Self-harm: addiction, causes, signs and treatment  

Self-harm is hurting or injuring oneself on purpose. Self-harm injuries are both minor and severe, potentially leading to permanent scars or serious health illnesses. It interferes with daily life, causing shame, and guilt, and affecting relationships.

Self-harm addiction refers to an escalation in the frequency and intensity of self-harming behaviors, resembling a behavioral addiction. Self-harm is an addictive behavior, although it is not universally considered as such, as it often stems from different motivations and requires distinct treatment approaches. Addiction is characterized by compulsive behavior aimed at obtaining pleasure or relief, while self-harm is often a response to emotional distress and a search for emotional relief.

Causes of self-harm encompass emotional distress, underlying mental health disorders, history of trauma, social and environmental factors, cultural and societal influences, genetics, control-seeking behavior, communication and attention-seeking behavior, and self-punishment.

Signs of self-harm include behavioral, physical, cognitive, and psychosocial signs. These endorse wearing long clothing to conceal injuries, preferring solitude, keeping sharp objects handy, losing interest in activities, displaying impulsive behaviors, scars, fresh scratches or cuts, unexplained bruises, broken bones, questioning of personal identity, feelings of helplessness, hopelessness, worthlessness, mood swings, persistent feelings of sadness, emptiness, or despair, and feelings of guilt, shame, and disgust related to their self-harm behavior and its consequences. 

Treatment for self-harm includes psychotherapy, medications, support groups, family therapy, hospitalization, self-help strategies, mindfulness practices, and lifestyle changes.

What is Self-harm?

Self-harm is the deliberate act of inflicting harm on oneself without the intention of suicide or causing death. Individuals who engage in self-harm often do so for multifaceted reasons, like as a coping mechanism, offering temporary relief, or as a perception of control over overwhelming emotions. Others utilize self-harm to manage challenging feelings, like anger, sadness, guilt, or shame.

Additionally, self-harm serves as a method of communication, signaling distress and a need for support from others, as it manifests as a visible indicator of internal turmoil. It is important to recognize self-harm as a complex behavior associated with significant physical and psychological consequences.

Self-harm results in feelings of shame, particularly due to permanent scars from cutting or burning. Combining self-harm with alcohol or drugs increases the risk of more severe injuries. Self-harm negatively impacts various aspects of life. People self-harm as a means of dealing with overwhelming emotional distress or to express inner struggles.

Self-harm addiction entails a recurring pattern in individuals engaging in self-harming behaviors, resembling a behavioral addiction. However, self-harm differs from addiction due to varying motives, leading to distinct treatment needs for each. Addiction usually involves compulsive behaviors driven by a craving for pleasure or relief, while self-harm often serves as a coping mechanism in response to emotional distress, serving as a means to seek emotional relief. The American Psychiatric Association’sDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), acknowledges self-harm as a non-suicidal self-injury disorder (NSSI). NSSI is categorized in the “Conditions in Need of Further Study” section of the DSM-5, and its recognition has led to greater awareness and understanding, highlighting the importance of developing effective treatment approaches.

What is the cycle of Self-harm?

The cycle of self-harm is listed below.

• Emotional suffering: This phase encompasses experiencing emotional pain, distress, or discomfort, often stemming from factors like trauma, stress, anxiety, depression, or other mental health concerns.
• Emotional distress: As the emotional suffering deepens, it escalates into a state of heightened distress. This manifests as overwhelming feelings of sadness, anger, guilt, or shame.
• Panic: As emotional distress intensifies, individuals feel overwhelmed and unable to cope, leading to feelings of panic, desperation, or a sense of being trapped.
• Self-harm incident: This stage involves the individuals engaging in self-harming behavior, such as cutting, burning, hitting, or other forms of self-injury. It is often an attempt to cope with or alleviate emotional pain.
• Sense of relief: Following self-harm, the individuals temporarily experience relief or a sense of release from their emotional pain. This feeling is often described as a way to numb or distract from the emotional distress they are feeling.
• Guilt/shame: Once the initial relief diminishes, the individual undergoes a grief reaction, experiencing emotions such as guilt, regret, or shame for engaging in self-harm. These feelings often contribute to a negative cycle, compounding the emotional distress the individual is already experiencing.
• Reemergence of emotional suffering: As time passes, negative emotions and feelings accumulate once more, potentially triggered by various stressors or unresolved issues. This return to emotional suffering marks the beginning of a new cycle, restarting the pattern of self-harm if the underlying causes are not effectively addressed.

What are other names for Self-harm?

The other names for self-harm are non-suicidal self-injury (NSSI), self-inflicted injury (SII), self-mutilation, and self-injurious behavior (SIB). Less common terms include deliberate self-harm, self-destructive behavior, and para-suicide.

NSSI is the commonly used term in the Diagnostic and Statistical Manual-V, the leading diagnostic tool for mental health professionals, to describe self-harm without suicidal intent, as outlined in the American Psychiatric Association. Another research article, “The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature” by Maria Zetterqvist, published in the journal Child and Adolescent Psychiatry and Mental Health in 2015, discusses the DSM-5’s inclusion of nonsuicidal self-injury disorder. 

Self-inflicted injury (SII) represents a spectrum of intentionally self-harming behaviors, encompassing non-suicidal self-injuries, suicide attempts, and ultimately, death by suicide. This concept is discussed in the article “Development of self-inflicted injury: Comorbidities and continuities with borderline and antisocial personality traits” by Sheila E. Crowell and Erin A. Kaufman, featured in the journal Development and Psychopathology.

The article “Self-injurious behavior: A clinical appraisal” by K. Nagaraja Rao in 2008, published in the Indian Journal of Psychiatry, emphasized that self-injurious behavior (SIB) is a heterogeneous clinical phenomenon. It is present in different psychiatric syndromes, each characterized by unique psychopathological features. This highlights the complexity of SIB and the importance of understanding its various manifestations within different psychiatric contexts.

Is Self-harm addictive?

Yes, self-harm is addictive, as it is associated with compulsive behavior patterns. Self-harming behaviors resemble addiction to substances, as they activate the brain’s chemical reward system, causing a desire for the relief or rewards associated with the behavior. This relief creates a cycle where the individual relies on self-harm as a coping mechanism, leading to a pattern of addictive behavior. However, not everyone who self-harms will develop an addiction to it, as individual experiences and motivations for self-harm vary. It’s important for those struggling with self-harm to seek professional help to address underlying issues and develop healthier coping strategies.

Why does Self-harm become addictive?

Self-harm becomes addictive as it causes a sense of dependency, making individuals feel unable to cope without it. This results in an escalation of both the frequency and intensity of self-harming behaviors, resembling an addictive pattern. The release of endorphins during self-harm contributes to this addictive cycle, providing temporary relief or even euphoria. Additionally, self-harm has become a habitual coping mechanism for managing overwhelming emotions or stress, further reinforcing the behavior and contributing to its addictive nature.

A 2016 article “The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior” authored by Hilario Blasco-Fontecilla et al. and published in the journal Frontiers in Psychiatry, suggests that both non-suicidal self-injury and suicidal behavior are viewed as addictions. Self-harm’s addictive nature is linked to its impact on brain chemistry, particularly involving the dopamine and opioid systems. Dopamine, which plays a key role in reward and learning, is released during self-harm, while the activation of the opioid system reduces feelings of stress and pain.

How to tell you are addicted to Self-harm?

You are addicted to self-harm if you feel a strong urge to harm yourself regularly, have difficulty controlling or stopping the behavior, and experience relief or pleasure from self-harming despite knowing it’s harmful. Additionally, if self-harm has become a habit or coping mechanism that you rely on to manage emotions or stress, it indicates addiction.

A 1995 research study titled “Addictive characteristics of the behavior of self-mutilation” authored by P. Faye and published in the Journal of Psychosocial Nursing and Mental Health Services, revealed that self-harm shares traits with addictive behaviors. These include similarities in their origins, the emotions involved, and the repetitive nature of tension-release responses. Recognizing these similarities assists clinicians in offering improved care for individuals struggling with self-harm behaviors.

What are the causes of Self-harm?

The causes of self-harm are listed below.

• Emotional distress: Emotional distress is typically used as a coping mechanism for intense emotions like anger, trauma, overwhelm, and feelings of loneliness or isolation. When individuals feel emotionally drained, self-harm serves as a way to numb or release these emotions. 
• Underlying mental health disorders: Self-harming behavior is associated with mental health conditions like mood disorders, borderline personality disorder, alcohol abuse, schizophrenia, eating disorders, attention deficit hyperactivity disorder, depression, or anxiety disorders. 

The 2023 article “Physical and mental illness comorbidity among individuals with frequent self-harm episodes”, authored by Anvar Sadath et al., and published in Frontiers in Psychology, highlights the association of self-harm with emotional dysregulation, non-acceptance of emotional responses, lack of emotional awareness, impulse control issues, and challenges in goal-directed behavior. Self-harm co-occurring with mental health disorders increases the risk of repeated and highly lethal episodes, contributing to feelings of distress, impulsivity, and low self-esteem.

• History of trauma: Experiencing trauma, like abuse, neglect, or significant traumatic life events, increases the likelihood of self-harm. Trauma leads to feelings of helplessness and emotional pain that lead to self-harm.
• Social and environmental factors: These include factors like bullying, social isolation, or dysfunctional family dynamics that contribute to self-harm. These experiences lead to feelings of loneliness, rejection, or lack of support that exacerbate self-harm.
• Cultural and societal influences: Cultural norms and societal pressures stigmatize mental health issues or discourage emotional expressions. Therefore, individuals use self-harm as a secretive way to cope with their struggles.
• Genetics: Genetics influences both the tendency to engage in self-harm and the underlying factors contributing to it. Research has identified specific genes associated with self-harm ideation and behavior, indicating a genetic predisposition to self-harming behaviors. A study titled “Genetic aetiology of self-harm ideation and behaviour” by Adrian I. Campos et al., published in the journal Scientific Reports in 2020, identified seven genes linked to self-harm ideation and four genes associated with self-harm behavior.
• Control-seeking behavior: Self-harm offers a sense of control in situations where someone feels powerless or out of control. By choosing to harm themselves, individuals feel a temporary sense of power over their bodies and pain, which is empowering in the moment.
• Communication and attention-seeking behavior: Self-harm is a way to communicate distress or seek attention. Individuals use self-harm as a cry for help when they struggle to express their emotions verbally or feel unheard in their pain.
• Self-punishment: Feelings of guilt, shame, or self-loathing lead individuals to self-harm as a form of punishment for perceived mistakes or shortcomings.

What are the types of Self-harm?

The types of self-harm are listed below.

• Cutting or scratching: Cutting or scratching is using sharp objects to cut or scratch the skin. Individuals use it as a way to cope with intense emotions like anger, guilt, shame, and feelings of hopelessness, helplessness, and worthlessness.
• Burning: To distract from the emotional pain, individuals burn themselves using cigarettes, lighters, or other hot objects to cause pain and injury to the skin.
• Hitting or punching: This involves hitting or punching oneself, often in the head, face, or other parts of the body. This is done by individuals to express anger or frustration, or to feel physical pain as a distraction from emotional pain.
• Hair pulling: Pulling out one’s hair is a type of self-harm used as a coping mechanism against stress or anxiety. It is done without conscious awareness and is compulsive.
• Picking at skin or wounds: This includes picking at the skin or wounds. It leads to infection, further injury, and scarring.
• Biting: It is biting oneself, which causes bruising and tissue damage. Individuals do this to express anger or frustration and use it as a means of self-harm.
• Interference with wound healing: This includes reopening wounds or preventing wounds from healing properly, which leads to infection and other complications. It is used as a way to maintain a sense of control or to punish oneself.
• Self-poisoning: This involves ingesting toxic substances, such as medications or household chemicals, with the intent to harm oneself. It is considered a more severe type of self-harm and is life-threatening.
• Emotional self-harm: Self-harm doesn’t always have to be physical. Calling names, berating, and holding oneself to unreasonable standards are other forms of emotional self-harm. It perpetuates negative self-perceptions and worsens mental health.

What are the signs and symptoms of Self-harm?

The signs and symptoms of self-harm are listed below.

• Behavioral signs & symptoms: Behavioral signs and symptoms of self-harm include wearing long clothing to conceal injuries, dismissing injuries as accidents, preferring solitude, experiencing difficulties in relationships, keeping sharp objects handy, losing interest in activities, and displaying impulsive behaviors. These behaviors indicate an individual’s struggle with self-harm and the need for professional help to address underlying issues.
• Physical signs & symptoms: These include visible scars, fresh scratches or cuts, unexplained bruises, broken bones in severe cases, and patches of missing hair due to hair-pulling. These signs indicate recent or ongoing self-harm behavior, and it is important for individuals exhibiting these symptoms to seek professional help for proper evaluation and support.
• Cognitive signs & symptoms: These include ongoing questioning of personal identity and feelings of helplessness, and hopelessness, and worthlessness. These negative beliefs contribute to self-harm as a coping mechanism.
• Psychosocial signs & symptoms: These include emotional numbing, where individuals feel disconnected from their emotions or have a lack of emotional response. They experience emotional instability, with mood fluctuations ranging from extreme highs to lows, as well as unpredictable mood swings. Persistent feelings of sadness, emptiness, or despair indicate depression, which is common among those who self-harm. Increased anxiety, especially when unable to self-injure due to restricted access, is a symptom. Additionally, individuals experience feelings of guilt, shame, and disgust related to their self-harm behavior and its consequences.

What are the side effects of Self-harm?

The side effects of self-harm are listed below.

• Direct injuries: Self-harm causes cuts, bruises, burns, or other physical injuries that lead to scarring or permanent damage.
• Transmission of bloodborne illnesses: Self-harm methods involving blood exposure increase the risk of contracting bloodborne illnesses like hepatitis B or C, particularly if shared instruments are used.
• Infections: Wounds from self-harm become infected, especially if not properly cleaned and cared for, leading to further health complications.  
• Nerve damage: In severe cases, self-harm results in nerve damage, which causes numbness, weakness, or other neurological symptoms.
• Emotional consequences: Self-harm worsens feelings of guilt, shame, or low self-esteem, and contributes to a cycle of negative emotions.
• Interference with healing: Continued self-harm interferes with the body’s natural healing process, leading to delayed recovery and potentially worsening physical outcomes.
• Stigma and discrimination: Self-harm is stigmatized, leading to feelings of isolation, shame, and difficulty seeking help.  

Can you have withdrawal from Self-harming?

Yes, you can have withdrawal from self-harming. A study titled “Getting “clean” from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm” by McKenzie Himelein-Wachowiak et al., published in the Journal of Behavioral Addictions in 2022, reveals that individuals trying to quit self-harm often encounter withdrawal symptoms.

Self-harming induces symptoms similar to those experienced in substance use withdrawal. The article “Addictive characteristics of the behavior of self-mutilation” by P. Faye, published in the Journal of Psychosocial Nursing and Mental Health Services in 1995, suggests that self-mutilation shares characteristics with addictive behavior. These similarities encompass aspects such as their origin, the emotional experiences involved, family dynamics, and the repetitive cycle of tension and release responses. Withdrawal symptoms include increased emotional distress, such as heightened anxiety, depression, or anger. These symptoms arise when the intense emotions that self-harm help manage to resurface or intensify. Additionally, individuals experience cravings for self-harm, similar to cravings for substances in addiction, despite having stopped the behavior. Individuals report physical discomfort, such as headaches, nausea, or difficulty sleeping, when they cease self-harming. These symptoms increase the risk of relapse, as the combination of emotional distress, cravings, and physical discomfort makes it challenging to resist the urge to self-harm again.

What are the complications of Self-harm?

The complications of self-harm are listed below.

• Physical damage: Self-harm leads to severe tissue damage, especially in cases of deep cuts or burns, which require surgical interventions to repair.
• Visible scars: Self-harm results in visible scars, which are a constant reminder of past struggles and impact self-esteem and body image.
• Anemia: Chronic self-harm, particularly in cases involving significant blood loss, leads to anemia, which causes fatigue and weakness.
• Bleeding or hemorrhages: Self-harm injuries cause excessive bleeding or hemorrhages, which are life-threatening in severe cases.
• Damaged nerves: Self-harm results in damage to the nerves, leading to numbness, tingling, or loss of sensation in affected body parts. It affects mobility and the functions of daily life.
• Risk of escalation: Self-harm becomes a pattern of behavior that escalates over time, leading to more severe injuries and an increased risk of complications.
• Accidental suicide: Self-harm attempts unintentionally result in fatal outcomes like suicide. 
• Lowered self-esteem: The presence of visible scars or ongoing struggles with self-harm leads to lowered self-esteem and feelings of shame or guilt.
• Comorbid mental health conditions: Self-harm triggers underlying mental health conditions and behaviors that intensify stressful emotions. Individuals who engage in self-harm experience significant shame or guilt about their behavior, which impacts their mental health and well-being.
• Loss of social support: Self-harm strains relationships with friends, family, or partners, leading to conflict or loss of social support.

What are the risk factors for Self-harm?

The risk factors for self-harm are listed below.

• Adolescence age: The 2016 article “Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review” by Salome Grandclerc et al., published in the journal PLoS One, mentions adolescence as a risk period for self-harm. It starts usually during puberty, at the age of 13 -15 years.
• Adverse childhood experiences: Adverse experiences in childhood like abuse, neglect, or household dysfunction, significantly increase the risk of self-harm later in life. These experiences lead to the development of maladaptive coping mechanisms and mental health issues, which predispose individuals to self-harm as a way to cope with distressing emotions or memories. Early intervention and support to address these adverse experiences are crucial in reducing the risk of self-harm.
• Mental health disorders: Conditions such as depression, anxiety, borderline personality disorder, or post-traumatic stress disorder (PTSD) increase the risk of self-harm as individuals use self-harm as a way to manage their symptoms.
• Bullying: Bullying increases self-harm risk by causing helplessness, low self-esteem, and depression. It isolates and emotionally distresses individuals, who then turn to self-harm for coping. Early intervention and support are crucial.
• Low health literacy: It increases the risk of self-harm by hindering an individual’s ability to understand and access appropriate mental health resources and support, leading to a lack of effective coping strategies.
• Problematic behaviors: Problematic behaviors like impulsivity, agitation, and aggression, are significant risk factors for self-harm. These behaviors typically co-occur with mental health issues and exacerbate feelings of distress, leading individuals to self-harm as a coping mechanism.
• Substance abuse: The use of substances can impair judgment and exacerbate underlying emotional distress, leading to a higher risk of self-harm incidents.
• Poor coping mechanisms: Avoidance, denial, or self-isolation, increase the risk of self-harm. These strategies fail to address underlying issues, leading individuals to resort to self-harm as a maladaptive coping strategy.
• Female gender: The article “Risk factors for non-suicidal self-injury (NSSI) in adolescents: A meta-analysis” by Yu-Jing Wang et al., published in eClinicalMedicine, part of the Lancet Discovery Science in 2022, highlights that being female is a risk factor for self-harm.

What are the available treatments for Self-harm?

The available treatments for self-harm are listed below. 

• Psychotherapy: Cognitive behavioral therapy (CBT) assists individuals in recognizing and altering negative thought patterns and behaviors that lead to self-harm. Once these patterns are identified, the therapist helps the individual challenge and reframe them more realistically and positively. This process helps the individual develop more adaptive ways of thinking, which can lead to changes in behavior and emotional well-being.

Cognitive behavioral therapy focuses on teaching practical skills and techniques to help individuals cope with difficult situations. These may include stress management techniques, problem-solving skills, and relaxation techniques. CBT is short-term, goal-focused, and effective for self-harm.

Another psychotherapy is dialectical behavior therapy (DBT), which emphasizes mindfulness, emotional regulation, and interpersonal skills. It aids individuals in managing intense emotions, enhancing communication, and cultivating healthy relationships.

• Medications: Medications are particularly useful in cases where psychological therapies alone may not be sufficient. These include antidepressants, mood stabilizers, and antipsychotics and are prescribed based on the individual’s specific mental health needs. For example, antidepressants are prescribed to manage symptoms of depression, anxiety, and other mental health conditions that contribute to self-harm. 
• Support groups: Connecting with others who understand what you’re going through provides valuable support and encouragement. Joining a support group for individuals who self-harm provides a sense of community, understanding, and encouragement to help individuals work toward recovery.
• Family therapy: Involving family members in therapy helps improve family dynamics and provides additional support for the individual struggling with self-harm.
• Hospitalization: In severe cases where self-harm poses a significant risk to the individual’s safety, hospitalization in a psychiatric facility is necessary to provide intensive treatment and monitoring.
• Self-help strategies: Learning and practicing healthy coping mechanisms like mindfulness, relaxation techniques, and stress management, help individuals manage the urge to self-harm.
• Mindfulness practices: Meditation, yoga, and other mindfulness techniques help individuals become more aware of their thoughts and emotions and develop healthier coping mechanisms.
• Lifestyle changes: Getting enough sleep, eating a healthy diet, and exercising regularly contribute to overall well-being and reduce stress, which helps manage urges to self-harm.

How are Self-harm scars treated?

Self-harm scars are treated with a multidisciplinary approach that includes both non-surgical and surgical interventions. The 2018 article “Deliberate self-harm scars: Review of the current literature” by Weiguang Ho et al., published in the journal JPRAS Open, discusses various interventions for self-harm scars. Treatment options such as steroid injections, silicone gel therapy, surgical revision, laser therapy, and camouflage are available, which vary depending on the scar’s nature and size.

Another research article titled, “Management options for self-harm scars: non-surgical and surgical modalities” by Omar Abbassi et al., published in the Journal of Aesthetic Nursing in 2021, outlines various other procedures to treat scars. Non-surgical options for managing self-harming scars include camouflage makeup, decorative tattooing, re-pigmentation, dermabrasion, microneedling, and laser treatments.

The research also emphasizes surgical interventions, such as follicular transfer, a form of hair transplant, and surgical resurfacing procedures that involve scar removal with direct closure. These procedures are particularly suitable for wide, depressed scars or clusters in small areas with loose skin.

A newer research approach includes the use of artificial skin in conjunction with skin grafting and isotopic split skin grafting. This newer technique involves harvesting skin layers to remove wide scars and reposition the graft. These methods provide options for enhancing scar appearance, with the choice depending on scar characteristics and individual needs. An article titled. “Treatment of Deliberate Self-harm Scars with Rotated Thin-skin Graft and Minced-skin Graft” by Kento Takaya et al., published in Plastic and Reconstructive Surgery Global Open in 2020, discusses the successful use of skin grafting to camouflage scars and restore skin texture at the wound site. Although temporary nodules, pigmentation changes, and redness occurred after the grafting, these issues resolved over time.

How to stop Self-harming?

To stop self-harming, start by identifying the triggers that lead to the behavior. This involves recognizing specific emotions or situations that precede the urge to self-harm. Once you’ve identified these triggers, work on developing alternative coping mechanisms to manage them. Healthy coping strategies include talking to a trusted friend or therapist, practicing relaxation techniques, or engaging in physical activity. It is helpful to remove or limit access to tools or objects used for self-harm to reduce temptation.

Seeking professional help is important for stopping self-harm. A mental health professional provides support, helps you understand underlying issues contributing to self-harm, and assists in developing coping strategies. Building a support system for understanding individuals is beneficial. Surrounding yourself with supportive friends, and family, or joining a support group provides encouragement and guidance. Practicing self-care, such as getting enough sleep, eating well, and engaging in activities that bring joy, is important for managing emotions and reducing the urge to self-harm.

Lastly, be patient and compassionate with yourself throughout the recovery process. Recovery from self-harm takes time, and setbacks occur. Acknowledge progress, no matter how small, and remember that it’s okay to ask for help when needed. With the right support and strategies, it is possible to stop self-harming behavior and develop healthier coping mechanisms for managing difficult emotions.

How to prevent Self-harm relapse?

To prevent self-harm relapse, it’s important to continue practicing healthy coping strategies and address underlying issues contributing to the behavior. Stay connected with your support system, whether friends, family, or a therapist, and communicate openly about your feelings. Develop a relapse prevention plan with your therapist, identifying triggers, coping mechanisms, and emergency contacts. Engage in self-care activities like exercise, hobbies, and relaxation techniques. 

Building resilience against self-harm involves creating a support network and developing healthy coping mechanisms. Connect with trusted individuals to share your struggles and receive encouragement. Identify triggers and develop a plan to manage them with healthy alternatives. Practice relaxation techniques like mindfulness meditation or yoga to manage stress. Engage in activities you enjoy to provide positive distractions and boost your mood. Remove potential tools used for self-harm from your environment and seek professional help from a therapist specializing in self-harm.

When is Self-harm counseling necessary?

Self-harm counseling is necessary when self-harming behavior becomes repetitive or shows an escalating pattern, indicating that the individual is unable to manage their emotions effectively. The individual is struggling with self-harming behaviors, which are often used as a way to cope with emotional pain, stress, or trauma. Additionally, counseling is necessary when self-harm is accompanied by other mental health issues such as depression, anxiety, or substance abuse. In such cases, counseling helps individuals explore the underlying issues contributing to their self-harm, develop healthier coping strategies, and work toward healing and recovery.

The article “Counsellors’ perspectives on self-harm and the role of the therapeutic relationship for working with clients who self-harm” by Maggie Long and Mary Jenkin, published in the journal Counselling and Psychotherapy Research in 2010, highlights the vital, complex, long-term, and multi-dimensional nature of the therapeutic relationship in self-harm counseling. The counselors emphasized the importance of providing a long-term, safe, non-judgmental, equal, and sensitive therapeutic environment where clients express their feelings and experiences freely. These findings indicate that the therapeutic relationship plays an important role in promoting psychological healing for individuals who self-harm.

How is Self-harm diagnosed?

Self-harm is typically diagnosed with a physical examination to inspect any visible injuries and note patterns or scars from past self-harm incidents. Healthcare providers inquire about the individual’s medical history, including any mental health conditions, and their social history. Understanding the current life circumstances, such as stressors like financial issues, recent losses, school or work problems, bullying, or relationship difficulties, is important in the diagnostic process. Through these assessments and discussions, healthcare providers aim to gather information to comprehend the context and triggers of self-harming behavior.

The article “Clinical and personality characteristics of adolescents with anorexia nervosa with or without non-suicidal self-injurious behavior” by Chiara Davico et al. in 2019 published in the journal Comprehensive Psychiatry, highlights the criteria for diagnosing self-harm according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for nonsuicidal self-injury (NSSI) include deliberate self-inflicted harm to the body’s surface, without the intent to die, self-harm behavior in an attempt to seek relief from negative emotions or to resolve interpersonal issues or induce positive feelings, the behavior occurring on at least five or more days in the past year; and the self-injury being associated with interpersonal difficulties or negative thoughts or feelings such as depression, anxiety, tension, anger, or self-criticism, or preoccupation with the behavior that is hard to control, or frequent thoughts of self-injury even when not carried out.

How common is Self-harm?

Self-harm is common among a significant number of teenagers, with 27% of young adolescents reporting thoughts of self-harm and 15% reporting at least one act of self-harm, as outlined in the article “Self-harm in young adolescents (12–16 years): onset and short-term continuation in a community sample” by Paul Stallard et al, published in the journal BMC Psychiatry in 2013.

Among college students, 13.73% exhibited self-harming behavior, as indicated in the research article “Features of Nonsuicidal Self-Injury and Relationships with Coping Methods among College Students” by Jinting Wu and Hairong Liu, published in the Iranian Journal of Public Health in 2019. The study indicates that self-injury behavior was associated with factors such as their place of origin, mother’s education, family finances, type of family, relationships, gender, frequent internet use, and smoking.  

According to the 2017 article “Nonsuicidal Self-injury: A Systematic Review”  by Annarosa Cipriano et al., published in Frontiers in Psychology, 4-23% of adults engage in non-suicidal self-injury (NSSI). The main causes of NSSI seem to be linked to childhood trauma, its comorbidity with various other disorders, the different functions of NSSI, and the possibility of NSSI existing independently as a disorder. 

The article “Why Is Non-suicidal Self-injury More Common in Women? Mediation and Moderation Analyses of Psychological Distress, Emotion Dysregulation, and Impulsivity” published in the journal International Academy for Suicide Research by Nina M Lutz et al. in 2023, found that females between the age of 18-33 are more likely to engage in non-suicidal self-injury (NSSI). Specifically, females were twice as likely as males to report engaging in NSSI in the past year, with rates of 14.47% for females and 7.78% for males.The 2019 research titled “Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis” conducted by Richard T. Liu et al., published in the journal Clinical Psychology Review, highlights that sexual and gender minority (SGM) individuals are at an elevated risk for engaging in non-suicidal self-injury (NSSI) compared to heterosexual and cisgender individuals. Specifically, the study found that among sexual minority individuals, the lifetime prevalence of NSSI was 29.68%, while among gender minority individuals, it was 46.65%. Transgender individuals exhibited a lifetime prevalence rate of 46.65%, and bisexual individuals had a lifetime prevalence of 41.47%. The reasons for this increased risk are likely due to a combination of general risk factors that are more prevalent among SGM individuals, as well as SGM-specific risk factors, such as stigma and discrimination. The article also emphasizes the necessity for further research to better comprehend the factors influencing NSSI in SGM populations, as well as to create effective prevention and treatment strategies. 

How often do people Self-harm?

People often do self-harm, with prevalence rates varying among populations. Research suggests that young people between 14 and 25 years of age engage in self-harming behaviors, often starting in adolescence. This information is emphasized in the article “Suicidal Behaviour, including Ideation and Self-Harm, in Young Migrants: A Systematic Review” by Aditya Basu et al., published in the International Journal of Environmental Research and Public Health in 2022.

An article by the U.S. Department of Veterans Affairs; National Center for PTSD, titled Self-help and Trauma last updated in Sept 2022 states that self-harm rates differ based on the group being studied. In the general population, approximately 2% to 6% of individuals engage in self-harm while among students it ranges from 13% to 35%. Moreover, individuals undergoing treatment for mental health issues, particularly those diagnosed with post-traumatic stress disorder (PTSD), are more prone to self-harm than those without PTSD.\

What is the relation between Self-harm and suicide?

The relation between self-harm and suicide shows a statistical association, as outlined in the article “Relations between Nonsuicidal Self-Injury and Suicidal Behavior in Adolescence: A Systematic Review” by Salome Grandclerc et al., published in 2016 by the journal PLoS One. It was found that 70% of individuals with a history of NSSI have attempted suicide at least once, and 55% of them have made multiple attempts. After an episode of NSSI, the risk remains high for around six months and tends to decrease gradually. 

It’s important to note that self-harm does not directly cause suicide in all instances. Individuals who self-harm are at a higher risk for suicide attempts than the general population. Self-harm acts as a risk factor for suicide, but it is often one of several factors contributing to suicidal behavior.

The key distinction between suicide and self-harm lies in the intent behind the actions. Individuals who are suicidal often face overwhelming life stressors or mental health disorders that cause intense suffering, leading them to see suicide as the only way to end their pain. Suicide attempts typically stem from feelings of despair, hopelessness, and worthlessness.

In contrast, individuals who self-harm, do so as a coping mechanism to regulate their emotions and stressors. Self-harm does not effectively address the underlying causes, consequently increasing the vulnerability to suicidal thoughts or behaviors. The physical pain from self-injury serves as a reminder of their existence, particularly when they feel emotionally disconnected from the world. The act of cutting or burning triggers pain receptors in the body, leading to an adrenaline rush that is addictive.
Common underlying factors for both self-harm and suicide include mental health conditions such as depression, anxiety, and personality disorders, as well as experiences of trauma, emotional dysregulation, and difficulty coping with intense emotions.

What is the relation between Self-harm and attention-seeking?

The relation between self-harm and attention-seeking suggests that attention-seeking is a factor for some individuals, but it is often one of many reasons for self-harm. While individuals engage in self-harm as a way to seek attention or communicate distress, this is not true for everyone who self-harms. As of 2024, this relationship is not yet fully understood. 

A study titled “Nonsuicidal Self-Injury: What We Know, and What We Need to Know” published in the Canadian Journal of Psychiatry by E. David Klonsky et al. in 2014, challenged the misconception regarding the motivation for nonsuicidal self-injury (NSSI). While it is commonly assumed that NSSI is primarily attention-seeking behavior, research indicates otherwise. Studies across diverse populations and using various methods suggest that NSSI is rarely driven by a desire for attention or reactions from others, despite instances where it serves interpersonal functions.

Another study, titled “A qualitative study of motivations for non-suicidal self-injury in a sample of psychiatric outpatients in Singapore” authored by Shazana Shahwan et al. and published in the Singapore Medical Journal in 2022, suggests that NSSI is not solely for attention-seeking purposes. The research suggests that viewing NSSI as solely attention-seeking perpetuates stigma and discourages individuals from seeking the psychological care they need. NSSI indicates both internal conflicts and external environments that individuals perceive as unsafe. Understanding the underlying motives behind NSSI is crucial for effectively treating individuals experiencing such behaviors.

What is the relation between Self-harm and drug abuse?

The relation between self-harm and drug abuse typically co-occurs in individuals experiencing emotional distress or mental health issues. According to a 2019 study by Rishi Gupta et al., published in the Indian Journal of Psychiatry, titled “Patterns and predictors of self-harm in patients with substance-use disorder” 20% of patients visiting the emergency department with a history of self-harm were found to have at least one substance use disorder, with most evidence focusing on alcohol use.

During adolescence, there is a strong association between substance abuse and self-harm. A 2015 study by P Moran et al published in Acta Psychiatrica Scandinavica, titled “Substance use in adulthood following adolescent self-harm: a population-based cohort study” investigated the long-term link between self-harm and addiction to drugs and alcohol. It revealed that teenagers who engage in self-harm are more likely to develop substance abuse issues. This is because drug abuse and alcohol temporarily alleviate emotional distress, similar to self-harm while producing a euphoric effect. Untreated depression or other mental health disorders lead individuals to resort to these harmful coping mechanisms, and in cases, escalate to suicide.