples, but this does not necessarily apply to people from other cultures and countries. To offer an overview of how self-injury is understood in other countries, and stress the need for cross-cultural research about NSSI, ISSS – the International Society for the Study of Self-Injury – organized a panel presentation with ambassadors from New Zealand, Brazil and the Philippines. Here is a summary from this event, which was hosted on April 22 2024 on Zoom. 

Prof. Marc Wilson’s intervention (New Zealand)

Prof. Marc Wilson opened the meeting by describing the current state of research about NSSI across the world. He argues the imbalanced distribution of psychology research across the globe is problematic. In the 2010s, about 60% of studies came from North America and 30% from other Western developed nations, meaning that only 10% represented the rest of the world. In NSSI research, rates are rather similar, with 52% of all samples coming from North America, 24% from Europe, 9% from Australia and New Zealand, and 11% from Asian countries.

Different types of research are used to investigate NSSI across cultures. Some analyze NSSI across countries, using the same comparison elements (such as methods or functions of self-injury). These studies have found that the most prevalent forms of NSSI may vary between contexts. For example one method of self-injury might be more common in a country than in another.

Another type of research – which is rather rare – focuses on NSSI among minority groups within nations. For example in New Zealand, the few studies that focused on indigenous people suggest there are no real differences between NSSI amongst Māori people and New Zealanders from European origins. This is surprising given the rate of suicide is higher amongst Māoris.

Finally, some studies revolve around NSSI in non-Western nations, but many of them might not be available to most people due to the language barrier.

It is important to consult with the population in question. What we may or may not consider NSSI in a given context might not be seen as such in another. For instance, in an indigenous population of New Zealand, excessive alcohol consumption is commonly seen as a form of NSSI, whereas in a Western context substance use is usually excluded from that category.

Dr. Carlos Aragão Neto’s intervention (Brazil)

Dr. Carlos Aragão Neto explained the state of self-injury in Brazil, where the common term for non-suicidal self-injury is “self-mutilation”. He prefers to use the term “Autolesão sem Intenção Suicida”, or ASIS (literal translation of “non-suicidal self-injury”), to better refer to the behavior. Cutting is the most common method of self-harm in Brazil.

Dr. Carlos Aragão Neto started his presentation by giving some context about the law surrounding self-injury. On April 26 2019, Lei n°13.819 established the National Policy for the Prevention of Self-Mutilation and Suicide. The law made it compulsory to health institutions and schools to report cases of self-injury. Unfortunately, according to Dr. Carlos Aragão Neto, it takes time for newly passed laws to be put in practice in Brazil, so we can hope to have more consistent research about NSSI in the next few years. It is of particular importance as a study published in 2024 found a 6% yearly growth of the suicide rate among young people from 2011 and 2022 and a yearly 29% increase in reported rates of self-harm (comprising self-injury, self-poisoning and suicide attempts). The increase is higher than in the general population, for both suicide and self-harm. Dr. Carlos Aragão Neto observed several reasons for self-harm in Brazil, such as physical, emotional, or sexual abuse, parents’ divorce, absence of a father figure, death of a loved one, or bullying. He also remarked young people in Brazil now use technologies in excess, have a poor sleep pattern, do not have direct contact with nature anymore, lack regular physical activity, and face intense pressure for high performance.

Dr. Ma Pilar Charmaine Malata (Philippines)

Dr. Ma Pilar Charmaine Malata first gave an overview of the specific context of the Philippines, which is made up of more than 7,100 islands and where more than 170 languages are spoken. The country is impacted by a strong shortage of registered guidance counselors in schools, with one guidance counselor for every 14,000 students.

In 2018, the Philippine Mental Health Law was passed, which required non-specialized health professionals and volunteers to be trained in the identification of suicidal behaviors. As part of the national suicide prevention strategy, Dr. Ma Pilar Charmaine Malata has given training about self-injury to high school teachers and staff.

There are very few studies about NSSI in the Philippines, but a 2019 study among 160 college students in Iloilo found that 48.1% of the students engaged in NSSI, and that the most common forms of NSSI were hitting themselves, pulling their hair out, biting themselves, and cutting or carving their skin. The study was presented by Dr. Rigel Kent Villaruel at the ISSS 18th Annual International Conference in Vienna, Austria in 2023. Parental neglect is a strong risk factor for NSSI in the Philippines. But the family can also be a source of support, as Filipino values attach importance to the family in the recovery of teenagers who self-injure (for more on that topic, see this study). 

Due to the large number of languages spoken in the Philippines, Dr. Ma Pilar Charmaine Malata helps her students practice empathetic support phrases in their own dialects, as most resources found in leaflets are in English. This raises questions about the accessibility of resources across different cultural contexts.

Discussion

After the presentations, the ambassadors and viewers of the meeting were able to make comments and ask questions. This allowed for a cross-cultural discussion and reflection about some topics.

Self-injury, perfectionism, and parental pressure

Prof. Marc Wilson noticed that family can both be a negative and a positive influence in a young person’s self-injury: while in the Philippines, family can be a protective factor, it can also lead to high pressure as is the case in Brazil. In New Zealand, Māori people report greater perfectionism than individuals from European origins. This enables us to reflect on collectivism, which can be a source of support but also of increased pressure for high performance. To illustrate this aspect, Dr. Ma Pilar Charmaine Malata mentions her experience with some students who would cut on weekends to better focus on their studies and perform better on exams on Monday.

Gender, and what constitutes “culture”

A guest mentioned that cross-cultural research should also take into account different gender perspectives, which triggered a reflection about what culture is. Prof. Marc Wilson remarked cultures can be defined by whether or not they are collectivist or individualist, but they can also be categorized according to diverse factors, such as the distribution of power (hierarchical or egalitarian for instance).

In Western countries, self-injury is often assumed to be a female behavior. We may wonder if gender-based stereotypes are similar across the world. According to Dr. Carlos Aragão Neto, females engage in self-injury much more than males in Brazil, with 1 male self-injuring for every 4 females. In New Zealand, the situation is more nuanced, with more women disclosing self-injury than men, but rates showing no difference between men and women depending on the screening tools. Dr. Ma Pilar Charmaine Malata cannot provide gender rates about self-injury in the Philippines as very few studies exist. She explained it is a sensitive topic and researchers are discouraged from pursuing studies on it. Prof. Wilson added that while members of the LGBT community are found to be more likely to self-injure, differences in rates disappear when factors such as minority stress are controlled. It suggests that it is not being an LGBT individual per se that is a risk factor, but rather stigma and discrimination that are attached to it.

The prevalence of psychological terms on social media

Prof. Wilson remarked that terms borrowed from the field of psychology, such as “trigger” or “trauma” became very prevalent on social media, but are often trivialized and used improperly. Dr. Ruth Tatnell argued that the incorrect appropriation of these terms by young people is not entirely negative, as it enables them to share their experience, raise awareness, and have their perspective validated.

For more information about the International Society for the Study of Self-Injury, check their website: https://www.itriples.org

Studies mentioned in the presentations

Overview

Wilson, M. S. (2024). 10 Cross-Cultural Representations of NSSI. The Oxford Handbook of Nonsuicidal Self-Injury. https://doi.org/10.1093/oxfordhb/9780197611272.013.6

Brazil

Alves, F. J. O., Fialho, E., de Araújo, J. A. P., Naslund, J. A., Barreto, M. L., Patel, V., & Machado, D. B. (2024). The rising trends of self-harm in Brazil: an ecological analysis of notifications, hospitalisations, and mortality between 2011 and 2022. The Lancet Regional Health–Americas, 31. https://doi.org/10.1016/j.lana.2024.100691

Philippines

Galicia, J. R. U., & Bautista, T. D. (2018). Prevalence of nonsuicidal Self-injury and Suicide Attempt among Young Adult university Students . Acta Medica Philippina, 52(1). https://doi.org/10.47895/amp.v52i1.460

Gayoles, L. A. M., & Magno, J. R. A. (2020). The Effect of Cognitive Behavioral Therapy Group Counseling on the Well-Being of Self-Harming Emerging Adults. Philippine Social Science Journal, 3(1), 35-52. https://doi.org/10.52006/main.v3i1.120

Cayubit, R. F. O., Dimaculangan, D. M. H., Lim, S. M. G., Sanchez, G. M. J. B., Pazcoguin, J. M. A., & Reyes, M. E. S. (2022). Social networking and depressive symptom: Predictors of non-suicidal self-injury among adolescents. Current Psychology, 1-9. https://doi.org/10.1007/s12144-021-02541-6

Reyes, M. E. S., Davis, R. D., Rojales, A. M. D., Zamora, C. P. R., Germodo, D. F., Lanuza, L. R. V., & Manahan, A. N. R. (2019). Adverse childhood experiences and non-suicidal self-injury as mediated by pathological personality traits. Suicidol Online, 10, 9.

Sulleza, G., (2022). Stories of Significant Others of the Adolescents with Self-Injurious Behaviors. Psychology and Education: A Multidisciplinary Journal, 6(2), 169-178. https://doi.org/10.5281/zenodo.7443290

I was not able to find Alcala et al., 2024 and Villaruel et al., 2019