Self-Harm: Myths, Facts, & Treatment

What is self-harm?

Self-harm is the intentional damaging of one’s own body without intending to die. Smoking, drugs, purging, etc. are not done with the intention of damaging one’s body tissue in the moment, therefore are not considered self-harm behaviors.

Self-harm behaviors include: cutting, burning, skin picking, head banging, biting, and hitting, among others. When someone self-harms they can see the damage in that moment.The other qualifying factor is that the self inflicted injury works to modulate the present distress every single time.

MYTH: People self-harm to get attention and manipulate others.


MYTH #1: Only girls self-harm. 
Self-harm exists across all genders, social classes and cultures and is equally common among males as females.

MYTH #2: People who self-harm are trying to kill themselves. 
In fact, most who self injure do so moderate their emotional experience

MYTH #3: Self-harm is not dangerous.
While some people don’t harm themselves very often or never need medical attention for their self-harm it can be easy to make this mistake. Three associated factors described under FACT contribute to make this a false belief.

MYTH #4: People self-harm to get attention and manipulate others.
This is a dangerous assumption. First, we cannot assume to know what another person intends by their behavior and two all humans need love and attention from others. Sometimes that need is so strong or unmet that the person will accept negative attention rather than go without. Second, perpetuating this myth and the associated name calling, “crazy” “sick” and “irrational” increases the stigma associated with the behavior making it more difficult for people to ask for needed help.

MYTH #5: The worse the injury, the worse the distress. 
There is no correlation between the level of distress and the severity of the injury. Even a scratch may indicate serious levels of emotion dysregulation.

MYTH #6: Only people with borderline personality disorder self-harm.
People who don’t have BPD also harm themselves. Self-harm is seen in a number of different disorders including depression, PTSD, dissociative disorders, and eating and anxiety disorders.

bruised and bleeding fingernails on a child's hand

FACT: There is nothing pathological about self-harm. It is a behavior that people learn works to help them manage intense emotions.

8 facts about self-harm:

FACT #1: A person who self-harms is most likely experiencing some terribly painful emotions and is trying to cope in the way that works best for them. 

FACT #2: Some people build tolerance and need more and more serious self-harm to get the same relief or wanted effect.
Others have to get closer and closer to lethal self-harm in order to get the same thrill, rush, or relief. Regardless, the potential for a life-threatening situation is clear.

FACT #3: Some people self-harm while they are in a dissociated state. They may not be aware of how seriously they are harming themselves.

FACT #4: Self-harm is one of the best predictors of eventual death by suicide.
This is partly because people who hurt themselves are at risk of accidentally taking it too far. Also, many people struggle with both suicidal behaviors and self-harm. Since in the long-term self-harm can increase shame and self-hatred, experiencing these emotions might make it more likely the person would try to kill themselves.

FACT #5: There is nothing pathological about self-harm. It is a behavior that people learn works to help them manage intense emotions.

FACT #6: Today the behaviors are common among middle school, high school students as well as those higher level education approximately 20% of HS students and up to 40% of college students have self-harmed, (15-17% regularly), and it is more common than schizophrenia, bipolar disorder, and eating disorders.

FACT #7: Although most people who report self-harm say they began the behavior around age 13-14 some people report beginning as early as 5-6 years old.
When the behavior begins at such an early age it’s usually a sign of severe problems such as abuse, neglect, or extremely stressful situations.Not surprisingly, when the behavior begins at such an early age it is likely to last longer and be more severe than in those who begin later.

FACT #8: Similar to other impulsive behaviors, most people stop harming themselves as they get older. While it does occur, it is pretty unusual to see self harm in people ages 40-55 and above.

grayscale photo of a young man with his hands covering his face

symptoms of self-harm

Signs and symptoms of self-injury may include: 

  • Old or new scars
  • Fresh cuts, scratches, bruises or other wounds
  • Excessive rubbing of an area to create a burn
  • Keeping sharp objects on hand
  • Wearing long sleeves or long pants, even in hot weather
  • Burn marks on the skin
  • Scratching or picking at the skin
  • Hitting or punching either themselves or an object
  • Deliberately breaking of bones
  • Pulling out hair
  • Carving words or symbols on the skin
  • Piercing the skin with sharp objects

Self-harm usually occurs in private, and any area of the body can be targeted. Frequently the arms, legs, or front torso are chosen because these can be covered and hidden allowing for the self-harm to continue in secret. Some people self-harm only a few times and then stop but others will continue, creating a long-term repetitive behavior.

man covered with coat, long pants and turtleneck

Some reasons people self-harm:

  • To temper an emotional experience that feels intolerable so they can feel better
    Trying to feel something rather than feel numb
  • To communicate the distress they are feeling because they don’t have the words to
    describe their emotional experience
  • To release negative emotions and pain
  • To distract from emotional pain
  • To punishment themselves
  • To get a rush or a high

How & why does self-harm work?

It’s a mix of chemistry and physiology:

  • There is a rush of adrenalin experienced plus an endorphin release that can provide a thrill, rush or release, relaxation, and/or calm which for many has a very addictive component. Like an opioid, self-harm can hook people and be very difficult to stop.
  • Again, as with some drugs, self-harm is a quick and easy way to feel better right away. Thus the person often experiences powerful urges to engage in the behavior. They could even spend hours thinking about the behavior, planning to engage in the behavior, and finding a time and place they can engage. Something as mundane as seeing a razor or lighter can trigger urges. Happily there are skills one can learn and practice to manage and resist these urges.
  • Much like with drugs, a lot of people who self-harm go back and forth with wanting to stop and and not wanting to stop, at times believing it isn’t possible to stop.

If you never feel good or never feel anything, it can be tempting—at least in the the short term—to induce any pleasurable sensation that is strong enough to register in your brain and keep you functioning.

Unfortunately, shame comes up as soon as the effects have dissipated creating a new negative emotion state which starts the cycle off again.

The act of self-harm can result in short-term expressions of love and concern in the environment.

The human need for love and belonging is powerful as is the reinforcement that comes from being noticed, especially when you don’t have the skill to ask for what you need, or the environment dismisses your emotional needs as unimportant or “too much.”

When emotions are strong and a person believes they are powerless to tolerate or change them, the relief associated with everything from anticipating the behavior, engaging in the behavior, and the associated aftereffects provides a false but immense sense of power and control.

Self-harm affects the lives of the loved ones as well as the individual who engages in the behavior(s). It can be terrifying and often people don’t know what to say. At times, what they say can make the problem worse. Self-harm damages relationships, makes it more difficult to handle stress, and triggers tremendous shame. Stigma around the behavior is powerful and harmful. There is nothing pathological about self-harm. It is a behavior that people learn works to help them manage intense emotions.


causes of self-harm

There’s no one single or simple cause that leads someone to self-harm. In general, though, it is thought that non-suicidal self-harm is usually the result of an inability to cope in healthy ways with psychological pain.

The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-harm is complex e.g. there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality. Additional factors may include innate personality and other mental health problems.

Certain risk factors may increase the risk of self-harm, including:

  • Age
  • Having friends who self-harm
  • Life issues: neglect, abuse or other traumatic events
  • Mental health issues: borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders
  • Excessive alcohol or drug use

There has been a great deal of study over the last 20 years as scientists and researchers attempt to answer the same questions which you have probably asked yourself:

  1. What would cause anyone to injure themself ?
  2. Why do some people self harm yet others don’t?
  3. Are there risk factors that can predict that a person might be vulnerable to self injuring?

In this day and age we look to the brain first for answers and there has been some solid evidence gathered to suggest the following:

  1. The areas in the brain that seem to be directly related to self harm are the same areas that are related to the experience of pain and distress.
  2. The pain relief system called the opioid system, and the emotional system called the serotonin system are all involved


Serotonin is a neurotransmitter that regulates many things including mood, hunger, aggression, and sleep.

Some solid research suggests that people who self-harm could have less serotonin activity in the synapses (spaces) between the neurons in their brains than other people, creating a risk factor for self-harm.

One of the problems associated with too little serotonin is irritability, so the lower a person’s serotonin activity, the more likely they will act on their irritability by doing something impulsive or aggressive. Self-harm is considered to be an aggressive behavior.

Since people self-harm when they feel upset, those with less serotonin activity in their system may experience a lot of distress and thus be at risk for self-harm.

the Opioid System

Endogenous opioids are another set of neurotransmitters that function in areas of the brain that control, pleasure, euphoria, and pain relief. They work like the drugs heroin, morphine, or oxycodone.

Opioids are released when a person experiences pain—they are the bodies all natural pain management system. When athletes talk about “runners high,” they are describing the rush of endorphins they get when they exercise.

Some research indicates that people who self-harm have overly active opioid systems which makes them vulnerable to experiencing a large burst of opioid activity when they get hurt that is more than what others experience.

People who have a strong opioid response most likely experience pleasure, calmness, and relief or even a sense of euphoria from self harming. It’s possible for the individual to get “hooked” on the behavior.

Treatment of self-harm

There is no one treatment plan for self-harm and it is based on the needs of the individual being treated taking into account any other mental health-related issue. Psychotherapy also known as talk therapy or psychological counseling can help the individual identify and manage the underlying issues that trigger self-harm. Several types of individual psychotherapy may be helpful, such as:

  • Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
  • Dialectical behavior therapy (DBT), a type of CBT that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others.
  • Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination, guided by a therapist.
  • Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression and improve your general well-being.

In addition to individual therapy sessions, family therapy or group therapy also may be recommended. Don’t forget that as parents and a family you, too, need support so consider therapy for yourself and any siblings.

If the person injures themselves severely or repeatedly, the doctor may recommend that they be admitted to a hospital for psychiatric care. Hospitalization, often short-term, can provide a safe environment and more intensive treatment until they get through a crisis. Day treatment programs also may be an option.

If your family is in need of additional support, I am here to help.

This information is not a substitute for professional advice from a Medical Doctor, Psychiatrist, or Licensed Counselor. The information provided by does not constitute legal or professional advice nor is it intended to be.
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