THE CHALLENGES OF SEX AS SELF-INJURY IN THE DUTCH HEALTHCARE SYSTEM & CREATING IMPACT WITH DOCUMENTARY
2023/2024
Understanding Sex as Self-Injury (SASI)
In 2008, Swedish journalist Caroline Engvall published a book about a girl who used risky sexual behavior to cope with trauma. This sparked a national discussion in Sweden about sex as self-injury (SASI) and created space for others to share similar experiences. Their stories are urgent: many people affected by SASI face repeated sexual victimization, misunderstanding, and stigma - even within healthcare. While Sweden has made progress in acknowledging and addressing the issue, it remains largely unspoken elsewhere.
I collaborated with professionals and experts from the Netherlands, Belgium, and Sweden to explore how SASI is (or isn’t) recognized within the Dutch healthcare system. While more research and dialogue are needed, one thing is clear: individuals who experience what Sweden calls ‘sex as self-injury’ are often overlooked, dismissed, or stigmatized. This project highlights the gaps in our system and aims to build a stronger support network for those affected, using documentary film as a catalyst for change.
On the Terminology
More research is needed to fully understand and define sex as self-injury and to assess whether the label itself is helpful. The term is complex: it exists in a gray area between self-harm and sexual abuse, and it could reinforce victim-blaming. Within this project, the term is used with caution. It provides a framework for exploring the issue from a perspective that is often unheard. It challenges us to ask different questions and offers new language to articulate these experiences.
What is Sex as Self-Injury?
Long before Engvall’s book, research had already shown that people who have experienced sexual abuse are at greater risk of further victimization, unintended pregnancies, and engaging in sex work. Some studies suggested a link between sexual risk-taking and self-injury, yet the topic remained underexplored. Fortunately, in Sweden, a growing body of research has emerged.
SASI refers to risky sexual behavior that a person deliberately engages in to inflict physical and/or emotional harm on themselves. This can include:
- Seeking out sexual situations where violence is expected
- Engaging in sex without desire
- Re-experiencing past abuse through sexual encounters
- Giving away control over one’s body in ways that feel harmful
- Engaging in sex without desire
- Re-experiencing past abuse through sexual encounters
- Giving away control over one’s body in ways that feel harmful
While SASI typically involves other people, it can also manifest in solitary behaviors, such as masturbation leading to injury or engaging in unsafe online sexual activity.
The primary motivation behind SASI is emotional regulation. Like other forms of self-injury, it can temporarily numb feelings of self-hatred, emptiness, or the need for self-punishment. However, these effects are short-lived, often leading to a cycle of escalating risk-taking—where increasingly violent situations are sought in an attempt to suppress growing distress.
Barriers in Healthcare
People struggling with SASI often face significant obstacles when seeking help. Many find it difficult to put their experiences into words due to the lack of societal understanding, available support, and accessible information. Cultural norms surrounding sex, shame, and victimhood further contribute to stigma, making it even harder to reach out.
Even when individuals do seek help, they often encounter a healthcare system that is unprepared to address their needs. As a result, they may be misdiagnosed, undertreated, or dismissed altogether. This can deepen their isolation, shame, and vulnerability to (further) sexual violence.
Creating Impact Through Documentary
SASI remains surrounded by stigma, silence, and misunderstanding. Through documentary film, I wanted to create a space where those affected are seen through a more compassionate and human lens.
This documentary is designed for professionals and is used in training and dialogue settings. By offering insight into the socio-psychological core of SASI, it encourages professionals to safely engage with the protagonist’s reality. The film calls for a shift in perspective, a reconsideration of the questions we ask ourselves and others, and a deeper reflection on our attitude towards the behavior.
The documentary is currently being used in training sessions for healthcare professionals. If you are a trainer or professional interested in using the film for education or dialogue, please contact me for access.
Expositions and screenings
2024
March: Screening & after talk, Schouwburg Tilburg (T*Agency)
October: Dutch Design Week