Ask a Therapist: Is Self-Harm an Addiction?

“Is there such a thing as a self-harm addiction? My daughter has been struggling with cutting, and I’m wondering if she’s become addicted to hurting herself.” 

Questions like this show how self-harm can be difficult for parents to understand. The idea that a child could become addicted to harming themselves could be even more difficult to process — as confusing as it is unsettling. It can be difficult for parents to understand.  

According to a Fair Health analysis of over 32 billion private health claims, medical claim reports for intentional self-harm among U.S. teens ages 13 to 18 increased by 99.8% from April 2019 to April 2020. This is a troubling statistic that might have you wondering how to best support your teen — or young adult — so they don’t end up addicted to self-harm. 

To better understand this issue, we spoke with Embark Behavioral Health Clinical Director Brandy Spindel, a licensed marriage and family therapist who works at a short-term residential program in San Martin, California. She’s helped many teenagers who are addicted to self-harm. Spindel shared several causes and signs of this troubling behavior as well as insights on how alternative coping skills can help your son or daughter recover. 

Is Self-Harm an Addiction?

When it comes to the question “Is self-harm an addiction?”, the answer is it can be for some. As Spindel explained, those who self-injure have a difficult time regulating their emotions. By cutting, burning, or otherwise self-harming, they stimulate the endogenous opioid system in their brains, creating sensations like drug or alcohol reactions. 

“When the endogenous opioid system is activated, the body produces naturally occurring chemicals that can make people feel better and relieve stress and pain,” Spindel said. “This relief can cause many teenagers to use self-harm as a dysfunctional coping mechanism and become addicted to hurting themselves.” 

Why Is Self-Harming Addictive?

According to Spindel, one reason why young people can become addicted to self-harm is low emotional control. The brain does not stop developing until around age 25, so teens and those in their early 20s can have a hard time managing their emotions. Spindel said this is especially true for those with trauma. To compensate for their low emotional control, teenagers and young adults can become addicted to self-harm because it makes them feel they’re in control of their emotions. 

Other reasons for developing self-harm addictions include: 

• Gaining a sense of control over life stressors when stress becomes overwhelming. 
• Relieving emotional pain. 
• Processing or distracting from negative feelings like shame or guilt. 
• Self-punishment. 

Why is cutting so addictive for teens?

While self-harm can take many forms, becoming addicted to cutting is common. According to an analysis of multiple studies that was published in the Journal of the American Academy of Child and Adolescent Psychiatry, cutting is the most common type of self-injury among youths ages 12-18, with 45% reporting using that method.   

Spindel, who’s worked with many teens addicted to cutting, said young people who lack the ability to self-regulate their emotions can turn to this type of self-harm because of the sensations it produces. She noted it’s believed to stimulate dopamine production in the brain, and the feelings of relief this hormone helps produce can lead young people to become addicted to cutting.   

What Are the Signs of a Self-Harm Addiction?

What signs indicate a teen is addicted to self-harm? Although Spindel noted the signs below are not exclusive to self-harm and can indicate other mental health issues, you should pay attention to the following: 

• Wearing long-sleeved shirts and pants: This is a common indication of self-harm, according to Spindel, especially if a teen covers up during hot weather to hide scars and other self-inflicted injuries. 
• Experiencing sudden mood changes: An upset teenager who goes into their room or a bathroom and emerges suddenly feeling much better could be using something to relieve their pain. This may include drugs, alcohol, or self-injury. 
• Having burns, scratches, bruises, cuts, or broken bones: While these injuries can indicate abuse or a careless lifestyle, they can also be a sign of self-harm addiction. 
• Experiencing feelings of worthlessness and helplessness: A teenager’s emotional state can be difficult to determine. Spindel advised creating nonjudgmental spaces where your child can feel safe sharing their feelings and talking about taboo subjects like self-harm. For example, avoid making statements such as “What’s wrong with you?” or “Why would you do that? That’s not normal.” Instead, make statements like “I love you” and “I’m here for you,” and ask questions such as “How are you doing?” or “Would you like to talk?” Use a soft, loving, and caring tone of voice.  
• Excusing injuries as accidents: “Teens recognize and understand that self-harm is not a healthy way to cope,” Spindel said. Excusing their self-inflicted injuries as accidents can be a way for them to hide their behavior. 
• Withdrawing from friends, family, and social activities: This behavior can also be a sign of depression and is not always linked to self-harm. Nevertheless, both depression and self-harm are issues that need to be addressed. 

Can Teens Suffer a Self-Harm Addiction Withdrawal?

As with any addictive behavior, teenagers — or young adults — who attempt to stop self-injuring can suffer from self-harm addiction withdrawal. This can cause them to relapse.   

“Teens are going to get these urges to self-harm because that’s their way of coping with stress,” Spindel said. “And if they don’t have another coping mechanism to use, and even when they’re learning new coping mechanisms, their brains are going to go straight back to ‘I need to self-harm. I need to have this relief. I need to feel better.’ The physiological sensations they get when they stop self-harming, such as increased irritability, crying, tingling sensations in the preferred self-harm area, and muscle tension, just make it extremely difficult to abstain from the behavior.” 

How To Help Stop a Self-Harm Addiction

Once a teen begins using self-harm to deal with difficult feelings and gain relief through physical pain, it can become a powerful addiction, one you’ll want to address quickly. However, you may be unsure how to stop someone from self-harming. 

While different people respond better to certain techniques, Spindel suggested using a few different strategies, ranging from creating a safe space for your teen to working with a therapist. 

Create a safe space for your teen to experience and share their emotions

Spindel emphasized it’s important to create a nonjudgmental space where your teenager can safely share their feelings. Be accepting and empathetic, and use co-regulation strategies, which are strategies that support your child’s self-regulation. They include providing a warm and caring environment, being in tune with your own emotions and emotional responses, and modeling behaviors and coping skills that support emotional regulation.   

Encourage using self-harm coping skills

Self-harm coping skills can help teens deal with difficult feelings and gain relief in a way that doesn’t involve injuring themselves. These strategies may range from breathing exercises to drawing. However, it’s important to develop several methods rather than focus on a single strategy. This provides teens with a tool kit they can use in multiple situations. You can help your teen develop and practice self-harm coping skills by providing alternatives to self-injury and encouraging use of distraction techniques. 

Provide alternatives to self-harm

Self-harm is a dysfunctional coping skill that teens adopt to deal with stress when it becomes overwhelming. Thus, replacing this damaging method with healthier alternatives is an essential part of the recovery process. Spindel found the following alternatives to self-harm worked well for her clients: 

• Drawing: “I had one kid who told me he liked the scars self-harming gave him,” Spindel said. “So, we got him tattoo markers to draw on his hands and arms while experiencing stress, which was very helpful to him.” Other clients found that drawing pictures of their feelings on paper helped. 
• Mindful breathing: Spindel found that teens who practiced mindful breathing and progressive muscle relaxation could slow themselves down and regulate their emotions during difficult times. 
• Writing: For teenagers who express themselves better through words than images, Spindel suggested getting them to write poems or stories. 
• Singing: Vocalizing feelings through song can be helpful. However, teens can’t always find a private room to sing, so Spindel encouraged developing other coping methods, such as mindful breathing, that are easier to practice in everyday situations. 
• Exercising: This can include a variety of physical activities, from playing sports to running to lifting weights. 

Ultimately, Spindel stressed that working with teens to discover what they like to do is a vital part of coming up with the alternatives to self-harm that work best for them. 

Encourage using self-harm distraction techniques

Self-harm distraction techniques can delay the urge to self-injure when stress becomes overwhelming — and that delay could make the urge to self-harm fade away. Spindel added that some distraction techniques can even develop into coping skills that replace self-injuring behaviors. Some effective self-harm distraction techniques include: 

• Coloring a blank sheet of paper: This, along with doodling or sketching, can help take a teen’s mind off self-harming. If the act of drawing provides relief from stress, it can also become an effective coping skill to replace self-harm. 

• Listening to music: Hearing and even singing along with favorite songs can be an effective distraction technique as well as a coping skill. By wearing earbuds, teens can make this act more private and easier to use in crowded areas. 
• Calling a friend: Chatting with a friend is a good way to relieve stress and distract from self-injuring. However, since talking to someone isn’t always possible, Spindel encouraged teens to develop alternative self-harm distraction techniques. 
• Ripping paper: If a teenager is feeling particularly angry, ripping or crumpling paper can be an effective way of expressing that anger while distracting from more destructive behavior. 
• Holding or squeezing an ice cube: Teens may engage in self-harm when they crave sensation or want to cut through feelings of numbness. Squeezing ice provides a way to feel strong sensations without damaging the body. 
• Reading: Reading requires focus, which can shift initial impulses away from a desire to self-harm. It can also help distract from or alleviate feelings of sadness and depression. 
• Listing good things about themselves: Feelings of guilt can drive teens to self-harm. Reminding themselves about their positive qualities helps shift their mindsets away from guilt and shame. 

Seek treatment for self-harm addictions like cutting

Working with a therapist who specializes in self-harm addiction treatment can help teens — and young adults — recover. When choosing a therapist, it’s particularly important to find one with experience treating cutting if your teen struggles with that issue. 

Spindel found that dialectical behavior therapy (DBT) is particularly effective in self-harm addiction treatment because it emphasizes practicing mindfulness, regulating emotions, and improving relationships with others. These approaches can address the source of the overwhelming stress that’s driving self-injury. She also recommended cognitive behavioral therapy (CBT), which helps teens see the link between their thoughts, emotions, and behaviors, allowing them to change their responses to behaviors like self-harm. 

In her work with clients who cut, Spindel uses a technique known as “harm reduction.” After establishing that a teenager’s cutting behavior does not involve suicidal intent, she works with them to gradually reduce the number of shallow cuts they make when experiencing overwhelming stress. By showing she recognizes that they cut as a coping mechanism, she removes much of the shame surrounding self-harm. In many cases, this allows the self-harming behavior to gradually go away. 

Self-Harm Addiction Wrapup

Teens — and young adults — who struggle to regulate their emotions can develop a self-harm addiction, using self-injury as a dysfunctional coping mechanism to experience emotional relief. While this can be unsettling for parents, it’s important to keep in mind that recovery is possible. 

By creating a safe place for your son or daughter to experience and share their emotions, helping them develop alternative coping skills and distraction techniques, and working with a therapist, you can help them adopt healthier ways to deal with overwhelming stress and process their emotions. Ultimately, being empathetic is key to providing them the support they need so they can overcome being addicted to self-harm.  

“By being understanding and validating their feelings about and reasons for self-harm addiction, including their belief that self-harm actually does help them, we avoid discrediting or dismissing their feelings,” Spindel said. “This will allow the teen to feel less judged and more open to receiving support and exploring other coping methods.” 

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!