Understanding Self-Harm and How Therapy Can Support Recovery

When someone is unable to handle distressing emotions in a healthy way, they may turn to self harm to help ease the pain. Thankfully, therapy to prevent self-harm and address underlying issues is available.

Most individuals engaging in self harm are not suicidal; however, their extreme actions and emotional distress should be evaluated by a licensed mental health professional.

What Is Self Harm?

Self harm, clinically known as non suicidal self injury (NSSI), describes behavior in which a person intentionally causes injury to themselves, without the intent to end their life.

The definition and diagnostic criteria of self harm include the following factors:

It is deliberate; a person meant to self harm.
It is non suicidal; there is no intent to end their own life
It is direct, with no intervening steps that influenced the act.
It does not include socially sanctioned actions, like piercings or tattoos.
It is moderately intense, producing some bleeding or bruising.
Harm must occur immediately after the action.

Self harm is typically performed in private and often followed by feelings of shame or guilt afterward. Often, someone who is self harming has other co occurring mental health disorders.

NSSI may refer to any form of self injury, including burning, cutting or hitting. While some mental health disorders, such as eating disorders, are indirect forms of self harm, they are not the same as NSSI.

To be considered self harm, shortly after the act, an individual must exhibit one of the following behaviors:

Relief from negative thoughts or feelings.
The interpersonal problem is resolved.
Mood is lifted and becomes more positive

In addition, at least one of the following must occur right before the self harm act:

Negative thoughts or feelings.
Thoughts about self harm are hard to control.
Frequent thoughts about self injury, even if no act is performed.

A diagnosis of self harm must occur at least five times in the past year to be considered a pattern of unhealthy behavior. Additionally, it cannot be attributed to another medical or psychiatric disorder.

Reasons People Self Harm

People who engage in self harm behaviors typically don’t have adequate coping skills needed to deal with the problems or stress that is occurring in their lives.

They may also self harm for the following reasons:

They feel empty or numb inside and want to feel something.
They want to distract themselves from traumatic memories.
They need to release overwhelming feelings.
They want to punish themselves.
They need to feel in control of their lives.

There are specific risk factors that make one person more likely to do self harm than another.

Myths & Misconceptions

Self harm is often misunderstood. Myths and misconceptions arise from a lack of information or education on the topic.

Myth: People Who Self Harm Are Suicidal.

Truth: NSSI or self harm most often applies to people who do not want to die.

Instead, they are using self harm as a coping mechanism to regulate their emotions. Unfortunately, accidents can happen when an act of self harm goes too far.

Myth: Cutting Is The Most Common Way To Self Harm.

Truth: While cutting may be one way to self harm, it is not the only way.

Some people cause injury by burning, hitting or punching themselves or even banging their heads on objects or surfaces. Self harm is any action that brings immediate injury, including bleeding or bruising.

Myth: People Who Self Harm Want Attention.

Truth: Some people use self harm as a means of crying for help. However, most people who self harm do so in private and go to great lengths to hide their injuries.

They use self harm to alleviate pain because they lack healthy coping skills to process what they are going through.

Myth: There Is No Specific Treatment For Self-Harm.

Truth: There are very effective self injury treatment programs that help individuals develop the healthy coping skills needed to process stress, trauma or negative emotions.

In treatment, a licensed mental health professional will work with their client to create an individualized treatment plan that is based on their unique needs.

Therapy Approaches for Self Harm

Someone engaging in self harm can benefit from working with a licensed mental health professional who specializes in treating this condition, as well as many other commonly occurring mental health disorders.

These co occuring conditions may includesubstance use disorders, depression, anxiety, autism, personality disorders, eating disorders or post traumatic stress disorder ( PTSD).

Mental health therapists may use a variety of treatment modalities to address self harm and co occuring disorders. Some of the most effective therapies include:

Cognitive Behavioral Therapy (CBT)

CBT is a form of talk therapy. CBT helps someone to identify the negative thought patterns that may lead to unhealthy behaviors, like self harm. Individuals learn not only to recognize negative thoughts but also to replace them with positive ones, leading to healthier reactions.

Dialectical-Behavioral Therapy (DBT)

DBT is a form of CBT that incorporates a mindfulness component, teaching individuals to accept their lives and circumstances as they are and make changes to improve them. It also helps people learn how to regulate their emotions, which is difficult for people who self harm.

Integrated therapy approaches are often the most effective. Someone engaging in self harm may require medication for stabilization or to ease symptoms, in addition to psychotherapies like CBT and DBT.

Therapists may also help their clients to create a safety and harm minimization plan as a part of their comprehensive treatment program.

Crisis Resources & Getting Help

Getting help early is crucial in preventing long-term consequences. One way to do this is by early recognition of the signs of self harm.

These may include having frequent injuries, such as cuts and bruises, wearing long sleeves or pants even in hot weather to cover up injuries, making excuses about injuries or lying about how they happenedor having sharp objects around for no apparent reason.

While these signs are not universal, they are common enough to suggest that something may be wrong and warrant further investigation. It is much better to care and be wrong about a situation than to dismiss the signs and allow someone’s mental and physical health to deteriorate.

If you or someone you know needs help, crisis resources are available.

Online, you can find information from the following organizations: the American Psychological Association, the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator, and the American Academy of Child and Adolescent Psychiatry.

To learn more about self harm, including how to get an assessment and diagnosis or self help therapy options, check out Therapy.com online directory to find help near you.

Frequently Asked Questions (FAQs)

Who Engages In Self Harm?

There are no specifics about who engages in self harm. This disorder can affect individuals of all ages and genders.

However, there are risk factors that increase the likelihood of self harm, including having a mental health disorder, experiencing trauma and living in an unhealthy environment.

Are People Who Self-Harm Trying to Kill Themselves?

Not usually, but if they do not receive proper self injury help, their coping methods and mental health may worsen over time.

Why Do People Self Harm?

People who self harm may be trying to cope with negative emotions. They may also be trying to feel something because, without self harming, they feel detached or numb inside.

What Are The Most Common Forms Of Self Harm?

Cutting, burning and hitting are the most common forms of violence. However, any action that causes immediate bruising or bleeding qualifies as self harm.

What Are The Best Treatments For Self-Harm?

An integrated approach to treatment is best for individuals engaging in self harm. This includes the use of mindfulness based talk therapies such as CBT and DBT.

For some, the use of medications may support the stabilization that is needed to treat any co-occurring conditions such as anxiety, depression or substance use disorders. In some cases, family therapy may be another useful tool to support a person’s recovery from self harm.