Self-harm or non-suicidal self-injury (NSSI) refers to intentionally hurting one’s own body as a way of coping with difficult emotions, painful memories, or overwhelming situations. People who self-harm may do so to express feelings that are hard to verbalise, turn emotional pain into physical pain, take agency or regain a sense of control, or escape traumatic memories. It is paramount to acknowledge that even though self-harm carries risks, it may not always involve suicidal intent.
Some common reasons why people may self-harm include:
- express overwhelming emotional distress
- express difficult feelings
- feel in control, especially when some aspects of one’s life feel out of control.
Overwhelming emotions
In most cases, people who self-harm do it to help them cope with overwhelming emotional pain. This could be caused by social problems, trauma or psychological reasons.
Social problems can include being bullied, having problems at work or school, having difficult relationships with friends, partners, or family, coming to terms with sexual orientation or gender identity, or coping with familial or wider societal expectations.
Trauma can be linked to myriad issues including physical, emotional, or sexual abuse, a life-changing event such as a close bereavement, having a miscarriage, or divorce. Other forms of trauma can date back to childhood attachment issues, witnessing or experiencing domestic violence.
Psychological causes can take many forms including having repeated thoughts or voices telling them to self-harm, dissociation – losing touch with who they are and with their surroundings, or specific conditions such as borderline personality disorder (BPD).
Self-harm can also be linked to anxiety and depression. These mental health conditions can affect people of any age.
Express difficult or hidden feelings
It’s not uncommon to feel numb or empty as a result of overwhelming feelings. Self-harm may provide a temporary sense of feeling again or a way to express negative emotions. It can turn invisible thoughts or feelings into something visible.
You may also be trying to:
- change emotional pain into physical pain
- escape traumatic memories
- punish yourself for feelings or experiences
- stop feeling numb, disconnected or dissociated, or
- express suicidal feelings and thoughts without taking your own life.
Forms of self-harm
Self-harm can present itself in various ways, including:
- cutting yourself
- over or undereating
- biting yourself
- picking, scratching, or burning your skin
- hitting yourself or walls
- misusing alcohol, prescription and recreational drugs
- hair pulling
- having unsafe sex
- getting into unwinnable fights.
Signs of self-harm
People who self-harm may try to hide it from those around them. However, if you think a friend or relative is self-harming, look out for telltale signs, including:
- unexplained cuts, bruises or cigarette burns – usually on the wrists, arms, thighs and chest
- keeping themselves fully covered at all times, even in hot weather
- pulling out their hair
- misusing alcohol or drugs
- self-loathing and expressing a wish to punish themselves
- speaking about not wanting to go on and wishing to end it all
- becoming very withdrawn and not speaking to others
- changes in eating habits or being secretive about eating
- unusual weight loss or weight gain
- signs of low self-esteem, such as blaming themselves for any problems or thinking they’re not good enough
People who self-harm can seriously hurt themselves. While they are continuing to use this as a ‘coping’ mechanism they are not learning effective ways of managing distress.
Addiction
Addiction is a chronic condition characterised by compulsive engagement in rewarding behaviours or substance use, despite adverse consequences. It involves craving and a powerful urge to continue using a substance or engaging in a behaviour, even when it harms one’s life. Addiction can be associated with substances like drugs, alcohol, and nicotine, as well as behaviours like gambling, sex, shopping, or excessive internet use.
Psychological addiction involves a strong emotional and psychological dependence on a substance, behaviour, or activities. Even without severe withdrawal symptoms, individuals experience an intense mental desire for the addictive substance. For example, users of marijuana may not display physical dependency but can still develop a compelling desire for it, impacting sleep, mood, and appetite.
In terms of physical addiction, this can occur when the body becomes accustomed to a substance, leading to withdrawal symptoms upon cessation. The withdrawal symptoms can include nausea, diarrhoea, body aches, chills, and shakes.
Addiction is a complex mental health condition characterised by behaviour that is difficult to control and continues despite adverse consequences. It can take various forms, including:
- Chemical addiction: This type involves the use of substances such as alcohol, tobacco, opioids, or other drugs.
- Behavioural addiction: Here, compulsive behaviours become addictive, such as gambling, shopping, or excessive internet use.
- Process addiction: This includes addictions related to specific activities, like food (eating).
- Dual diagnosis addiction: When someone experiences both substance addiction and a mental health disorder simultaneously.
- Cross-addiction: When an individual switches from one addictive behaviour or substance to another.
Similarities
NSSI shares experiential similarities with substance use disorders. Here are some key points:
- Language and perception: People who engage in self-harm often describe it using terms associated with addiction, such as “getting clean,” “relapse,” or “recovery.”
- Motivation: The motivations behind self-harm are diverse but often include a desire for reward or relief. Many individuals self-harm to cope with feelings of depression, anxiety, and stress.
- Emotional triggers: Studies note emotional triggers and strong urges in both self-harm and addiction. However, self-harm is primarily perpetuated by negative reinforcement, while addiction involves seeking pleasurable effects and avoiding withdrawal symptoms.
- Risk factors: Substance abuse and self-harm are linked. People with mental health conditions (e.g., depression, anxiety) and those who have experienced trauma or abuse are at higher risk for both.
- Substance use and suicidal thoughts: People who misuse substances are more likely to experience suicidal feelings and thoughts. The association is due to both immediate effects (such as increased impulsiveness due to binge drinking, for example) and long-term physical and mental health issues experienced in those dependent on substances.
- The most common criteria described were having irresistible urges/cravings and the need to increase self-harm severity to achieve the same effect.
While self-harm is distinct from addiction, there can be some similarities. The main reason why people self-harm is to seek and obtain relief from intense emotional experiences like distress or sadness. Alcohol and drugs can serve a similar function, but these substances are also frequently used (and misused) by people experiencing positive feelings.
Although addiction is typically discussed in conjunction with substances, many experts believe that behavioural addictions have similar effects on the brain. Like drugs, certain behaviours may trigger your brain’s chemical reward system, creating a situation where you start to crave the relief or reward of the behaviour. In this way, self-harm can serve as a form of behavioural addiction just as shopping, gambling, or sex does. However, this doesn’t necessarily mean that self-harm is always an addiction as they may have different underlying motivations and require tailored treatment approaches.
Seeking support
- consult your GP as the first step
- talk therapies in one-to-one or group settings
- support groups in the community
- online support
- treatment for scars.
It is important to remember that it is possible to live without self-harm. With the right help and support most people who self-harm can and do fully recover. Seeking support from professionals and those around you is the first step on the path to recovery.