I hurt myself today
To see if I still feel
I focus on the pain
The only thing that’s real
The needle tears a hole
The old familiar sting
Try to kill it all away
But I remember everything
Trent Reznor (Nine Inch Nails)
The term “self-harm” is used when someone deliberately and directly takes steps to hurt or harm themselves in some way. Counsellors refer to it as nonsuicidal self-injury since behaviours like cutting, scratching, or burning are often more about coping with overwhelming emotions than suicidal intent. Self-harm is confusing for both the person engaging in it as well as those who know someone who does it.
The desire to deliberately inflict pain or harm to self is relatively common among adults – statistics tell us that about 4-6% of adults experience it. We also know that it is much more common in adolescents. Some studies report an average of 18% of teenagers will engage in some form of self-harm during their adolescence. We also know that it is more common in teenage girls and young women.
Here are three essential things to understand about self-harming behaviours:
#1 - What Causes Self-Harm
There is no easy answer to the question of what causes someone to harm themselves deliberately. We know the answer is complicated and that many different factors contribute. A history of having anxiety or depression is most often the starting place. Researchers also acknowledge it is often linked to a history of traumatic experiences in childhood including abuse, chronic illness, and disrupted attachment with caregivers.
For those who have experienced traumatic events, self-harm may be more about managing the anxiety, depression, or other trauma symptoms that have resulted from trauma.
#2 - Why People Self-Harm
It helps manage overwhelming emotions
One of the common reasons people give for engaging in self-harm is that it helps them manage difficult emotional experiences. Those who have a trauma history are particularly vulnerable to feeling extreme distress and then being unable to cope with their intense emotions.
Often, people with childhood trauma have challenges in their ability to regulate strong emotions, racing thoughts, or intrusive memories. And early adverse childhood experiences tend to impact the development of healthy and adaptive coping skills. Self-harm becomes of a way self-soothing even though it seems so contrary to others.
The most common emotional triggers for self-harming behaviours include anger, loneliness, shame, and feeling abandoned.
It helps manage hyper-arousal symptoms of trauma and PTSD
The term “hyper-arousal” refers to the high level of activation that remains in the nervous system and the physical body following traumatic experiences – it’s an ongoing activation of the fight or flight response even after the threat or the trauma has ended.
Those who engage in self-harming behaviours as a way cope often experience this extreme physical, emotional, or mental activation.
Self-injury helps people cope with emotional reactivity, angry reactions, overwhelming physical sensations, intrusive memories, and flashbacks.
It provides an external reason for internal distress
Many of the wounds created by trauma are not visible – it is difficult to see the “scars” of painful life experiences when it affects the ability to trust or feel secure in a relationship. The damaged sense of self or the difficulty navigating painful emotions are not always apparent to others.
Self-harm is a way of making an internal experience of distress more visible on the outside.
It is a way of punishing themselves
Most people who experience self-harming behaviours also suffer a deep sense of shame – they live with a powerful sense of inadequacy. In addition to powerful feelings of shame and inadequacy, self-blame is also a contributing factor in self-harm. Often, those who experienced trauma as children hold themselves responsible for the traumatic events that occurred.
Shame and self-blame are common for those who self-harm - and their actions are often an expression of their self-loathing.
It is a way to feel something
Rather than feeling too much as a motivation for self-harm, some people feel too little – and then they use self-inflicted pain as a way of creating something to feel. It can also produce specific sought-after experiences that can include feeling more alive – pain can be a welcome reminder of being alive if someone feels empty and hollow. Or it can also produce feelings of euphoria as the result of the endorphins that are released in the process of self-harm. Endorphins are a type of hormone that activates our naturally-occurring opioid receptors.
Physical pain can sometimes be a way of stopping feelings of numbness, emptiness, or depression.
#3 - The Connection Between Self-Harm and Substance Use
It’s important to discuss the evident relationship between self-injury and the unhealthy use of substances. As it was stated earlier, a large number of adolescents report they have engaged in self-harming behaviours (about 18%). If we look at the number of adults who self-harm, that number decreases significantly (to 6%) These statistics may seem to indicate that the tendency to self-harm arrears to diminish as teenagers move into adulthood. For some, it is the result of learning new tools to help manage difficult emotions. But for others, there is something vitally important we need to pay attention to.
Substance use and addiction are more common for young adults with a history of self-harm in the adolescence. A recent study by Paul Moran and his associates summed up their findings in this way:
Although most adolescent self-harming behaviour appears to resolve spontaneously, our findings indicate that young people who self-harm are at substantial risk of heavy and dependent substance use in their third decade of life.*
Summing It Up
Self-harm is a way someone is communicating the pain and distress they are feeling. Often, it is a pain resulting from unresolved traumatic experiences. It is vital that children, teens, and young adults have the support they need to address not only unhealthy coping behaviours but also the underlying trauma as well. If not, then they remain at a much higher risk of continuing with unhealthy coping tools and moving into substance misuse and addiction disorders.
Research shows some adolescents who self-harm develop other concerning behaviours that also pose serious health risks that continue on into adulthood – specifically disordered eating and substance use.
Substance use in adulthood following adolescent self-harm: a population-based cohort study
Moran, Coffey, Romaniuk, et al.
Acta Psychiatrica Scandinavica 2015: 131: 61–68