Why Do People Self-Harm? Understanding, Recognizing, and Addressing It

Finding out that cuts, burns, or bruises on your child were self-inflicted can be overwhelming. You’ll likely wonder “Why would my child do this? Why do people self-harm? What do I do now?”

Unfortunately, self-harm, or the act of intentionally damaging or inflicting pain on yourself, is a significant problem for young people.

• Medical claim reports for intentional self-harm among adolescents ages 13 to 18 increased 99.8% between April 2019 and April 2020, according to FAIR Health’s analysis of over 32 billion private health claims.
• According to the most recent Centers for Disease Control and Prevention statistics, in 2018, 312,000 emergency department visits were for self-harm.
• An analysis of studies published in the Journal of the American Academy of Child and Adolescent Psychiatry reported that 16.9% of people will self-harm during their lifetime, and the average age people start to self-harm is 13.

Given all of this, it’s imperative that parents and loved ones learn not only how to spot the signs of self-harm but also the underlying causes behind this behavior. To help, we spoke with Kevin Randall, the executive clinical director at Fulshear Treatment to Transition, a program that treats young adult women for depression, anxiety, mood disorders, trauma, and personality disorders.

Having worked with many clients who engage in self-injury, Randall has an insightful perspective on the issue, including the question “Why do people self-harm?” Here, he clears up misconceptions about self-injury and explores effective ways to treat the behavior.

What Is Self-Harm?

Although many believe people self-harm because of suicidal tendencies, Randall emphasized that self-injury is different from suicide attempts.* Where suicidal people are trying to end their lives, those who self-harm are trying to cope with intense emotional pain.

It’s important to note that mental or emotional conditions such as depression, anxiety, or borderline personality disorder cause many emotions, including guilt, shame, and anxiety, to overwhelm a person’s mind and body. Seeking a way to gain a sense of control over this emotional pain, a person may resort to extreme measures, including self-mutilation.

“I’ve heard people say that the physical pain is so much better than the emotional pain,” Randall said. “They can’t do anything about the emotional pain, but they can control the physical pain.” 

He noted that the endorphins the body produces to deal with physical pain can temporarily make a person feel better and distract them from their emotional pain. However, he’s also found that after that immediate release, people who self-harm feel a sense of shame that leaves them in a dark place.

The most common methods of self-harm are skin cutting (70%-90%), head banging or hitting (21%-44%), and self-burning (15%-35%), according to Mental Health America.

Open vs. Hidden Self-Harm

Randall noted that some people will be open about self-harm while others won’t. For example, some will display their injuries publicly or discuss them with peers. Randall said that while these people sometimes do this to form connections with others, it’s often a way of seeking support or trying to get help.

“A lot of people would call them attention seeking or manipulative, but don’t look at it that way,” he stressed. “What we have here is somebody who’s in distress and doesn’t have the skill or language or ability to get their systems calmed down in any other way. They need somebody to understand the distress they feel inside.” 

Others, Randall said, practice self-harm in secret to combat feelings of hopelessness and emptiness.

“They’re hiding injuries under clothing, and if they get discovered, it’s by accident,” Randall explained. “And that’s scary because there’s no one aware of the level of distress they’re in. So, you look for a level of isolation, feelings of depression, a despondent type of person. That in and of itself won’t indicate they’re self-injuring, but self-harm is one of the self-destructive behaviors they can engage in.”

Consequences of Self-Harm

Although people who self-harm or have a self-harm relapse are not seeking to kill themselves, Randall acknowledged that actions such as cutting can result in more serious injuries, often by accident if the person is using a new razor blade that’s sharper than they thought.. Some can end up in the emergency room if they accidentally cut too deep. For example, they may use a new blade that’s sharper than they expected or an unfamiliar object such as a broken piece of glass.

In addition, mental health can continue to decline as a person regularly practices self-harm, causing them to sink further into depression and distress and perhaps eventually into suicide attempts if they don’t receive needed care.

It’s important to note that those who use self-injury to connect with others reinforce a negative self-harm pattern that causes them to keep hurting themselves. They can also:

• Burn out relationships if others become frustrated by the self-injury continuing and therefore feel helpless, hopeless, or afraid for the person who’s harming themselves.
• Get stuck in unhealthy relationships with people who also self-injure.   

Treating Self-Harm Behaviors

“Self-harm is an attachment issue,” Randall said. “It’s a relational issue. So, treating self-harm isn’t entirely about finding coping skills. It’s about finding healthy ways to seek comfort and support and security within relationships with other people. Because when we have that, there isn’t a need for self-injury.”

Randall emphasized that parents and mental health and medical professionals should avoid invalidating, dismissing, or discounting what young people who self-harm are going through. Such remarks can cause a person to feel more isolated. Unhelpful remarks his clients have heard in the past include:

• “Just don’t worry about it. It’s going to be fine.”
• “Just don’t cut yourself, OK?”
• “You’re just overly sensitive.”
• “You’re just attention seeking.”
• “If you use coping skills like drawing or taking a walk, you’ll be better.”
• “You just need to change your attitude.”

To best support self-harming individuals, be available to offer responsive and secure help, not only for immediate self-injury but also long-term emotional well-being. A mental health professional will be a critical partner in this process. A therapist can work closely with your child to treat any underlying issues and recommend if a higher level of care, such as a short-term residential treatment center, is needed.

Randall also recommended that parents promote trusting relationships with their child by:

• Being available to “sit with them in the dark of their pain” without pushing them into anything they aren’t ready to do.
• Validating the difficulty of overcoming self-harming behaviors and acknowledging their efforts.
• Exhibiting patience and telling your child you want to connect with and support them.
• Naming emotions your child may be feeling to help them connect with what they’re experiencing as well as help them experience that they’re seen, known, and matter.

“People sometimes believe self-harm is within a person’s control to stop immediately,” Randall said. “Even if they did stop, it wouldn’t resolve the difficulties that led them to injure themselves in the first place. They need connection and relationship. They’re not in need of someone to shame them or give them advice. They need someone who will listen, someone to understand. They need someone to get to the depth of the pain with.”

Working With a Mental Health Professional

If your child is already working with a therapist, make sure that person is aware your son or daughter is self-harming and provide as many details as possible, such as when it started, what method your child is using, and any recent events that may have triggered the behavior. This will help ensure the therapist has a full picture of the situation and can provide the best care possible.

If your child is not seeing a therapist, you can find one near you by using the Psychology Today search tool.

*This article is for informational purposes only and not to be considered medical advice. If your child is having a mental health emergency, contact the 988 Suicide & Crisis Lifeline for immediate support by calling, texting, or chatting 988. You can also text HOME to 741741 -the Crisis Text Line- from anywhere in the country to talk with a trained crisis counselor.

Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!

Related Posts:

• What Is Suicidal Ideation in Teens?
• How to Discuss Thoughts of Depression and Suicide.
• When Suicide Prevention Involves Your Own Teen.
• What Parents Need to Know About Preventing the Tragedy of Teen Suicide.
• How to Actually Listen to Your Teen.
• The Journey: Stories of Healing at Short-Term Residential Treatment Centers.
• 9 Successful Family Traits.