Self-injury is a universal phenomenon, and it can affect anyone, no matter their age, gender, or culture. Yet, just because self-injury is global doesn’t mean it’s the same everywhere. Unfortunately, psychology research mainly focuses on western populations. About half samples studied in research about self-injury are from North America, and a fourth from Europe1. This leaves a large part of the world population under-represented. This article won’t seek exhaustivity: the goal is not to describe the state of self-injury in each country, but rather to raise the issue of representation and diversity, and to encourage open-mindedness. Because what might be true in one setting might not apply to another.
Self-injury among adolescents has become an alarming issue across the globe. Interestingly, youth rates of self-injury tend to be rather similar in all regions2, particularly among female adolescents3, but male adolescents tend to self-injure more in Asia than in other regions of the world3.
Yet, self-harm is not the same everywhere; functions and methods vary2. Regarding functions, people who self-injure in non-Western countries appear to do so more frequently to deal with emotions which result from interpersonal conflicts, instead of dealing with more general negative emotions3. As for methods, some are more frequently used in specific countries than others. For example, cutting tends to be more common in the United States than in Germany, despite the two countries having similar rates of self-injury. Likewise, India and Belgium have the same self-injury prevalence, but head-banging is more common in India, particularly amongst Indian males, and cutting is more rare2.
But it is also important to remain open-minded about the definition of non-suicidal self-injury and self-harm to fully grasp the difference of methods across the globe. Some cultures define self-harm differently than the traditional Western research approach. For example, cutting one’s hair can be seen as a form of self-injury for Australian aboriginals4. While substance use is usually excluded from the definition of non-suicidal self-injury in the West, excessive alcohol consumption is also considered self-injury for Maoris (indigenous people in New Zealand)1, along with more foreign ideas such as getting tattoos that don’t have any cultural significance, or harming one’s spirituality or distancing oneself from God2, 4.
It is therefore important to consider the functions that a behavior holds for someone, to understand if it can be a form of self-harm, offer more appropriate help, but also to distinguish maladaptive coping mechanisms from cultural practices. To name only a few cultural practices that take the form of injury to the self, we can think of “sorry cuts”, which are engaged in by some Australian Aboriginals to grieve a relative2, or “Konjo-yaki”, a common practice among juvenile delinquents in Japan, which consists of burning oneself with a cigarette to prove one’s courage and bind socially5. Many grieving practices and rites of passage involve self-injury.
It’s also important to understand how culture can influence manifestations of distress. For example, collectivist cultures can be a source of support, but can also increase pressure and perfectionism1 while more individualistic societies can make it more difficult to talk about their mental health.
Of course, we can’t understand and know about each culture. But just keeping an open-mind can make a difference, as our perspective on self-harm and psychology may differ from that of others. We also need to keep in mind that some culture-specific factors can impact someone’s mental health, and may need to be taken into account in treatment and therapy.
For more information, please see this summary of an ISSS discussion about self-injury across the world, and this interview, which offers some elements about self-injury in Japan and Taiwan. For a list of other cultural self-harm, I invite you to visit this index, which is a work in progress.
References
[1] Wilson, M. (2024, April 22). ISSS panel presentation with ambassadors from New Zealand, Brazil and the Philippines [Presentation via Zoom].
[2] Wilson, M., & Westers, N. J. (2022, April 29). Self-Harm Across Cultures, with Dr. Marc Wilson. The Psychology of Self-Injury. https://the-psychology-of-self-injury.simplecast.com/episodes/self-harm-across-cultures-with-dr-marc-wilson
[3] Moloney, F., Amini, J., Sinyor, M., Schaffer, A., Lanctôt, K. L., & Mitchell, R. H.B. (2024). Sex Differences in the Global Prevalence of Nonsuicidal Self-Injury in Adolescents: A Meta-Analysis. JAMA Network Open, 7(6). https://doi.org/10.1001/jamanetworkopen.2024.15436
[4] Westers, N. J. (2024). Cultural interpretations of nonsuicidal self-injury and suicide: Insights from around the world. Clinical Child Psychology and Psychiatry, 29(4). https://doi.org/10.1177/13591045241287249
[5] Matsumoto, T., Yamaguchi, A., Chiba, Y., Asami, T., Iseki, E., & Hirayasu, Y. (2005). Self-burning versus self-cutting: Patterns and implications of self-mutilation; a preliminary study of differences between self-cutting and self-burning in a Japanese juvenile detention center. Psychiatry and Clinical Neuroscience, 59(1), 62-69. https://doi.org/10.1111/j.1440-1819.2005.01333.x
Exploring self-harm 