Understanding Self-Harm

Self-harm is intentional, non-suicidal injury to one’s body. It is common—as many as 1 in 3 adolescents report they have self-harmed at some point. Self-harm can be scary and difficult to understand. I hope to contribute to greater understanding of self-harm and provide a starting point for intervention. Like most of my blogs, this is an oversimplification and I encourage you to supplement this with your own research.

This post is for those who want a better understanding of some of the dynamics that influence self-harm behavior. This post refers to self harm that is not a result of psychosis, tic disorders, substance use, or otherwise culturally accepted behavior (such as piercing or tattoos). If you are currently self-harming TWLOHA has a great resource page. You can also view 24 hour helplines here.

Why does it occur?

To put it simply, self-harm can be influenced by emotional reasons (such as emotional regulation) or social reasons (like connection or to communicate a need). Self-harm is never is isolation and often signals greater suffering or a need for care. It may be a symptom of an emotional disorder or it may indicate a history of trauma or relational wounding. Experimentation with self-harm is not uncommon, similar to experimentation with other means of coping such as substance use. For some individuals, self-harm becomes chronic or even addictive. It is important to unpack the why and stay curious about the individual behind the behavior.

Communication and Connection

Self-harm always serves a purpose. Sometimes it is about communicating needs. You have probably heard that self-harm is for attention or that it is manipulation. These assumptions are harmful as they often lead others to withdraw care of place judgement on the individual. We need to be curious before critical here. Belonging and connection are fundamental human needs. We long to be seen and heard.

Individuals who grow up in homes that are not conducive to expressing feelings and needs OR where expressing feelings and needs is unsafe, must learn other ways of communicating suffering. We may communicate in indirect ways when we don’t trust our needs will be honored or when having or expressing needs is unsafe.

Self-harm may communicate a desire for care. It may communicate pain in a more tangible way. You cannot bandage emotional hurt, but you can bandage a cut or burn. Self-harm may engage caregivers and friends and it often demands attention. In a world where we crave connection but lack the skills to ask for it, self-harm works to facilitate this need. Self-harm is also common in individuals who fear abandonment because it will keep others engaged. This is unhealthy and violates the boundaries of others. It may eventually lead to resentment, but the immediate needs of the self-harmer will often trump the long-term relational and physical consequences of self-harm.

You may have observed that individuals who self-harm more likely to identify with “emo” or “gothic” subcultures. This is a stereotype that is supported by research. What you may not know is that many individuals who self-harm engage in self-harm prior to identifying with these subcultures. They seek out the subculture after self-harm begins. This may be because these subcultures are more accepting of self-harm—there is less judgment. This alone should speak to the high need for connection and support.

Emotional Regulation

Self-harm is not always about connection and communication. In fact, it is most often an unhealthy means of regulating emotions. We are all equipped with a sophisticated stress response system that helps us manage difficult situations. I will not go into all the science here but as long as the stress is within our window of tolerance (a concept developed by Pat Ogden) we are able to tolerate the difficult feeling associated with the situation without getting stuck in an activated state of fight, flight, or freeze.

Feelings exist for a reason. They are a purposeful part of our human design. Even difficult feelings like anger or anxiety serve a purpose. Anger energizes us and lends us courage to set necessary boundaries as an appropriate response to injustice. Healthy coping requires that we feel the hard feelings—it does not “fix the feelings” or make them go away. But if we have no safe outlet for feelings, if feelings trigger deeper wounds, or if they are outside what we can reasonably manage, we are more likely to seek “coping skills” that allow us to numb or distract us from the feeling rather than coping skills that allow us to tolerate the feeling.

If we were to identify the coping skills that allow us to numb or distract from difficult feelings, we would likely find that most of them provide immediate gratification and many are addictive in nature. Cellular, biological dependency is important to understand in addictive substances. Emotional dependency is important to understand in behavioral addictions. When we numb difficult or distressing feelings, we become less equipped to feel them over time. We become emotionally out-of-shape, dependent on behaviors (or substances) to numb or distract from difficult feelings. When we don’t tolerate hard things, we become less tolerant of hard things—seeking out behaviors or substances more frequently and at more intensity.

The Role of Trauma

But it is more complicated than not tolerating feelings. Individuals who experience trauma, especially trauma that is severe or chronic, may have a sensitized stress response system. This means that their fight, flight, and freeze responses are more easily triggered. Self-harm appears to be related to the freeze response, which involves avoidance, compliance, and dissociation. Dissociation is the sense of being disconnected from the body. It is a normal response to stress and happens to different degrees. During a freeze response, our goal under threat is to endure rather than to act. During dissociation, we experience a physiological response that helps us to separate (dissociate) from our physical experience so that we feel less pain. In fact, our brain will release opiates to aid in this important and amazing survival response.

So what does this have to do with self-harm? Well, an individual with a sensitized dissociative response may feel more “reward” from inflicting pain. Their brain will release opiates earlier and more often than the brains of their non-traumatized peers. The traumatized individual is more likely to repeat self-harm because the pay-off is higher—it feels better. As a result, self-harm becomes an unhealthy but effective means of coping similar to a substance like alcohol. While experimentation with self-harm is relatively normal, traumatized individuals are more likely to engage in chronic self-harm.

In addition to this, traumatized individuals are not always able to control their dissociation, meaning any sign of threat can cause them to essentially “shut down”. Self-harm may help the individual control their dissociative process by both inducing dissociation through the brain’s physiological freeze response when they are overwhelmed or by interrupting a dissociative episode by providing strong physical sensation. Not every individual who chronically self-harms begins with a sensitized stress response. I believe it may also be possible that through the act of repeated self-harm the stress response system becomes more sensitive over time.

Now What?

Self-harm can be complicated. Understanding the dynamics helps use to stay in compassion. Responding to self-harm can feel overwhelming. Read more about responding to self harm here. As always, take care of you and reach out with questions.

Resources:

To Write Love on Her Arms; https://twloha.com/

The Psychology of Self-Injury podcast; https://the-psychology-of-self-injury.simplecast.com/

The Boy Raised as a Dog, Chapter 8, Bruce Perry

Self Harm and PTSD: https://www.ptsd.va.gov/understand/related/self_harm.asp