Self-harm is often a frightening response to stress, depression, and other mental health problems. It’s alarming to loved ones, but it may also surprise and concern you if you engage in it. Why do I do this, and why can’t I stop? Though it seems counter-productive, many people report using it as a release, to feel better in light of overwhelming negative emotions. You may do it to feel something real, despite emotional numbness. Whatever the cause, self-harm is often a coping response when there doesn’t seem to be any other options.
But there are other options.
Treatment for self-harm can give someone the tools to deal with their problems in a way that’s healthy and doesn’t lead to scars and injury. Learn more about self-harm and how it can be treated.
Self-harm is an unhealthy coping response to strong negative emotions. Self-harm is not its own mental health issue, but it can be a symptom of a mental health problem that you have not learned to cope with effectively. Self-harm is associated with multiple mental health issues, including depression, personality disorders, eating disorders, anxiety, and post-traumatic stress. Self-harm may begin out of anger, frustration, or despair.
It’s often described as a release when complex negative emotions are replaced by something more tangible, like physical pain. Some theorize that the pain of self-harm also releases endorphins, a neurochemical that’s similar to morphine that’s designed to manage pain. The release of this chemical may reinforce self-harm as a response to powerful negative emotions.
The warning signs of self-harm may seem obvious, but they may be difficult to distinguish from normal accidental injuries. Small cuts on a person’s arms or legs may be the most commonly associated self-harm injuries, but bruises, scraps, and other wounds may also be associated with self-harm. Plus, injuries may also accompany other symptoms. Signs and symptoms may include:
Self-harm is often associated with intense emotional episodes like despair or outrage. Many people only engage in self-harm once or twice before stopping. However, a pattern of self-harm may develop as you grow accustomed to using it as a coping response to mental and emotional distress.
Drug misuse is often seen alongside mental health problems and issues like self-harm. Both drug misuse and self-harm may present as forms of unhealthy coping responses to negative emotions. Someone struggling with depression or anxiety may start to engage in self-harm as a release. Substance use disorders tend to worsen existing mental health problems. If self-harm is a consistent symptom of a mental health issue, drug use may worsen those symptoms too. Substance use disorders can quickly get out of control. Spiraling mental health issues and a growing substance use problem may make someone feel emotionally overwhelmed, which may increase their risk of self-harm.
Adolescents are often vulnerable to self-harm as a coping response. A 2014 study found that self-harm among adolescents may be a risk factor for later substance use problems. However, this could be because self-harm and substance use issues can have some of the same underlying causes, like unaddressed mental health problems.
Self-harm and suicidal thoughts and behaviors are often associated as one category, but they may be very different for people that experience them. Both suicide and self-harm may come from a place of despair and a feeling of powerlessness. However, people with suicidal thoughts and actions may feel like suicide will be a permanent end to the pain they experience. It often comes with feelings of hopelessness, and no confidence that pain will end or things will get better.
Self-harm is similar, but people that use it as a coping mechanism often feel that it is a remedy to helplessness. They feel better without knowing why. People that engage in self-harm usually don’t set out to fatally wound themselves, just to replace uncontrollable emotional feelings with manageable physical pain.
In fact, the rush of endorphins and adrenaline that comes with self-harm may be seen as a way to affirm life to someone that is emotionally numb. People that use self-harm as a coping mechanism may one day become suicidal, but self-harm itself does not indicate that a person wants to die.
In both self-harm and suicidal cases, people in distress don’t have or don’t yet know the coming skills that can help them through their problems in a healthy way. For both self-harm and suicide, learning positive coping skills may help show them that there are healthy solutions to their problems.
If you or someone you know is struggling with issues that have led to self-harm, there are treatment options available. There is no one perfect treatment plan for someone that has engaged in self-harm, and it may require finding a diagnosis for their underlying issues like post-traumatic stress, depression, or anxiety.
However, the first step in dealing with self-harm is talking to someone like a doctor, therapist, parent, or a trusted friend. Talking about a problem with someone else breaks the feeling of isolation and shame you may have felt in dealing with the problem on your own. There is also comfort in learning that issues like anxiety, depression, and even self-harm are very common, and you don’t have to go through it alone.
Since self-harm is a symptom of a mental health issue, it’s important to identify the underlying problem in order to begin treatment.
Medications are available for problems like depression and anxiety, but there is no one medication for self-harm. To explore pharmacotherapeutic options, it’s essential to speak to a medical professional. It’s also important to realize that medicine isn’t a silver bullet for mental health issues. It may take time to find the right diagnosis, medication, and dosage for your needs.
A pattern of self-harm often calls for a psychotherapeutic approach, especially one in which you can learn healthy coping mechanisms. Talk therapy with a clinician can help you identify causes and triggers of negative emotions, learn skills to manage stress, and find new ways of dealing with overwhelming negative emotions. You may also learn to connect with others, which can help strengthen your support system.
Behavioral therapies are common in treating a variety of mental and behavioral health problems. Cognitive-behavioral therapy (CBT) is particularly useful in treating issues like self-harm. CBT involves a process of identifying common triggers, increasing self-efficacy, and learning coping strategies.
Self-efficacy is a measure of how well you can use coping strategies to overcome challenges. CBT can help train you to identify the roots of overwhelming negative emotions and apply healthy coping skills to avoid unhealthy responses like self-harm, substance misuse, or isolation.
Another behavioral therapy that can be used is dialectical behavior therapy (DBT). The aim of DBT is to help you manage emotions, tolerate stress, and improve your social relationships.
There is no one-size-fits-all treatment plan that works for everyone. Finding the right treatment plan for your needs will be a process that requires commitment and hard work on your part. But if feelings of hopelessness cause you to harm yourself, there are treatment options available to lead to recovery and healthy coping.
Lohmann, R. C., Ph.D. (2012, October 28). Understanding Suicide and Self-Harm. from https://www.psychologytoday.com/us/blog/teen-angst/201210/understanding-suicide-and-self-harm
Moran, P., Coffey, C., Romaniuk, H., Degenhardt, L., Borschmann, R., & Patton, G. (2014, June 23). Substance use in adulthood following adolescent self‐harm: A population‐based cohort study. from https://onlinelibrary.wiley.com/doi/full/10.1111/acps.12306
National Institute of Mental Health. (2018, February). Depression. from https://www.nimh.nih.gov/health/topics/depression/index.shtml
National Institute of Mental Health. (2018, July). Anxiety Disorders. from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
National Institute of Mental Health. (2019, May). Post-Traumatic Stress Disorder. from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml