Self-harm

Based on Wikipedia: Self-harm

In 1896, two American eye doctors named George Gould and Walter Pyle sat down to categorize something that had puzzled physicians for centuries. They divided cases of self-inflicted wounds into three groups: those driven by temporary madness, those with suicidal intent, and those motivated by religious fervor. It was a tidy system for something deeply untidy—the human impulse to hurt oneself.

More than a century later, we're still trying to understand it.

What Self-Harm Actually Is

Self-harm is exactly what it sounds like: intentionally causing damage to your own body. The most common forms include cutting skin with sharp objects, scratching with fingernails, hitting oneself, or burning. But here's what surprises many people: self-harm is, by definition, not a suicide attempt.

This distinction matters enormously.

People who self-harm are typically not trying to end their lives. Instead, research suggests they're using physical pain as a coping mechanism—a way to manage overwhelming emotional distress, to communicate something they can't put into words, or to feel something when numbness has taken over.

That said, the relationship with suicide is complicated. People who self-harm are statistically more likely to eventually die by suicide, and somewhere between 40 and 60 percent of people who die by suicide have previously harmed themselves. Yet only a minority of those who self-harm ever become suicidal. It's a correlation, not a destiny.

The Many Reasons Why

If you've never experienced the urge to hurt yourself, the behavior can seem baffling. Why would anyone deliberately cause themselves pain?

The answers are varied and often layered on top of each other. Some people describe using self-harm as a release valve for unbearable anxiety or depression. The physical pain provides a momentary escape from emotional anguish that feels even worse. Others report feeling emotionally numb—disconnected from their own lives—and use self-harm to feel something, to prove to themselves they're still alive and present in their bodies.

Research has identified several distinct functions that self-harm can serve:

• Self-punishment — Studies show strong support for this motivation. People may hurt themselves because they believe they deserve to suffer.
• Anti-dissociation — When someone feels disconnected from reality, physical pain can serve as an anchor back to the present moment.
• Interpersonal influence — Sometimes self-harm communicates distress to others when words fail.
• Anti-suicide — Paradoxically, some people use self-harm as a substitute for suicide, a way to release overwhelming feelings without ending their lives.
• Sensation-seeking — For some, especially those who feel chronically numb, any intense sensation becomes desirable.

What's particularly important to understand is that self-harm doesn't only occur in people with diagnosed mental disorders. It can happen in otherwise high-functioning individuals who have no underlying psychiatric condition. The behavior often emerges as an attempt to cope with trauma, stress, or circumstances that exceed a person's other coping resources.

The Shadow of Trauma

Childhood abuse casts a long shadow over self-harm statistics. Researchers have accepted abuse during childhood—physical, sexual, or emotional—as a primary social factor that increases the likelihood someone will self-harm later in life. The connection makes a certain terrible sense: children who experience abuse often grow up with disrupted relationships to their own bodies, confused boundaries between pain and care, and limited emotional regulation skills.

But trauma isn't the whole story. Bereavement can trigger self-harm. So can troubled relationships with parents or romantic partners. Broader societal factors play a role too: war, poverty, unemployment, and substance abuse all correlate with higher rates of self-injury.

Researchers have also identified psychological patterns that predict self-harm: feelings of being trapped, a sense of defeat, not belonging anywhere, perceiving oneself as a burden to others. People who self-harm often describe feeling like they have no other options—that this is the only thing that provides relief, the only language they have for their pain.

When It Begins

Self-harm typically first appears during adolescence. This isn't coincidental.

Two studies found that self-harm correlates more strongly with pubertal stage than with age itself—particularly the end of puberty, peaking around age fifteen for girls. The teenage brain is still developing the neural architecture for emotional regulation. Adolescents face intense social pressures. Depression, alcohol use, and sexual activity all independently contribute to the risk. Add together a developing brain, overwhelming emotions, and a culture that often dismisses teenage distress as melodrama, and the conditions are ripe.

Transgender adolescents face particularly elevated risks. Gender dysphoria—the distress that comes from a mismatch between one's gender identity and assigned sex—combined with higher rates of bullying, abuse, and mental illness create a perfect storm.

Self-harm in childhood, while once relatively rare, has been increasing since the 1980s. At the other end of life, older adults who self-harm face different patterns: self-poisoning (including intentional overdose) is by far their most common method, and their risk of serious injury and death is higher than in younger people who self-harm.

The Concealment Problem

One of the most challenging aspects of self-harm is how often it hides.

People commonly injure areas of their bodies that clothing easily covers: forearms, thighs, torso. They may use makeup or tattoos to disguise scars. They may harm themselves in ways that leave less visible evidence. The stigma surrounding self-harm drives much of this concealment—the fear of being seen as attention-seeking, mentally unstable, or weak.

This creates a cruel paradox. The shame that leads to hiding often prevents people from seeking help, which allows the behavior to continue and potentially escalate.

Not everyone hides, though. Some people don't conceal their wounds because the wounds serve a communicative function. They're trying to show others what they can't say—seeking validation, protection, or simply acknowledgment that something is very wrong.

The Connection to Mental Health Conditions

While self-harm can occur without any diagnosed mental illness, it frequently appears alongside psychiatric conditions. The overlaps are significant:

Borderline personality disorder has perhaps the strongest connection. As many as 70 percent of people with this condition engage in self-harm. Borderline personality disorder is characterized by intense emotional instability, troubled relationships, and a fragmented sense of identity—all factors that can make self-harm's temporary relief appealing.

Approximately 30 percent of autistic individuals self-harm at some point, often in forms like eye-poking, skin-picking, hand-biting, or head-banging. For some autistic people, self-injury may serve as a response to sensory overload or as a form of self-regulation when other coping mechanisms aren't available.

Self-harm also correlates with eating disorders, depression, bipolar disorder, anxiety disorders, and dissociative conditions. Among people with schizophrenia, self-harm is common and serves as a significant predictor of suicide risk.

There's even an interesting parallel with factitious disorder—a condition where people fake illnesses to receive medical attention. Both may share a common ground: inner distress that manifests as harm directed at one's own body.

Substance Use and Self-Harm

Alcohol deserves special mention. A study examining self-harm cases that arrived at emergency rooms in Northern Ireland found alcohol involved in nearly 64 percent of presentations. Alcohol lowers inhibitions, impairs judgment, and intensifies emotional states—all of which can transform a fleeting urge into action.

Benzodiazepines—a class of sedatives that includes drugs like Valium and Xanax—are associated with self-harm both during active use and during withdrawal. The withdrawal process in particular can involve intense anxiety and emotional dysregulation that may trigger self-injury.

Cannabis presents a more complicated picture. A 2021 analysis of multiple studies found a significant association between cannabis use and self-injurious behaviors, particularly with chronic use and when depressive symptoms or other mental disorders are present. However, earlier research suggested cannabis might not be a specific risk factor for deliberate self-harm in younger adolescents.

Smoking, too, has been linked to both self-harm and suicide attempts in adolescents, though researchers aren't yet certain whether this reflects a causal relationship or shared underlying factors.

A History of Misunderstanding

The 20th-century psychiatrist Karl Menninger is often credited with first clinically characterizing self-harm, but the behavior itself is ancient. What Menninger contributed was a framework for understanding it.

He saw self-harm as what he called "partial suicide"—an attenuated expression of a death wish that stopped short of actual death. His classification system ranged from the mundane (nail-clipping, hair trimming) to the severe (self-amputation, genital mutilation), with many gradations in between. He included religious self-flagellation, puberty rites like circumcision, and what he termed "neurotic" behaviors like extreme hair removal.

Later researchers refined these categories. In the 1970s, one psychiatrist distinguished between "delicate" cutters—typically young, with multiple episodes of superficial cuts—and "coarse" cutters, who were older and often psychotic. Another pair of researchers divided self-harm into nine groups based on method: cutting, biting, abrading, severing, inserting, burning, ingesting, hitting, and constricting.

Perhaps most useful was the distinction made by researchers Favazza and Rosenthal between culturally sanctioned self-harm and deviant self-harm. The former includes rituals passed down through generations—reflecting the traditions and beliefs of a society—as well as more casual practices like ear piercing. The latter is what we typically mean today when we discuss self-harm as a clinical concern.

The Language We Use

The terminology around self-harm has evolved and remains inconsistent, which has actually made research more difficult.

Self-harm, self-injury, nonsuicidal self-injury (often abbreviated as NSSI), and self-injurious behavior all describe essentially the same thing: intentional tissue damage performed without suicidal intent. The word "deliberate" was once commonly attached to these terms but has fallen out of favor—some view it as presumptuous, as if questioning whether the person really meant to do it.

Older and less common terms include self-mutilation, self-abuse, and self-destructive behavior. Some clinicians have proposed "self-soothing" as intentionally positive language to counter negative associations, though this hasn't gained widespread adoption.

The confusion deepens because different countries and different sources draw the boundaries differently. Some definitions include drug overdoses and eating disorders under the self-harm umbrella. Others explicitly exclude them. In the United Kingdom, official definitions often include suicidal acts alongside nonsuicidal ones. This lack of standardization makes it harder to compare studies and develop consistent treatment approaches.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders—the DSM-5-TR, the handbook American psychiatrists use to classify mental conditions—lists nonsuicidal self-injury as a "condition that may be a focus of clinical attention" rather than as a standalone disorder. The criteria require five or more days of self-inflicted harm over a year, without suicidal intent, motivated by seeking relief from negative emotional states, resolving interpersonal difficulties, or achieving a positive feeling.

Beyond Humans

Here's something that might surprise you: humans aren't the only animals that harm themselves.

Captive birds and monkeys are known to engage in self-injurious behaviors. This observation has provided researchers with clues about the environmental factors that contribute to self-harm—particularly the role of captivity, stress, and limited control over one's circumstances. When animals can't escape stressful situations, some turn their distress inward.

There's also a rare genetic condition called Lesch-Nyhan syndrome whose most distinctive feature is uncontrollable self-harm. People with this condition may compulsively bite their fingers, lips, and the inside of their mouths, or bang their heads—behaviors they often report wanting to stop but being unable to control. This suggests that for at least some forms of self-injury, the roots may be partly biological.

Genetics may also contribute indirectly by increasing vulnerability to anxiety, depression, or other conditions that can lead to self-harming behavior. However, the direct link between genetics and self-harm in otherwise healthy individuals remains largely inconclusive.

The Road to Recovery

Treatment for self-harm typically takes one of two broad approaches: addressing the underlying causes or targeting the behavior itself.

The underlying-causes approach means treating whatever is driving the distress—depression, anxiety, trauma, relationship problems. If the emotional pain diminishes, the need for self-harm as a coping mechanism may diminish too.

The behavioral approach focuses on interrupting the self-harm pattern directly. This often involves avoidance techniques that keep the person occupied with other activities, or harm-reduction strategies that replace dangerous methods with safer alternatives that don't cause permanent damage.

What works varies enormously from person to person. For some, therapy that processes past trauma proves transformative. For others, learning new emotional regulation skills makes the difference. Medication may help when self-harm accompanies conditions like depression or anxiety. And sometimes, simply having someone who listens without judgment—who doesn't recoil or lecture—provides the first crack in the armor.

The Scars We Carry

Self-harm can leave permanent marks, both physical and psychological.

Serious injury and scarring are common consequences. And while nonsuicidal self-injury by definition lacks suicidal intent, accidents happen—cuts go deeper than intended, infections develop, situations spiral. Deaths have occurred even when the person didn't mean to die.

Young people with repeated episodes of self-harm are more likely to continue the behavior into adulthood and face elevated suicide risk. For older adults, the picture is complicated by additional factors: financial problems, physical illness, chronic pain, loneliness, and what some describe as the perceived burden of aging. The motivations shift across the lifespan, but the underlying thread—seeking relief from unbearable distress—often remains.

There's a positive statistical correlation between self-harm and having experienced physical, sexual, or emotional abuse. For some survivors, self-harm becomes a way of managing pain—exerting control over their bodies and their suffering in a way they couldn't during their abuse. The harm they inflict now is harm they choose, in contrast to the harm that was once forced upon them.

It's a devastating logic, but it is a logic.

Understanding Without Judging

Self-harm remains deeply stigmatized. People who self-harm often describe being dismissed as attention-seekers, treated as manipulative, or regarded with fear and disgust. These reactions drive concealment, delay treatment, and deepen shame.

What the research tells us is more nuanced. Self-harm is a complex behavior with many possible functions and causes. It occurs across ages, genders, and cultures. It can happen to people with severe mental illness and to high-functioning individuals with no diagnosis at all. It is neither simply a failed suicide attempt nor merely a bid for attention—though it can sometimes function as a cry for help from someone who doesn't know how else to be heard.

Understanding self-harm means sitting with discomfort. It means accepting that sometimes people hurt themselves because, in that moment, it feels like the only option that provides relief. It means recognizing that the person beneath the scars is suffering, and that suffering deserves compassion rather than contempt.

This isn't about condoning self-harm or treating it as harmless. The behavior carries real risks and reflects real pain that deserves real treatment. But responding with judgment typically drives people further into secrecy and shame, making recovery harder.

What helps is being present, listening, and—when appropriate—gently connecting people with professional support. Because beneath the visible wounds lies the invisible one: a person trying, however imperfectly, to survive their own life.