Representations of
Non-Suicidal Self-Injury
in Motion Pictures

Christopher Trewavas, Penelope Hasking, and Margaret McAllister

The aim of this study was to investigate representations of non-suicidal self-injury
(NSSI) in popular media. Forty-one motion pictures were viewed, coded, and ana-
lyzed. NSSI was correlated with mental illness, child maltreatment, and substance
abuse. NSSI was generally portrayed as severe, habitual and covert. Further, depic-
tions of NSSI were often sensationalized and featured prominently. NSSI was less
likely to be associated with completed suicide than other psychological factors, but more
closely associated with suicide than NSSI is in the community. Although NSSI was
associated with psychiatric illness, few characters were receiving psychiatric care at the
time of NSSI. However a significant proportion received support after engaging in
NSSI. The portrayal of NSSI is generally accurate regarding correlates and function,
but is inaccurately associated with suicide. Implications of the relatively accurate
portrayal of NSSI are discussed in light of the potential for imitation, and the possi-
bility of using cinematherapy to promote effective problem resolution.

Keywords

film, media representations, non suicidal self injury, self harm, self injury

Non-suicidal self-injury is a prevalent and
acute psychological health concern. Corre-
lated with multiple risk factors, NSSI is
defined as the deliberate direct self-inflicted
damage of body tissue, and is differentiated
from suicidal behavior by the absence
of suicidal intent (Nock, 2009). Although
NSSI is a risk factor for suicide, it is more
aptly characterised as a coping mechanism,
engaged as a method of affect regulation
(Klonsky, 2007; Welch, Linehan, Sylvers
et al., 2008), interpersonal regulation (Nock
& Prinstein, 2004, 2005), or physiological
arousal (Nock & Mendes, 2008).

Consistent with the phenomenon of

suicide contagion (Bollen & Phillips, 1982;
Hassan, 1995; Martin, 1998; Phillips, 1974,
1985; Romer, Jamieson, & Jamieson, 2006),
preliminary research reveals that media

depictions of drug overdose influence
imitative acts of self-poisoning (Hawton,
Simkin, Deeks et al., 1999). Although not
directly examined, media depictions of
NSSI might also prompt imitative behavior.
However, media depictions of NSSI may
also serve as a useful clinical tool, if
effective problem resolution is depicted.
Thus, it is important to understand how
NSSI is portrayed in popular media culture,
and to consider the possible effects of its
portrayal on audiences.

Nature and Extent of NSSI

In order to determine whether the

portrayal of NSSI in motion pictures is
accurate, it is first necessary to summarize
the current state of knowledge concerning

Archives of Suicide Research, 14:89–103, 2010
Copyright # International Academy for Suicide Research
ISSN: 1381-1118 print=1543-6136 online
DOI: 10.1080/13811110903479110

89

NSSI. Although prevalence estimates of
NSSI vary according to the definition used
and means of assessment, studies prompt-
ing participants to recall specific forms of
NSSI (including cutting, burning wound
interference, head banging, etc.) suggest
the prevalence may be as high as 46.5%
(Lloyd-Richardson, Perrine, Dierker et al.,
2007) for community samples of adoles-
cents, 43.6% (Hasking, Momeni, Swannell
et al., 2008) for community samples of
adults (aged 18–30 years) and 38% in col-
lege students (Gratz, Conrad, & Roemer,
2002). Studies using a more stringent
approach, suggest the prevalence may be
between 10% and 20% (DeLeo & Heller,
2004; Ross & Heath, 2002). Correlated with
maladaptive

cognitions

(Muehlenkamp,

2006), peripheral serotonin levels (Crowell,
Beauchaine, McCauley et al., 2008), dis-
sociation (Armey & Crowther, 2008), bor-
derline personality type (Welch, Linehan,
Siylvers et al., 2008), deficits in problems
solving ability (Nock & Mendes, 2008),
child abuse (Glassman, Weierich, Hooley
et al., 2007), post-traumatic stress (Weierich
& Nock, 2008), and alcohol abuse (Hasking,
Momeni, Swannell et al., 2008; Williams &
Hasking, in press), NSSI is motivated by a
combination of interacting physiological,
interpersonal

and

intrapsychic

factors

(Crowell, Beauchaine, McCauley et al., 2008;
Heath, Toste, Nedecheva et al., 2008; Nock
& Mendes, 2008). Klonsky (2007) identified
affect regulation and self-punishment as the
most commonly reported functions of
NSSI, and Hilt, Cha, and Nolen-Hoeksema
(2008) recently reported affect regulation as
the primary function of NSSI among
adolescent women.

The Werther Effect

Extant research indicates that media

may play a role in the decision to engage
in NSSI, either by direct modeling or
in conjunction with pre-existing contribu-
ting factors such as suicidal ideation or

psychological distress. Nixon, Cloutier
and Jansson (2008) reported that 29% of
a community sample of adolescents (mean
age ¼ 15.2 years) had gained the idea to
engage in NSSI from friends, 15.1% from
television or movies, and 11.8% from read-
ing material. Hawton, Simkin, Deeks et al.
(1999) reported a 17% increase in cases
of overdose (including paracetamol and
non-paracetamol overdoses) after the airing
of a television program featuring scenes of
paracetamol overdose.

The phenomenon of copycat suicidal

behavior, commonly referred to as the
‘‘Werther effect,’’ indicates the influence
of media imagery on human behavior. Such
a phenomenon needs to be taken into
account

when

exploring

triggers

that

exacerbate the incidence and risk of NSSI.
Despite a dearth of literature on the influ-
ence of media portrayals of NSSI on
self-injurious behavior and attitudes to
self-injury, the ‘‘Werther effect’’ has been
substantiated by empirical research, parti-
cularly in cases involving celebrities (Stack,
2005) or where suicide method is explicitly
described (Martin, 1998). The ‘‘Werther
effect’’ is believed to be more likely
depending on how suicide is portrayed in
the media (Gould, Wallenstein, & Davidson,
1989; Motto, 1970; Phillips & Carstensen,
1988). There is an increased risk of
imitative suicide when non-fictional acts
of suicide are glorified (Martin, 1998), sen-
sationalized (Stack, 2003), portrayed repeat-
edly, or featured prominently in popular
media culture (Hawton, Rodham, & Evans,
2006; Martin & Koo, 1997; Pirkis & Blood,
2001). Accordingly, sensationalist media
coverage of suicidal behavior is now con-
sidered unethical, and is subject to litigation
(Martin, 1998; Pirkis & Blood, 2001; Stack,
2003). However, despite the likelihood that
media coverage of NSSI may similarly
impact on the attitudes and behavior of
viewers, specific guidelines for the appro-
priate reporting of NSSI are apparently
yet to be formulated.

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Similarly, social cognitive theory holds

that people can learn vicariously by model-
ing the behavior of others (Bandura, 1986).
In cases where individuals identify with a
model, the risk of imitating that model’s
behavior is increased. Thus, individuals
are more likely to identify with, and subse-
quently imitate, the behavior of realistic or
non-fictional representations of suicidal
behavior (Stack, 2003, 2005), and arguably
NSSI. A key component of social cognitive
theory is the expectation of a dose-
response effect (Pirkis & Blood, 2001).
That is, the likelihood of imitative NSSI
is theoretically proportionate to the num-
ber of models shown engaging in NSSI,
and how often their self-injurious behavior
is publicized. However, the risk of imitative
NSSI is also determined by the perceived
consequences of the model’s actions (Ban-
dura, 1977, 1986). Thus, media images that
depict NSSI as being rewarded or rein-
forced may increase the likelihood that
viewers who are vulnerable to self-injurious
behavior will engage in NSSI.

The Influence of Motion Pictures

The cinema is a definitive model of

contemporary media culture and, given
the global distribution and accessibility of
the medium of film, movies featuring
scenes of NSSI have the potential to
exert a wide-ranging and potent influence
(Wedding & Niemiec, 2003). To illustrate,
Zahl and Hawton (2004) investigated the
influence of audiovisual media (e.g., tele-
vision, the internet, motion pictures) on
deliberate self-harm (self-poisoning and self-
injury) among a clinical sample who had
recently engaged in deliberate self-harm,
and reported that scenes of self-harm fea-
tured in the films Girl Interrupted (Mangold,
2000) and The Virgin Suicides (Coppola,
1999) had directly incited episodes of actual
self-harm. Although not explicitly examin-
ing the effect of movies on NSSI, these
findings suggest that the manner in which

NSSI is represented in motion pictures has
the potential to influence how NSSI is
conceptualized, to affect how those who
engage in NSSI are perceived and treated,
and to expose who is most vulnerable to
identifying with and subsequently imitating
representations of NSSI.

As noted above, accurate portrayals of

NSSI may also have a positive therapeutic
utility. Originating in bibliotherapy and
designed to encourage clients to see their
problems from an alternative and more
objective perspective, cinematherapy utilizes
the narrative power of popular motion pic-
tures to facilitate or supplement therapeutic
processes; the logic being that people
sometimes understand themselves better
when they see themselves reflected in the
fictional lives of others (Hesley & Hesley,
2001; Sharp, Smith, & Amykay, 2002). If
a character is shown seeking professional
help for underlying psychiatric concerns
or NSSI, this can be effectively modeled
among those reluctant to seek help. In
those who have sought professional help,
the portrayal of problem resolution and
effective coping may also be modeled. To
date, however, no study has extensively
examined the representation of NSSI in
contemporary motion pictures.

The Current Study

The aims of the current study were: 1.

to explore how NSSI is represented in
modern cinema; 2. to determine if NSSI
is represented as being associated with its
empirically established correlates and func-
tions; and 3. to explore help-seeking among
characters who engage in NSSI.

METHOD

Design and Procedure

Forty-one movies (63.4% drama, 7.3%
action, 2.4% science fiction, 17.1% thriller,

C. Trewavas et al.

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91

7.3% biography, 2.4% comedy) featuring
scenes of NSSI were identified (see
Appendix A). To build a catalogue of rel-
evant movies, a list of potentially suitable
films was compiled by entering terms
such

as

‘‘self-mutilation,’’

‘‘self-harm,’’

‘‘self-injury,’’ ‘‘self-inflicted injury’’ and
‘‘parasuicide’’ into the IMDB (internet
movie database) and Google search engines,
the results of which were supplemented by
informal discussion with media and enter-
tainment

industry

professionals,

com-

munity members, and academic staff
involved in research on self-injury. In cases
where films known to depict self-injury
were not identified by these methods,
searches for each missing film were con-
ducted separately and the search terms
associated with them re-entered in order
to ensure all appropriate search terms were
used to identify all relevant films. In total,
128 candidate movies were identified, to
which exclusion criteria were subsequently
applied.

Movie genres considered too unrealis-

tic or featuring characters and situations
with which audience members would not
readily identify (i.e., horror, science fiction,
animation) were excluded from the cata-
logue. Exceptions were made, however, in
cases where films depicting fantastic, sur-
real or unrealistic plotlines nevertheless fea-
tured scenes of self-injury that were
realistic in isolation. Gladiator (Franzoni,
2000), for example, features a scene where
the lead character deliberately carves off his
own tattoo in order to disavow his associ-
ation with the Roman military; and The
Abyss

(Cameron, 1989) features a scene

where a naval officer suffering psychosis
deliberately cuts himself.

Consistent with the empirical definition

of NSSI, movies featuring scenes of cultu-
rally sanctioned or socially acceptable forms
of self-injury (e.g., body-piercing, tattooing,
binge-drinking, substance use, smoking)
were excluded from the catalogue. Likewise,
films made prior to 1975 were excluded

from the catalogue, as were non-English
language films, and any films made exclus-
ively for television.

One code sheet, containing 57 vari-

ables, was completed per film, and data
were coded as the film was being watched.
Data included in the coding sheet were
selected based on the functions (e.g.,
physiological

arousal,

emotional

self-

regulation, self-punishment), antecedents
(e.g., post-traumatic adaptation, perceived
threat of loss) and correlates (e.g., problem-
solving deficits, child maltreatment, psy-
chiatric history) of NSSI identified in the
literature. To ensure reliability of coding,
25% of films were dual coded by inde-
pendent raters. Inter-rater reliability was
sound for all variables (Kappa ¼ 0.79).

Character Demographics

. Demographic data

(gender, age, socioeconomic status, occu-
pation, marital status and sexual orien-
tation) were coded for each character
shown to engage in NSSI. Socio-economic
status was measured according to portrayed
living conditions and explicit references to
the character’s standard of living, material
resources and employment status. Age
was coded according to the age at which
characters first engaged in NSSI. However,
since the character’s exact age was often
not explicitly revealed, it was coded into
one of six categories: young adolescent
(13 to 14 years), middle adolescent (15 to
16 years), late adolescent (17 to 19 years),
young adult (20 to 30 years), middle adult
(30 to 45 years), and late adult (45 years
and above).

NSSI Behavior

. In cases where more than

one method of NSSI (e.g., cutting, burning,
etc.) was portrayed, the method most often
shown was recorded. In cases where the
method of NSSI could not be easily classi-
fied (e.g., chewing through body tissue), the
method was coded as ‘‘other.’’ In cases
where more than one character was
depicted engaging in NSSI, the character

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whose NSSI was most explicit or most
frequently depicted was selected. In cases
where NSSI was implied rather than
explicitly

shown,

method

was

coded

according to the information provided
(i.e., visible scarring or explicit reference
to a particular method of self-injury).
Additional data were coded according to
the context in which NSSI occurred (e.g.,
at home, at work, institutional setting,
religious setting). NSSI was considered sen-
sationalized in cases where self-injury was
depicted in a gratuitously graphic, glorified
or melodramatic manner.

Correlates

. As there were often multiple

correlates of NSSI contained in a single
motion picture, predominant themes were
separately coded as primary correlates.
Data related to portrayed psychiatric diag-
nosis were either inferred by implicit refer-
ence in the movie’s script=dialogue to
particular

psychiatric

symptoms

(e.g.,

depressive

symptoms,

dissociation)

or

determined by explicit reference to (or rep-
resentation of) a specific mental disorder
(e.g., BPD, schizophrenia). In cases where
no mental disorder was specified or appar-
ent, the entry was coded as ‘‘none.’’ In
cases where a mental disorder was apparent
but unspecified, the entry was coded as
‘‘unspecified mental disorder.’’

The portrayed relationships shared

between the character depicted engaging
in NSSI and other characters (e.g., family
members, friends, people in immediate
environment) were coded according to
the overall quality of the relationships,
and assessed by observing the reactions
of other characters to NSSI (i.e., supportive
or unsupportive). After coding, a proxy
measure of social support was created by
summating three variables measuring the
quality of the character’s portrayed family
(i.e., relationships with family members)
and social (e.g., relationships with friends,
relationships with people in immediate
environment) relationships on a scale

ranging from 1 ¼ very good, to 4 ¼ very
poor. Since it contained less than 10 items,
the reliability of the social support scale was
tested using mean inter-item correlation,
and found to have sound internal consist-
ency (Briggs & Cheek, 1986): mean
inter-item correlation ¼ .38.

Function of NSSI

. The functions of NSSI

were coded according to the portrayed
antecedents and consequences of NSSI,
and the explicit or implicit reasons provided
for acts of self-injurious behavior (e.g.,
self-punishment was coded in cases where
characters engaged in self-flagellation as a
part of a religious ritual to atone for
perceived sins).

Problem Resolution and Help-Seeking

. The

treatment status of the character was
recorded by noting whether the character
was an inpatient, outpatient, on medication
or in private therapy at the time of the
NSSI. In addition, the help-seeking beha-
vior of the character was recorded, as was
the form of help sought.

RESULTS

Demographic Characteristics

To determine how NSSI was represented,
preliminary

descriptive

analyses

were

designed to frame a demographic profile
of movie characters depicted as engaging
in NSSI. A total of 41 movie characters
were examined (male ¼ 24, female ¼ 17).
Data were analyzed using a series of chi-
square tests for independence. Assumption
testing was conducted to check for inde-
pendence of observations, sufficient sam-
ple size (n > 20), and minimum expected
cell frequency (n > 5 in 75% of cells). In
cases where small sample size resulted in
violations of the assumption of minimum
expected cell frequency (e.g., ethnicity, liv-
ing environment, sexual orientation), only

C. Trewavas et al.

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93

descriptive analyses are provided. Dichot-
omous measures of age, occupational sta-
tus, and relationships status were created
in order to permit additional chi-square
analyses.

There was a significant gender differ-

ence for age: v

2

(1, N ¼ 41) ¼ 8.33, p ¼ .00,

Cramer’s V ¼ .51, with 4.2% of males and
47.1% of females being depicted as adoles-
cents. There were no significant gender
differences,

however,

for

relationship

status (v

2

(1, N ¼ 41) ¼ .00, p > .05), socio-

economic

status

(v

2

(1,

N

¼ 41) ¼ .99,

p >

.05),

living

arrangements

(v

2

(1,

N

¼ 41) ¼ 3.2, p ¼ .07), or employment sta-

tus (v

2

(1, N ¼ 41) ¼ .87, p > .05). As shown

in Table 1, both genders were usually
portrayed as being heterosexual and of
Caucasian ethnicity, and a higher pro-
portion of females depicted engaging in

NSSI were portrayed as living in an urban
environment.

Both

genders

were

more

often

portrayed to use cutting or burning as their
primary methods of NSSI (see Table 2).
Although the percentage of characters
depicted as using cutting as a method of
NSSI did not differ according to gender
(v

2

(1, N ¼ 41) ¼ 3.20, p ¼ .07), male char-

acters were depicted engaging in more
NSSI methods than females. The majority
of characters were covert in their practice
of NSSI, and no gender differences were
observed in whether the NSSI was public
or private (v

2

(1, N ¼ 41) ¼ .02, p > .05).

Characters were generally shown to self-
injure to the extent that first aid treatment
or medical attention was required, and to
engage in repeated rather than isolated
incidents of NSSI. NSSI was typically

TABLE 1.

Demographic Characteristics of Characters Depicted in Movies Engaging in NSSI

Variable

% Males (n ¼ 24)

% Females (n ¼ 17)

Ethnicity (% Caucasian)

91.7 (n ¼ 22)

88.2 (n ¼ 15)

Age

Young adolescent

0.0

23.5 (n ¼ 4)

Middle adolescent

0.0

11.8 (n ¼ 2)

Late adolescent

4.2 (n ¼ 1)

11.8 (n ¼ 2)

Young adult

45.8 (n ¼ 11)

35.3 (n ¼ 6)

Middle adult

33.3 (n ¼ 8)

17.6 (n ¼ 3)

Late adult

16.7 (n ¼ 4)

0.0

Socioeconomic status (% High)

50.0 (n ¼ 12)

70.6 (n ¼ 12)

Occupational status

Unemployed

25.0 (n ¼ 6)

11.8 (n ¼ 2)

Student

4.2 (n ¼ 1)

41.2 (n ¼ 7)

Employed

70.8 (n ¼ 17)

47.0 (n ¼ 8)

Martial status

Single

50.0 (n ¼ 12)

52.9 (n ¼ 9)

Boy=girlfriend

29.2 (n ¼ 7)

35.3 (n ¼ 6)

Married

8.3 (n ¼ 2)

5.9 (n ¼ 1)

Sexual orientation (% Heterosexual)

87.5 (n ¼ 21)

88.2 (n ¼ 15)

Environment=setting (% Urban)

83.3 (n ¼ 20)

100.0 (n ¼ 17)

Living arrangements (% lives with other)

50.0 (n ¼ 12)

82.4 (n ¼ 14)

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VOLUME 14 NUMBER 1 2010

sensationalized (63.4%, n ¼ 26), in that
depictions were considered gratuitously
graphic, glorified or melodramatic.

Correlates of NSSI

Chi-square analyses were conducted

to investigate which correlates of NSSI
were evenly distributed across age, gender
and socioeconomic status (SES). Several
dichotomous variables were created to
allow for analyses of portrayed NSSI corre-
lates: psychiatric status (mentally ill or not
mentally ill

), maltreatment as a child (mal-

treated

or not maltreated), substance abuse

(abuse or no abuse) socioeconomic status
(SES; high or low); method (cutting or other);
and functions: affect regulation (affect regu-
lation

or

other

),

self-punishment

(self-

punishment

or other). No violations of

chi-square assumptions were noted when
data were categorized in this way.

NSSI was associated with child mal-

treatment (41.5%, n ¼ 17), substance abuse
(68.3%, n ¼ 29), and mental illness (65.9%,
n

¼ 27). Although no significant gender

(v

2

(1, N ¼ 41) ¼ 2.49, p > .05) or SES

(v

2

(1, N ¼ 41) ¼ 2.48, p > .05) differences

were observed among characters who had
a history of child maltreatment, there was
a significant difference for age, v

2

(1,

N

¼ 41) ¼ 4.49, p ¼ .03), Cramer’s V ¼ .39,

with 77.8% (n ¼ 7) of adolescents and
31.2% (n ¼ 10) of adults being portrayed
as having experienced child abuse. No
significant gender (v

2

(1, N ¼ 41) ¼ .54,

p >

.05), SES (v

2

(1, N ¼ 41) ¼ .01, p >

.05), or age (v

2

(1, N ¼ 41) ¼ .00, p > .05)

differences were observed among those
portrayed as having substance abuse issues.
Likewise, the percentage of characters
depicted as being mentally ill did not signifi-
cantly differ according to their gender, v

2

(1,

N

¼ 41) ¼ 0.00, p > .05, or portrayed age,

v

2

(1, N ¼ 41) ¼ 1.28, p ¼ .26. However,

significant differences were observed for
the relationship between portrayed psychi-
atric status and SES: v

2

(1, N ¼ 41) ¼ 7.87,

p

¼ .01, Cramer’s V ¼ .44, with 41.18%

(n ¼ 7) of characters of low SES and
83.33% (n ¼ 20) of characters of high SES
portrayed as having a mental illness.

The frequencies of specific psychiatric

diagnoses associated with NSSI according
to character gender and are presented in
Table 3. Overall, both genders were more
often portrayed as having some form of
mental disorder than none at all. However,
although both genders were portrayed as
having similar rates of psychosis, comorbid-
ity, mood and substance use disorders, no
female characters were portrayed as being
affected by post traumatic stress disorder,
anxiety disorder, or antisocial personality
disorder; and no male characters were
portrayed as being affected by an eating
disorder. Additionally, neither male nor
female characters were portrayed as having
borderline personality disorder. Although
portrayals of NSSI were more often

TABLE 2.

NSSI as Depicted in Motion Pictures

Variable

% Males

(n ¼ 24)

% Females

(n ¼ 17)

Type of NSSI

Cutting

45.8 (n ¼ 11)

76.5 (n ¼ 13)

Burning

25.0 (n ¼ 6)

11.8 (n ¼ 2)

Self-flagellation

8.3 (n ¼ 2)

0.0

Extreme risk-taking

8.3 (n ¼ 2)

0.0

Skin picking

4.2 (n ¼ 1)

0.0

Self-mutilation

4.2 (n ¼ 1)

5.9 (n ¼ 1)

Self-hitting

4.2 (n ¼ 1)

5.9 (n ¼ 1)

Severity of NSSI

Superficial

4.2 (n ¼ 1)

5.9 (n ¼ 1)

Home first aid

50.0 (n ¼ 12)

52.9 (n ¼ 9)

Medical attention

41.7 (n ¼ 10)

29.4 (n ¼ 5)

Life-threatening

4.2 (n ¼ 1)

11.8 (n ¼ 2)

Frequency of NSSI

Isolated incident

50.0 (n ¼ 12)

23.5 (n ¼ 4)

Repeated NSSI

50.0 (n ¼ 12)

76.5 (n ¼ 13)

Concealment of NSSI

Overt=public

33.3 (n ¼ 8)

35.3 (n ¼ 6)

Cover=private

66.7 (n ¼ 16)

64.7 (n ¼ 11)

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ARCHIVES OF SUICIDE RESEARCH

95

associated with suicidal ideation, characters
depicted as engaging in NSSI were not
usually shown to commit (19.5%, n ¼ 8)
or

attempt

(29.3%,

n

¼ 12)

suicide.

Although characters depicted as engaging
in NSSI were more often main characters
(68.3%),

more

supporting

characters

(46.2%) than main characters (7.1%) were
portrayed

committing

suicide

v

2

(1,

N

¼ 41) ¼ 6.29, p ¼ .01, with a moderate

association

between

these

variables:

Cramer’s V ¼ .46.

The social support scale (range ¼ 3

to 12; M ¼ 7.14, SD ¼ 1.84) was analyzed
for differences in relevant demographic
variables and correlates. However, no
significant differences were found in scores

on the social support scale for portrayed
gender, age, ethnicity, socio-economic sta-
tus, psychiatric status, suicidal ideation, or
privacy of NSSI (all p > .05).

Function of NSSI

The primary motives of NSSI were

portrayed

as

affect

regulation

and

self-punishment (see Table 3). There were
no gender (v

2

(1, N ¼ 41) ¼ 1.0, p > .05),

age (v

2

(1, N ¼ 41) ¼ .89, p > .05), or SES

(v

2

(1, N ¼ 41) ¼ 3.0, p > .05) differences

observed for self-punishment. Likewise,
the proportion of characters depicted as
engaging in NSSI for the purpose of

TABLE 3.

Correlates and Functions of NSSI

Variable

% Males (n ¼ 24)

% Females (n ¼ 17)

Correlates

Child maltreatment

29.2 (n ¼ 7)

58.8 (n ¼ 10)

Substance abuse

62.5 (n ¼ 15)

76.5 (n ¼ 13)

Mental illness

62.5 (n ¼ 15)

64.7 (n ¼ 11)

Anxiety disorder

4.2 (n ¼ 1)

0.0

Mood disorder

4.2 (n ¼ 1)

5.9 (n ¼ 1)

Psychosis

8.3 (n ¼ 2)

5.9 (n ¼ 1)

Anti-social personality

4.2 (n ¼ 1)

0.0

Dissociation

4.2 (n ¼ 1)

11.8 (n ¼ 2)

Eating disorder

0.0

5.9 (n ¼ 1)

Substance dependence

8.3 (n ¼ 2)

5.9 (n ¼ 1)

PTSD

4.2 (n ¼ 1)

0.0

Co-morbid conditions

8.3 (n ¼ 2)

11.8 (n ¼ 2)

Unspecified

16.7 (n ¼ 4)

17.6 (n ¼ 3)

Functions

Affect regulation

12.5 (n ¼ 3)

41.2 (n ¼ 7)

Self-punishment

33.3 (n ¼ 8)

17.6 (n ¼ 3)

Attention

8.3 (n ¼ 2)

11.8 (n ¼ 2)

Rite of passage

8.3 (n ¼ 2)

0.0

Social acceptance

4.2 (n ¼ 1)

0.0

Social communication

16.7 (n ¼ 4)

17.6 (n ¼ 3)

Manipulation of others

12.5 (n ¼ 3)

5.9 (n ¼ 1)

Escape unreality

0.0

5.9 (n ¼ 1)

Other

4.2 (n ¼ 1)

0.0

NSSI in Motion Pictures

96

VOLUME 14 NUMBER 1 2010

affect regulation did not differ according to
age (v

2

(1, N ¼ 41) ¼ .76, p > .05) or SES

(v

2

(1, N ¼ 41) ¼ .76, p > .05). However,

NSSI was more often portrayed as a mode
of affect regulation for females than
for males, v

2

(1, N ¼ 41) ¼ 6.10, p ¼ .01,

Cramer’s V ¼ .44.

Help-Seeking

The majority of characters were not in

any form of psychiatric treatment at the
time of NSSI (63.4%, n ¼ 26), however
many voluntarily sought support after the
NSSI

episode

(26.8%,

n ¼ 11).

An

additional 17.1% (n ¼ 7) were provided
help involuntarily, while no form of sup-
port was obtained by 31.7% (n ¼ 13) of
characters. Professional help was most
often obtained from psychiatrists (22.0%,
n ¼ 9), while friends or family were also
common sources of support (21.9%,
n ¼ 8). Family reactions to the character’s
NSSI were often not portrayed, although
31.7% (n ¼ 13) reacted in a positive and
supportive manner. The reaction of friends
was more often depicted. 46.3% (n ¼ 19)
were shown to be positive and supportive
of the character, while 19.5% (n ¼ 8) were
shown to be indifferent or unsupportive
of the character.

DISCUSSION

This study aimed to examine how NSSI is
depicted in motion pictures with a view
to determining whether the representations
are accurate in terms of the nature, corre-
lates and functions of NSSI. In addition,
problem resolution was explored by exam-
ining

help-seeking

among

characters.

Results indicated that NSSI was generally
sensationalized, featured prominently, and
depicted as covert, severe, and habitual.
Yet, overall, depictions of NSSI in motion
pictures were relatively consistent with

current literature on actual NSSI, although
important differences were also apparent.

Accuracy in Portrayal of NSSI

Movie characters depicted as engaging

in NSSI were typically male, Caucasian,
single, heterosexual, working adults of rela-
tively high socioeconomic status. Represen-
tations of women engaging in NSSI
conformed to a narrower pattern than for
that of men (i.e., women were depicted as
engaging in fewer methods of self-injury
and in association with fewer correlates).
This representation of NSSI in motion pic-
tures is partially consistent with research
findings on actual NSSI. Although some
research suggests that NSSI is more com-
mon in females (e.g., DeLeo & Heller,
2004), other reports suggest the gender dif-
ference may be relatively small, especially
when a range of NSSI behaviors (e.g.,
burning, hitting oneself) are assessed (e.g.,
Gratz, Conrad & Roemer, 2002; Hasking,
Momeni, Swannell et al., 2008). Further,
the fact that more films portrayed men
engaging in NSSI is not necessarily a reflec-
tion on the gender balance in the com-
munity, but rather an imbalance in what
the movie makers wish to portray. The
same is true of the over-representation of
people with high socio-economic status
classified as mentally ill or as engaging in
NSSI. Although recent reports suggest a
high incidence of NSSI among people of
high socio-economic status (Yates, Tracey,
&

Luthar,

2008),

usually

an

inverse

relationship is reported (e.g., Gratz, Con-
rad, & Roemer, 2006; Lipschitz, Winegar,
Nicolaou et al., 1999; Nada-raja, Skegg,
Langley et al., 2004; Whitlock, Eckenrode,
& Silverman, 2006).

As reflected in the findings on actual

NSSI

reported

by

Hilt,

Cha

and

Nolen-Hoeksema (2008), women were
portrayed as engaging in NSSI in order to
regulate their emotions. Consistent with

C. Trewavas et al.

ARCHIVES OF SUICIDE RESEARCH

97

some research findings (Klonsky, 2007;
Nixon, Cloutier & Jansson, 2008), cutting
was

the

most

frequently

represented

method of NSSI. However, burning was
more often represented in motion pictures
than is evidently reported in the literature,
while other types of NSSI commonly
reported,

such

as

severe

scratching

(Hasking, Momeni, Swannell et al., 2008;
Yates, 2004) were least often represented.

It is not clear why the portrayal of

women was narrower than that of men,
however demographic representations of
NSSI are dependent on the plot and charac-
ters revealed on screen. Although there was
no significant relationship between genre of
movie and gender of the character, story
lines involving women who engage in NSSI
tend to center on issues of psychological
distress and trauma (e.g., Girl Interrupted).
In such films, the stereotype of young
women who cut themselves for affect regu-
lation is readily apparent. Conversely, films
depicting men who engage in NSSI were
more likely to portray a broader range of
plot lines and thus a more diverse depiction
of NSSI. Although speculative, this might
explain the narrower range of NSSI
depicted for female characters.

Representations of NSSI were associa-

ted with correlates of NSSI identified
throughout the literature: affect regulation
(Hilt, Cha & Nolen-Hoeksema, 2008;
Nock, Holmberg, Photos et al., 2007),
mental illness (Welch, Linehan, Sylvers
et al., 2008), substance abuse (Nock,
Holmberg, Photos et al., 2007), and child
maltreatment (Glassman, Weierich, Hooley
et

al.,

2007;

Gratz,

2006;

Lipschitz,

Winegar, Nocolaou et al., 1999; Weierich
& Nock, 2008). Interestingly, however,
despite their frequent association in the
literature

(Dellinger-Ness

&

Handler,

2006; Welch, Linehan, Sylvers et al., 2008;
Yates, 2004), NSSI was not correlated with
borderline personality disorder. However,
this may reflect that pop culture does not
engage deeply in psychiatric language,

rather than indicating a lack of diagnosis.
Consistent with the findings of Hasking,
Momeni, Swsannell et al. (2008), Nock
and Mendes (2008), and Yates (2004),
NSSI was depicted as helpful in reducing
negative affective states.

As few as 30% of young people who

self-harm seek professional psychiatric help
(DeLeo & Heller, 2004). Since professional
help-seeking is more likely among those
who self-poison than those who engage
in other forms of self-injury (Hawton,
Rodham, Evans et al., 2009), it is likely that
even fewer who engage in NSSI seek pro-
fessional help. Similarly, movie characters
were rarely in psychiatric care at the time
of self-injury. However in contrast to what
we know about help-seeking in the com-
munity, many of the movie characters
received support after NSSI. Approxi-
mately one quarter of the sample obtained
professional psychiatric care, however fam-
ily and friends were also approached for
support. These findings suggest that movie
depictions of NSSI may be useful in a
therapeutic context. Modeling of help-
seeking behavior may assist in effective
problem-resolution for young people in
the community or in clinical settings. How-
ever the reliance on family and friends also
mirrors reports that young people prefer to
seek informal support from friends (Evans,
Hawton & Rodham, 2005). Arguably,
accurate movie portrayals of NSSI may be
useful in education and training of the
wider community, who are more likely to
encounter someone who engages in NSSI.

It is unclear why the portrayals of

NSSI were relatively accurate when por-
trayals of suicide and suicidal behavior tend
to be inaccurate (Pirkis & Blood, 2001).
One possible explanation is that portrayals
of NSSI in motion pictures appear to be a
relatively recent phenomena, with the
majority of movies reviewed in this study
(43.9%) released after 2000. In recent dec-
ades efforts have been made to increase the
accuracy and sensitivity with which suicide

NSSI in Motion Pictures

98

VOLUME 14 NUMBER 1 2010

is reported in media. These efforts may
have generalized to portrayal of NSSI.

However, although the depiction of

NSSI generally matched the existing litera-
ture on correlates of NSSI, the portrayals in
motion pictures were more likely to be
linked to suicide attempts and completed
suicide than is the case in the literature.
NSSI in the movies was less likely to be
related to suicide than other psychological
correlates, but with 19.5% of movie charac-
ters

committing

suicide

and

29.3%

attempting suicide an association between
NSSI and suicide is made clear in the
motion pictures. Few prospective studies
have examined suicide among those who
have self-injured. Those that have suggest
between 5–7% of people who self-injure
will suicide within 9–10 years of the NSSI
(DeMoore & Robertson, 1996; Owens,
Horrocks & House, 2002), a figure much
lower than portrayed in the motion
pictures. This link portrayed in motion pic-
tures may influence opinions of the viewing
public and foster the myth that NSSI is
always a suicidal act. De-bunking such
myths is important in providing effective
and timely care to those who self-injure
and in fostering self-confidence among
those who work in schools and emergency
departments, who often report fear and
uncertainty when faced with a person
who engages in NSSI (Huband & Tantam,
2000; McAllister, Creedy, Moyle et al.,
2002). More accurate portrayal of the
relationship between NSSI and suicide in
motion pictures may be one way to better
educate the viewing public about this
relationship.

Implications

The accuracy of movie representations

of NSSI may be helpful in challenging
stigma, however, the more accurately NSSI
is portrayed, the greater its potential impact
on actual self-injurious behavior. Since

viewers are more likely to internalize and
subsequently imitate realistic or non-
fictional

media

imagery

(Stack,

2003,

2005), accurate portrayals of NSSI, in the
absence of positive problem resolution,
may

increase

the

risk

of

imitative

self-injurious behavior. Adding to the
increased risk of imitative self-injurious
behavior, NSSI was typically sensationa-
lized, featured prominently, depicted as
severe, and repeatedly portrayed as a ritual
coping mechanism. This is concerning
because imitative acts of NSSI are more
likely depending on how prominently acts
of self-injury are featured, particularly in
cases

where

NSSI

is

sensationalized.

Additionally, a dose-response effect for
imitative NSSI is more likely when acts of
self-injury are shown more often and, since
the risk of suicide contagion is increased in
cases where suicide method is explicitly
described (Martin, 1998), the explicit por-
trayal of severe NSSI may likewise increase
the risk of imitative acts of NSSI. More-
over, motion pictures feature celebrities
engaging in fictional acts of NSSI, arguably
a variation of a risk factor for the ‘‘Werther
effect’’ reported by Stack (2003, 2005).
These findings underscore the need for
the sensitive and responsible portrayal of
self-injurious behavior in motion pictures.
The often sensationalized portrayal of
severe NSSI in films, and the frequently
depicted strong association of NSSI with
mental illness and suicide, may stigmatize
people who engage in self-injury, reducing
the likelihood that they actively seek or
willingly engage assistance (Wedding &
Niemiec, 2003).

The current study has important impli-

cations for the treatment of NSSI. As an
auxiliary therapeutic medium, motion pic-
tures have the potential to deliver a sense
of connection with the stories of others,
to foster empathy and self-awareness, to
encourage novel perspectives, to facilitate
therapeutic discussion, and to reduce the
subjective perception of social isolation

C. Trewavas et al.

ARCHIVES OF SUICIDE RESEARCH

99

(Hesley & Hesley, 2001; Schulenberg,
2003). Films that feature NSSI could be
even more powerful if they included a dis-
course of hope and recovery. The films
accurately portrayed that the majority of
people who engage in NSSI do not seek
professional help, and that family and
friends are often the only source of support
(Evans, Hawton & Rodham, 2005). Such
films may also help to reduce stigma asso-
ciated with NSSI, remove the guilt that is
often associated with repeated NSSI, and
could improve clinicians’ willingness and
ability to care for those who self-injure.

Limitations and Suggestions

for Future Research

The current study was limited by some

methodological weaknesses. First, cultural
bias reduces the generalizability of these
findings. The catalogue of selected movies
was limited to English language films made
after 1975, most of which were produced
in the United States—perhaps indicating a
relatively recent recognition of NSSI in
mainstream American. A larger sample
taken from a more linguistically and cultu-
rally heterogeneous range of films may
have revealed cultural differences in por-
trayals of NSSI, and yielded results more
representative of global trends in portrayals
of NSSI. Furthermore, since people are
often exposed to multiple forms of media,
the inclusion of a broader range of media
(internet, television, print, radio) would also
enable a comparison of NSSI depictions
across different media types.

It is also worth noting that motion

pictures cannot convey all relevant infor-
mation about a character. Specifically, fail-
ure to disclose diagnoses or treatment
history does not necessarily suggest that the
character was not imagined by the writers to
have a psychiatric or treatment history.
Consequently in viewing and reviewing
films it is important to acknowledge that

the data available for analysis are selected
by the writers and film makers. It would
be interesting in future to interview film
makers to ascertain their views on NSSI
and how it is portrayed in popular media,
as well as steps they make take in consider-
ing how to portray such behavior accurately
and sensitively.

Further studies into representations of

NSSI are needed in order to explore their
impact on viewers, and to investigate their
potential to reduce stigma. Although we
found that many of these films accurately
depict NSSI and that this may induce con-
tagion, there is as yet no evidence for this.
Indeed, it may be that plot devices within
the films actually reduce stigma and
enhance coping capacity. A study in which
participants view such films and record
their attitudes and beliefs before and after
viewing would be valuable. In addition,
examination of the use of cinematherapy
in treating people who engage in NSSI
would be a valuable step in improving the
care given to people who self-injure.

In summary, it appears that depictions

of NSSI in motion pictures are generally
accurate with respect to the correlates and
functions of NSSI often reported in the
literature. However links to suicide, and
the sensationalist presentation of NSSI
may have an adverse effect on some audi-
ence members. Accurate representation of
NSSI in motion pictures may increase the
likelihood of identification and imitation
of such acts, but may also offer a useful
mechanism for reducing stigma and model-
ing help-seeking behaviors.

AUTHOR NOTE

Special thanks are extended to Professor
Steven Stack, whose insightful suggestions
were helpful in determining coding para-
meters, and whose considerable experience
in the area of suicide research proved a
highly relevant and practical resource.

NSSI in Motion Pictures

100

VOLUME 14 NUMBER 1 2010

Christopher Trewavas and Penelope

Hasking, School of Psychology, Psychiatry
and Psychological Medicine, Monash Uni-
versity, Victoria, Australia.

Margaret McAllister, School of Health

and Sport Sciences, Faculty of Science,
Health and Education, University of the
Sunshine Coast, Maroochydore, Queens-
land, Australia.

Correspondence concerning this article

should be addressed to Penelope Hasking,
School of Psychology, Psychiatry and
Psychological Medicine, Monash Univer-
sity, Caulfield East VIC, 3145, Australia.
E-mail:

[e-mail]-

sh.edu.au

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APPENDIX. LIST OF MOVIES ANALYZED

True Blue, Gothika, Gun Shy, The Abyss, My
First Mister, 28 Days, The Scarlet Letter, Fear,
The Good Girl, American Beauty, The Virgin
Suicides, Girl Interrupted, Stay, The Return, Stig-
mata, A Beautiful Mind, Control, Cape Fear, 21
Grams, Fatal Attraction, Blue Car, Fight Club,
Sid & Nancy, Gangs of New York, Good Will
Hunting, The Professional, Gladiator, Seven,
Heathers, Thirteen, Romper Stomper, Chopper,
Million Dollar Baby, Taxi Driver, Platoon, Sec-
retary, Prozac Nation, The Da Vinci Code,
Sex: The Annabel Chong Story, Man on Fire,
The Name of the Rose.

C. Trewavas et al.

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