Self-injury, also called self-harm, is a behaviour in which individuals deliberately hurt themselves. Often not a sign of suicidal intent, this behaviour can be a symptom of underlying mental illness and can further affect the sufferer's mental health. For a full understanding of self-harm, we need to examine its many root causes, the impact it has on mental health, and what works best to treat it.

The Motivations of Self-Harm

Self-harm can serve several psychological purposes, and often it is a form of maladaptive coping. For many people, such behaviour is an effort to release feelings of deep depression and pain. When experiences become too intense or overwhelming, causing oneself physical pain offers immediate distraction and a passive sort of self-control. This is especially true for those with emotional numbness, feeling nothing except the intense pain they experience in their body.¹

On some occasions, self-harm is used as an act of self-punishment. An individual may feel very guilty or shame-filled, so they inflict pain upon themselves to repay perceived failings or imperfections. Self-loathing that is expressed is likely connected with negative cognition about oneself, particularly in this type of situation.

Feelings of being out of control also provoke self-destructive behaviour. For people who feel that their circumstances and emotions are outside of their control, self-harm supplies a necessary sense of order, albeit in a harmful way. The physical harm inflicted upon oneself can sometimes offer relief from mental anguish or a temporary sense of control.

Self-Harm and Mental Health Disorders

People who practise self-harm tend to present with a range of mental health disorders. To be specific, borderline personality disorder (BPD) is one such example. BPD sufferers usually experience intense and fluctuating emotions, where self-harm can become an extension of coping with these mood swings. For individuals with BPD, self-injury can act as both a sign and a coping strategy for emotional pain, while also expressing what they feel inside.

Depression is another mental health condition closely associated with self-harm. People experiencing depression may use self-injury to cope with emotions that feel both intense and overwhelming. This self-harming behaviour can become a way for people struggling with depressive moods to express inner turmoil and temporarily fill an emotional void.

Anxiety disorder, characterised by persistent and excessive worry, can also be linked to self-harm. Sufferers sometimes use self-injury as a means of diversion from the irritability that is their constant companion. Similarly, post-traumatic stress disorder (PTSD) can lead to self-harm as an attempt to cope with intruding thoughts or distressing memories resulting from traumatic events.²

The Psychological Impact of Self-Harm

Self-harm may come with considerable psychological effects. The relief from emotional pain provided by self-injury does not usually last long. People may feel increased shame, guilt, or self-aversion after self-harming, which merely fuels their emotional distress ahead of repeating the cycle.

This behaviour may also lead to increased isolation. Many self-harmers feel they cannot tell others about their experiences for fear of being judged or misunderstood. This secrecy leads to a lack of social support and increases their feelings of loneliness or alienation even further.

Self-harm also has wider implications for mental health. This behaviour can become a habituated response to emotional distress, making it difficult for people to develop healthier coping mechanisms. Over time, reliance on self-harm hinders the development of adaptive coping strategies and contributes to ongoing psychological distress.³

Effective Strategies

Confronting self-harm requires a comprehensive and multifaceted approach involving immediate care, psychotherapy, medication, and support strategies.⁴

Immediate Care

The initial focus of treatment frequently concerns healing physical injuries caused by self-harm. This may involve medical attention to close wounds and appropriate safety precautions. Another crucial component of immediate care is preventing further harm and treating any physical complications stemming from self-injury.

Psychotherapy

Therapy is fundamental to the treatment of self-harm. Cognitive Behavioural Therapy (CBT) is widely used to help individuals recognise and alter harmful thought and behaviour patterns. CBT enables people to find healthier methods of coping and to manage emotional pain more effectively. By addressing the thoughts and actions that lead to self-harm, CBT encourages clients to seek other ways of dealing with their feelings.

Another effective therapy for self-harm, particularly for those with borderline personality disorder, is dialectical behaviour therapy (DBT). This method focuses on learning to manage emotions and reduce self-harming behaviours, as well as improving interpersonal relationships. It combines individual therapy with instruction in areas such as emotion regulation, distress tolerance, and mindfulness techniques.

Other therapeutic approaches, such as psychodynamic therapy or Acceptance and Commitment Therapy (ACT), can also prove effective at times. Psychodynamic therapy looks at what caused the self-harm in the first place and how to address such issues going forward, while ACT focuses less on changing thoughts and more on changing one's relationship with those thoughts, helping people accept difficult emotions while committing to healthier behaviours.

Medication

Medication can help treat underlying mental health conditions such as depression and anxiety, and may be used alongside other therapies for individuals who self-harm and also experience these conditions. Antidepressants or anxiolytics may be prescribed to alleviate related symptoms. Medication alone is seldom sufficient to address self-harm, but it can support the goals of psychotherapy when used as an adjunct.

Support and Prevention

It is vital that those who are trying to help themselves or their loved ones overcome self-injury build a supportive network. Family members, friends, or support groups can provide invaluable emotional support. Meeting others with similar hardships helps people see that they are not alone, offering hope for the future.

Preventive measures are also essential, including building and practising skills to ensure that periods of emotional upheaval do not lead back into self-injury. Techniques such as mindfulness, creative outlets, and physical activity offer healthy alternatives to self-injury. Recognising and avoiding triggers means identifying situations or emotional states likely to lead to self-harm and finding other ways to cope with these challenges.

Education and awareness about self-injury are important for its prevention and treatment. Educating people, whether they are directly affected by self-injury, their families, or members of the local community, can help reduce stigma and increase awareness of available self-help resources. Greater awareness of the signs and symptoms can lead to earlier intervention and, ultimately, more effective treatment.

Self-harming behaviour is complex and often occurs alongside a range of different mental health disorders. Repeated self-harm can act as a maladaptive coping mechanism to avoid or reduce emotional pain and psychological distress. Self-harm is closely connected with mental health disorders such as depression, anxiety, and borderline personality disorder. It is both a reflection of, and a contributor to, such conditions, particularly those secondary to the primary disorder.⁵

Summary

Successful treatment demands a comprehensive approach, including immediate attention to physical injuries, psychological treatment aimed at underlying issues, therapy for coexisting mental health conditions, and support to help individuals overcome isolation and build stronger coping skills. Combining these methods with increased understanding can help people break the cycle of self-harm and move their overall mental health beyond crisis and toward positive development.

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