This is the most common question I get, not just from families but from other therapists. Most of us instinctively try to prevent harm to our bodies, so it seems confusing that someone would choose to hurt themselves.
However, understanding why some people do intentionally cause harm to themselves is an important step toward removing any judgments that can harm relationships and act as a barrier to treatment.
Background facts on self-harm
• Self-harm typically begins between the ages of 14-24.
• Females make up 60% of those engaging in self-harm, males 40%.
• Skin cutting is the most common form of self injury but there are multiple other methods such as burning, scratching, ingesting, piercing, banging, or interfering with wound healing.
• The average number of lifetime instances of self injury varies wildly, from less than five times to 50+.
Why do people do it?
Research shows that people predominately self-harm to regulate their mood. While other theories have been presented (including: to stop dissociation, prevent suicide, set interpersonal boundaries and keep others away, create influence over others, as self-punishment and even for sensation-seeking), findings indicate that the majority of self-harm actions occur as a way to manage one’s mood.
That’s because self-harm creates a chemical shift in the brain which affects one’s emotional experience – similar to the way alcohol, certain foods, gambling sex, etc. can be misused for the same effect. Emotions are an intensely physiological experience, and the biological effects of self-harm and its ability to create a short term mood boost due to chemistry shifts in the brain make it very difficult behavior to stop.
Of course, all the while, damage to the body, brain, self worth, and relationships continues to escalate.
It’s all in the biology!
All behavior is regulated by chemicals found in the brain called neurotransmitters. The chart below can help explain chemical releases in the brain and body that occur during self-harm acts.
|Dopamine||Excites||Connected with our reward and stimulation levels|
|Serotonin||Excites||Helps with appetite, sleep, pain and mood|
|Noradrenaline||Excites||Induces arousal, heightens mood|
|Acetylchooline (Ach)||Excites & Inhibits||Plays a role in memory, decreases blood pressure|
|GABA||Inhibits||Controls anxiety level|
|Enkephalin (opiate)||Inhibits||Reduces stress, promotes sense of calm, a natural painkiller|
How self-harm relieves stress (in the moment)
Most people self-harm when under extreme stress. Extreme stress elicits a chemical response in our brains that is very distressing. For most people they would recognize this discomfort in the body and then use healthy coping skills to respond to stress such as exercising, self soothing, or engaging in supportive discussion.
Research shows some people have a biological vulnerability to extreme stress. Likewise, some people experience extreme stress more frequently and intensely due to their life situation (poverty, family structure, trauma, etc). These, biological or environmental vulnerabilities to stress can set the stage for self-harm in some individuals and make it a more difficult urge to resist. Research has also shown a correlation between low serotonin levels and increased impulsive and self-harm behaviors.
In addition, when a person self-harms the following biological reactions occur:
1. Endogenous opioids are released.
- These are neurochemicals similar to heroin that are released when we are injured and/or in danger and bring about a positive feeling of calm and well being. The chemical produces insensitivity to pain.
2. Most people who self-harm report little or no pain during self-harm.
- The lack of pain, increase in pleasant feelings, and sense of survival reinforces the behavior over time
3. Humans can become “addicted” to our own endogenous opioids and need more to be released over time to produce a feeling of calm and wellbeing.
- This may explain why self-harm tends to increase in intensity and frequency over time.
4. Withdrawal from the natural opioids may increase body tension and emotional distress afterwards.
- Many people who self-harm report an emotional shift to depression after the short, initial mood boost (also known as “self-harm hangover”).
Self-harm is a significant problem for mental and physical health in the long run.
Many people falsely believe they have control over their self-harm behaviors—that they can stop when they want; that because they don’t need stitches or other medical attention after self-harm, they don’t have a real problem.
However, as the brain builds a tolerance, people find themselves having to self-harm more significantly (i.e. cut deeper, more cuts per episode) and more frequently, placing them at increased risk for accidental death, social rejection, and other consequences.
Another danger for self-harm includes the effect on physical health and system functioning over time. Body homeostasis will be out of balance if there are frequent mood swings, and as self-harm to the body continues, problems in the reproductive, digestive, and immune systems will build over time.
So, why would someone choose to cut themselves?
The simple answer is that they are in extreme emotional pain and distress and may lack the self-healing tools needed to manage their pain in another way. And although self-harm provides instant gratification and relief from emotional pain, it always betrays the victim and leaves them feeling worse afterwards.
If you know someone who is struggling with self-harm, please approach them with care and concern, be free of judgment, and let them know that there are resources to find help and therapy.
Kathy DeVries, LMSW, CAAC, is a Licensed Master Social Worker and Certified Advanced Addictions Counselor with over 10 years of experience in human services. She is the Program Coordinator for the Pine Rest Dialectical Behavioral Therapy (DBT) Program treatment team.