Why People Self-Harm and How to Help Them

Years into my psychology degree, I still knew very little about self-harm. Armed with a vague idea that people self-harmed either in an attempt at suicide or as a cry for help, I had done no further research on the subject. The college I attended did not seem all that inspired to teach me anything more about it.

When self-injury eventually did come up in college courses, it was generally listed as a symptom. People with mental health disorders sometimes used self-harm as a kind of coping mechanism which offered short-lived relief.

However, from personal experience and stories I have heard since leaving college, it has become clear that self-injury is more than a symptom. Millions of people self-harm on a regular basis, in a way that somewhat resembles substance use disorders.

Today’s prevailing evidence suggests that self-harm is often connected to substance use, and we can learn from contemporary thought on the treatment of substance use disorders. Old misconceptions are detrimental to those who self-harm. People who consider it a ploy for attention, tend to assume that ignoring it is the best option, which only makes already-isolated people feel more vulnerable.

As such, we must adjust our understanding of self-injury, including its causes and how to treat it.

What is Self-Harm?

Self-injury or self-harm, clinically referred to as nonsuicidal self-injury disorder, is a condition by which individuals purposely hurt themselves in a non-life-threatening way. Cutting and burning are the most common forms of self-harm, although other methods include hitting or biting oneself, hair-pulling, or banging one’s head against a wall.

Who Self-Harms?

The statistics show that self-harm is frighteningly common. Thirty percent of teens and adolescents have committed some form of self-harm at least once, and 23% continue self-harming into adulthood.

The statistics also show a correlation between self-injury and substance use. About 55% of adolescents who self-injure develop a co-occurring substance use disorder.

Without context, these statistics present a chicken-egg question. Does self-harm lead to substance use, or is it the other way around? Alternatively, is there a single cause leading to self-harm and substance use?

By looking at the causes of self-harm, we can begin to answer these questions.

What Causes Self-Harm or Injury?

Self-injury stems from an inability to cope with painful feelings and emotions. Without healthy coping mechanisms, teens and adolescents search for ways to find relief. Unfortunately, the fixes that provide the most instantaneous and instinctive relief also lead to long-term problems.

One such fix is substance use. Different substances dispense with painful feelings in different ways. Some numb the pain, while others distract from it. Some substances do both. Either way, the fix is short-lived. The pain comes back stronger than before, and the individual uses substances repeatedly to find relief, leading to dependence.

In this way, self-injury is a similar fix. Many people who have never self-harmed can relate to the urge to do so. For some, it is a spontaneous thought that happens on a rare occasion when their emotions feel overwhelming. For others, it is a strong urge to cut, burn, or hit themselves to release those emotions.

While it is not entirely known why self-harm provides temporary relief, scientific evidence shows that it occurs on a physiological level. The relief that occurs after physical pain peaks extends to emotional pain as well.

But as with substance use, the relief is short-lived, and the emotional pain returns along with guilt and shame about the self-harm. This can lead to further self-harm until the individual becomes dependent on it for relief.

For the most part, self-harm and substance abuse are two methods used by people who do not have healthy coping mechanisms or are unprepared for the severity of their emotional pain. In some circumstances, however, the relief from self-harm leads individuals to seek the same relief from substances. Alternatively, with inhibitions lessened by substance use, individuals are more likely to go through with self-harm.

With this in mind, we can begin to understand the treatment options for people who self-harm.

How is Self-Harm Treated?

Because self-harm arises due to the need to relieve emotional pain, it is best to treat it by training individuals to use healthy coping mechanisms. Healthy coping mechanisms work best when used before the pain becomes overwhelming. Treatment focuses on helping individuals identify early signs of emotional pain and teaching methods to regulate painful emotions.

This is similar to modern substance use treatment. As with substance use, cravings are difficult to manage on one’s own. Treatment is most effective when it is provided in a controlled environment, such as a rehab or inpatient setting.

Self-injury rarely occurs in isolation and is therefore often targeted in substance use treatment programs and treatment for mood and personality disorders. A stay in a controlled environment provides a safe space to work on one’s mental health.

Self-Injury Awareness Day is observed each year on the 1st of March. Awareness of what self-injury really entails, its causes, and its treatments can guide many sufferers to find the help they need.

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About the Author: Dr. Boris Vaisman, MD, is a Family Medicine Specialist in Woodland Hills, CA. He graduated from the Ross University School of Medicine in 2003. He is affiliated with West Hills Hospital & Medical Center and specializes in Emergency Medicine and Family Medicine. He has unique insight into mood and behavioral disorders. He also writes blog posts about mental health and addiction. He has contributed many resources and research to substance abuse treatment centers and addiction treatment centers.

Photo by Kristina Tripkovic on Unsplash

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