Self-Harm

Self-harm is a well-known yet misunderstood issue that many people struggle with. It’s a deeply personal and painful experience that some use to feel relief, but it only leaves people feeling shame, isolated, and lonely.

In this resource page, we’ll cover everything you need to know about self-harm, including:

• What it is
• Why it happens
• Who’s at risk
• And how it’s treated

What is Self-Harm?

Self-harm, or self-injury, occurs when someone intentionally harms themselves. It’s often a negative coping mechanism for uncomfortable feelings and distressing thoughts.

This often manifests as an impulse, and some people will have a difficult time stopping it. For some, it’s a behavioral addiction, but others may be able to freely stop at any time.

Related Resources: Is Self-Harm an Addiction?

Behaviors

There are several ways people self-harm. While it can manifest in various forms, some common behaviors include:

• Cutting
• Burning
• Scratching
• Hitting

Each of these behaviors comes with its own risks and can cause noticeable damage to the body. 

Is Self-Harm A Suicidal Behavior?

Self-harm is often misattributed as suicidal behavior or suicidal self-harm. However, suicidal behaviors and self-harm are different in several ways:

• Intent: The intent for self-harm is often to cope with feelings. The intent behind suicide is to end all feelings.
• Level of damage: The damage inflicted from self-harm is usually surface-level. Burning, cutting, and scratching typically don’t cause life-threatening damage, though they may require attention and care.
• Frequency: Self-harm is a behavior that happens frequently. Suicidal behaviors are rarer and usually only occur a couple of times.

Self-injury is not suicidal behavior. However, people who self-harm are at a higher risk of suicide.

Signs of Self-Harm

The visible signs of a person harming themself are usually hidden. This makes it hard to notice if a loved one or friend is harming themselves:

• Wearing heavy clothes on warm days
• Unexplainable scars, cuts, burns, and bruising in a similar location
• Emotionally withdrawn
• Vague explanations of injuries

The best way to know if someone is self-harming is to check up on them often. Ask open-ended, non-judgmental questions. Reach out to your friends often.

Why Does Someone Self-Harm?

The cause of self-harm could stem from any number of things. To understand what causes self-harm, look beyond the behavior itself and consider the emotional and psychological struggles that fuel it.

Poor Coping Skills

Self-harm is almost always used as a way to cope with difficult feelings that seem impossible to manage. For some, it’s an impulse they have little control over. When sadness, anger, anxiety, or emotional numbness become too intense, self-injury is used as a distraction.

These negative coping skills might offer a short relief from emotional pain, but they cannot treat the underlying issues. Instead, it pushes people further into isolation, shame, and self-criticism.

A Mental Health Condition

Some mental health conditions are known to cause self-harm. These include:

• Borderline personality disorder
• Obsessive-compulsive disorder
• Depression
• Anxiety disorders
• Post-traumatic stress disorder
• Eating disorders

 Each of these conditions can cause someone to self-injure. PTSD, BPD, anxiety, and depression each cause emotional dysregulation and hard-to-deal-with emotions. 

Eating disorders often involve self-hatred and distorted self-perception. People with eating disorders may self-harm as a way to punish themselves.

Self-Loathing

Self-loathing is a deep-seated sense of worthlessness, shame, or self-hatred that can significantly contribute to self-harming behaviors. 

When someone feels consumed by negative beliefs about themselves, they may turn to self-injury as a way to punish themselves or express the emotional pain they can't put into words. The act of harming the body can feel like a physical outlet for the internal anguish they carry.

What is NSSID?

Self-harm is often referred to as non-suicidal self-injury (NSSI). This is an important distinction that distinguishes self-harm from the intention of suicide. There is also a proposed diagnosis called non-suicidal self-injury disorder (NSSID). 

NSSID is a disorder where people self-harm, without the intent of suicide, as a way to cope with intense emotional feelings regularly. The proposed DSM-5 criteria for NSSID include: 

• Frequency: Self-harmed five or more days within the past year
• Function: The act and ritual of self-harm is used to relieve discomfort
• Interpersonal and psychological factors: Interpersonal difficulties, negative thoughts and emotions, or a preoccupation with self-injury before the behavior needs to be present
• Unsanctioned behavior: The self-harming behavior excludes body modifications like tattooing and piercing
• Significance: The behavior causes significant distress or interference in areas of functioning
• Exclusion of other disorders: The presence of self-harming behavior can’t be explained by another mental health or medical condition

While NSSID is included in the DSM-5, it’s in section 3. This means NSSID is considered a disorder requiring further research.

Who’s At Risk of Self-Harm?

Self-injury can affect anyone of any age. However, some groups are at a higher risk of self-injury.

Teenagers

Early teenage years are plagued with big emotions and a lot of quick, unexpected changes. Teens face significant changes during puberty, which can be overwhelming and difficult to manage. The mounting peer pressure, loneliness, parental conflicts, and waves of big emotions are hard to manage.

People With Mental Health Conditions

Again, many mental health conditions and disorders include self-harm as a symptom. People experiencing…

• Anxiety
• Depression
• Borderline personality disorder
• Eating disorders

… are more likely to engage in self-harm. This could be due to self-hate, shame, confusion, and dark thoughts caused by the condition.

Abuse Victims

Abuse in childhood has lasting effects through the teenage years and into adulthood. These effects cause difficulties with physical health, mental health, and relationships.

Abuse victims carry a lot, and they’re at a higher risk of self-harm. One study from 1995 showed a clear statistical association between sexual abuse in childhood and self-harm.

LGBTQIA+ Individuals

People who are in the LGBTQIA+ community are at a higher risk of self-harm. Many believe this is due to the high levels of adversity they face in their daily lives.

Self-Harm Treatment

Before receiving treatment for self-harm, you should tell someone what you’ve been experiencing. Going through treatment alone is difficult, but building a support system can make the process easier.

Because self-harm is often tied to a mental health condition, the best way to seek help is by seeking mental health treatment.

While at treatment for self-harm, you’ll work through any underlying issues and practice and develop healthy coping skills. It may take time, but through hard work and dedication to treatment, you can recover.

Talk Therapy

Something profound happens when you open up. Maybe there’s something that’s been bothering you, you're confused, or you feel guilty for something you did in secret. Whatever the reason for pent-up feelings, when you open up about it, the problem feels lighter.

Talk therapy gives people a space to open up in a safe environment. People can freely work through their thoughts, feelings, and behaviors, all while receiving feedback from a trained professional.

The typical talk therapy used when treating someone who self-harms includes:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Mindfulness-based therapies

If the negative coping skills are rooted in trauma, then other therapies like eye movement desensitization and reprocessing (EMDR) are often used.

Inpatient Care

If you harm yourself severely or often, your healthcare provider may recommend admission to a hospital or treatment center for 24-hour care. This is to ensure you’re safe and can be away from the urge to self-harm.

Hospitalization for self-harm is a short-term option, but treatment centers often offer treatments that last around 30 days. These inpatient treatments provide patients with multiple treatment options, including talk therapy and recreational therapy.

Developing Healthier Coping Skills

Treatment is a great place to develop new coping skills. These skills are meant to replace self-harm and may take time to practice, develop, and implement them into your daily life.

Because self-harm is often an impulse, coping skills are often called distraction techniques. People have reported that delaying the urge, even just a couple of minutes, can be enough to remove it. These coping skills can help when overwhelming emotions, like anger, arise.

• Squeezing ice
• Hitting a punching bag
• Flattening cans
• Tearing a piece of cardboard
• Stomping around

Not all coping skills need to be active. Some coping skills can be practiced throughout the day to bring a sense of calm.

• Cleaning
• Taking a long bath
• Micro meditation
• Mindfulness movement

Self-harm feels like a rut that’s impossible to get out of, but with the right help, you can live a life freed from it.

Get Help for Self-Harm Behaviors At Sequoia Behavioral Health

Sequoia Behavioral Health is a holistic treatment center that treats the symptoms of mental health conditions while also treating the underlying cause. 

If you’re struggling with self-harm and mental health conditions, contact us and ask any questions you may have. All personal information will be kept confidential.

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