Self-harm, also called self-injury, is the practice of intentionally hurting yourself. Individuals can injure themselves in various ways, including cutting, burning, hitting, piercing and pulling out hair. It’s not uncommon, especially for teens and young adults.
A large study by the University of Portland of more than 64,000 U.S. high school students found that almost 18% had injured themselves intentionally in the previous year. Girls were twice as likely to self-harm, and in some states, the rate of self-injury among teenage girls was more than 30%.
People self-harm for a variety of reasons, including the following:
It may distract them from overwhelming emotional pain.
When anxiety, depression or another unpleasant state feels like too much to handle, people may choose to take the focus off of what’s going on in their mind and put it on their body instead.
Sometimes it stimulates the body’s pain-killing hormones, which can improve mood.
The body produces chemicals called endorphins which help people deal with injuries. They can also cause people to feel happier, calmer or even euphoric. People can harm themselves for the same reasons they would use drugs or alcohol, but the chemicals are coming from inside their body.
It can relieve a sense of emotional and physical numbness.
This desire to numb may be especially common for people who’ve experienced traumatic events because trauma can cause dissociation, where people feel cut off from their physical selves. The earlier the trauma, the more likely people are to feel this lack of integration.
An article in the European Journal of Psychotraumatology on women’s body experiences with early childhood trauma notes that many people who’ve been traumatized young lack a sense of body ownership because the concept of “this is my body” wasn’t allowed to develop properly.
Self-harm can help people feel that they have some control over their lives.
When people find themselves in situations that feel chaotic, they may try to gain a sense of order and agency by finding something they can determine for themselves, such as engaging in self-injuring behavior. It can even be a way to preempt pain that they think someone else may cause them.
People may choose to self-harm to punish themselves for things they feel guilty about.
If people feel guilt or shame they don’t know how to manage, they may consciously or unconsciously choose to bring balance by injuring themselves.
Sometimes it can be a way to communicate a need for help.
Usually, people who engage in self-harming behaviors try to keep it a secret. Still, sometimes people who feel like they don’t have any other good way to communicate the emotional pain they’re feeling will hurt themselves as a way of physically signaling what’s going on inside.
Different people may harm themselves for different reasons, and the reasons may change even for a single person on different occasions.
The Trajectory of Self-Harm
Self-harming behavior typically begins in adolescence or even in childhood. An article in the journal Pediatrics found that 8% of third graders, 4% of sixth graders and 13% of ninth graders had engaged in a self-harming activity. By the ninth grade, gender differences were apparent, with girls engaging in self-harm three times the rate of boys at that age. The type of activity preferred also differed by gender, with girls preferring cutting and boys preferring hitting.
Sometimes people who self-harm as children or adolescents learn healthier coping techniques as they mature and don’t continue to self-injure as adults. Sometimes, however, the behavior continues. For some people, self-harming behavior becomes more like an addiction than a habit because of the endorphins that are released. Much like people develop tolerance to drugs and alcohol and begin to need more and more to achieve former results, the body can also develop a tolerance to its own chemical messengers.
For people who self-harm as a means of punishing themselves for perceived wrongs, the behavior can also have a cyclical nature. A sense of guilt or shame can lead to self-harm, which can promote more feelings of shame and more self-injury.
People who self-harm may hurt themselves more severely than they had planned. It is especially likely if people are under the influence of drugs or alcohol. The British Psychological Society notes that people who self-harm are also at significantly higher risk of later dying by suicide. Addressing the issues that are causing people to feel a need to self-harm is vital.
Self-Harm and Mental Health Disorders
Sometimes self-harming behavior accompanies a mental health disorder and may be an attempt to manage some of the associated symptoms.
Borderline personality disorder (BPD)
People with BPD experience strong emotions which intensify quickly and are slow to return to their baseline level. Self-harm may be used to regulate these intense emotional states. A study in the Journal of Personality Disorders comparing the reactions of people with and without BPD to a cut found that it increased tension in the people without BPD but decreased tension and heart rate in the people with borderline personality disorder.
A study published in the British Journal of Psychiatry found that people who engaged in self-harming behaviors had high rates of mental health disorders, with depression being the most common diagnosis, found in 71% of the individuals.
A challenge for people researching self-harm, especially within the population of people with depression, is separating non-suicidal self-harm from episodes that are suicide attempts. Experts note that it’s important to address each episode of self-injury separately and not assume that each episode has the same motivation.
People with anxiety disorders, as with other mood disorders, may use self-harm as a way to manage challenging emotions. The previously mentioned study in the British Journal of Psychiatry found that the types of anxiety most associated with self-harm are social phobia and agoraphobia.
Anxiety sensitivity, which may or may not accompany an anxiety disorder, is also associated with self-harm. Harvard Health has defined anxiety sensitivity as a tendency to interpret physical signs of anxiety as indications of or precursors to illness, danger, social rejection or loss of control.
The journal Psychological Trauma published a study of youth in a mental health treatment center who had experienced potentially traumatic events. The authors found that the presence of anxiety sensitivity along with post-traumatic stress disorder (PTSD) symptoms predicted self-harm more than PTSD symptoms alone.
Many people who self-harm have a history of trauma and a diagnosis of . An article in the journal Trauma, Violence and Abuse notes that child maltreatment, particularly sexual abuse, is strongly associated with self-harm. People with PTSD often experience dissociation or flashbacks, and self-harming behaviors may be an attempt to ground themselves and put their focus on the present moment.
The journal Neuropsychiatric Disease and Treatment published a study of girls hospitalized for eating disorders which found that almost half (49%) engaged in self-harming behaviors. The study authors note that in addition to the common types of self-harm (cutting, burning, etc.), people with eating disorders may be more likely to engage in less typical self-harming behaviors, such as extreme physical activity, use of tight waistbands or swallowing objects.
Experts note that what they call “poor body regard” may be an underlying factor in both eating disorders and self-harming behaviors. The American Psychological Association notes that people with poor emotional regulation and poor body regard are more likely to engage in self-harm than people with poor emotional regulation but normal body regard.
Treatment for Self-Harm
The best treatment for self-harm is individualized and addresses everything contributing to the behavior. Psychiatric Times notes that related factors that may need to be addressed are depression, low self-esteem, feelings of hopelessness and impulsivity. It’s also helpful to identify and address as many negative external influences as possible, such as bullying and family conflict.
Treatment for self-harming behavior may involve both psychotherapy and medications for an underlying condition like depression or anxiety. Goals for therapy are likely to include learning to identify triggering thoughts and feelings, regulate emotions, improve relationships that may be causing stress, solve problems in a healthy way and strengthen self-image. Many approaches can be used.
Cognitive-behavioral therapy (CBT) has a solid evidence base and is a cornerstone of much mental health treatment. A primary component of CBT is learning to monitor your thoughts and feelings and catch and address the ones causing problematic behavior.
A specific type of CBT known as dialectical behavior therapy (DBT) has also been proven helpful in treating a wide range of mental health conditions. DBT teaches people skills in areas like distress tolerance, emotional regulation and relationship building.
Traumatic experiences are at the root of many mental health disorders, and trauma can be addressed with Eye Movement Desensitization and Reprocessing (EMDR). In small and measured intervals, people focus on memories while also focusing on sensory input. This treatment can involve following movements with your eyes, tapping your hand or listening to an audio input. The idea is to access the brain network which stores the trauma, process the information more completely and make new associations.
Sometimes people respond to expressive therapies, in which they express themselves through art, music, dance, drama, poetry or another creative outlet. It can help people access and process emotions and memories that aren’t easily recognized or expressed otherwise. Here, the process is the key, not the final result. Expressive therapies are often used in combination with other psychotherapy approaches.
Hope for Self-Harm
People who have never had the urge to self-harm often find it hard to understand in others. If you have a friend or family member who self-harms, they may be afraid to talk to you about it because of fear that they’ll be judged or criticized.
Do your best to listen with an open mind and heart and realize that the behavior comes from real emotional pain that needs to be addressed. Let your loved one know that you’re on their side and ready to help them find the treatment they need.
Self-injury is often a sign that something bigger is lurking beneath the surface. When a person turns to self-harm, they are looking to avoid the emotions that come with mental health disorders. But there is hope.
At Promises Five Palms, we will work with you to help you understand the core of your mental health and learn to manage it without turning to damaging behaviors. Whether you are looking for help for yourself or a loved one, we are here for you.
Call us today to speak with our compassionate team about what
mental health treatment options are right for you at 1.844.675.1022.
By Martha McLaughlin