How Self-Harm and
Addiction Are Connected

Self-Harm and Addiction

Understanding Self-Harm

Self-harm is considered to be a form of addiction. People (especially adolescents) who purposely harm their bodies tend to crave this outlet as a way to release and cope with negative emotions.

Some people who engage in self-injurious behaviors couple self-harm with substance abuse. They may use substances to seek further relief from emotional turmoil.

Abusing drugs or alcohol can also lead to self-harm as an additional way of experiencing brief feelings of calm.

What is Self-Harm?

Self-harm is a term used to describe the actions someone takes to intentionally injure themselves repeatedly. The self-harming activity is usually done on impulse and is not meant to cause death.

Self-harm is also commonly referred to as self-mutilation, self-abuse, self-injury, and engaging in self-injurious behavior (SIB).

The medically correct term for self-harm is non-suicidal self-injury (NSSI).

Types of Self-Harm

There are various methods for engaging in NSSI. Just a few of the ways that people self-harm include:1

  • Cutting the Skin
  • Head-Banging
  • Burning Oneself
  • Pulling Out Hair
  • Scratching the Skin Deep Enough to Draw Blood
  • Skin-Picking
  • Causing an Infection on Purpose
  • Inserting Objects into Bodily Orifices
  • Drinking Dangerous Liquids

Three common methods of self-harm are cutting, head banging, and burning. It is estimated that between 70-90% of individuals who harm themselves do so by cutting their skin. 21-44% of people bang or hit their heads to self-harm, and 15-35% burn themselves.2

Cutting

This most common form of self-injury is sometimes related to having an obsessive-compulsive disorder (OCD). It involves a person making cuts on his or her skin in order to feel better about themselves or about certain life situations.

The cuts are most often made on the arms and legs, where it is easier to hide the marks with clothing.

Self-harm such as cutting often begins in early adolescence. Teenage or younger girls are most susceptible to cutting, though older women and males are also treated for self-harm practices.

The cuts a person makes on the body are often small, straight lines that are not very deep. Some people who cut to self-harm carve words instead of lines that often spell out terms that are self-derogatory, such as “fat” or “stupid.”

Cutting tends to escalate, requiring more cuts, done more often in order to make the person experience the same feelings of relief or calm. This is similar to people who are addicted to substances needing increased dosages to achieve the same high.

Hair Pulling

When someone has a hair-pulling disorder, it is medically known as trichotillomania. Someone with this form of self-harming disorder, which is also related to OCD, will pull their hair from the scalp, eyebrows, eyelashes, legs, or genital area.

Hair pulling is more common in teen and young adult females than in males. The practice can lead to bald patches on the scalp, sometimes affecting one side of the head more than the other.

Persons who pull their hair typically do so as a form of self-harm to find relief from emotional pain. Other causes of trichotillomania can involve a brain chemical imbalance or due to hormonal level changes that take place during puberty.

Skin Picking

Having a skin-picking disorder is known as dermatillomania or excoriation disorder. This is when someone cannot stop picking at their own skin. The disorder is also connected to OCD.

Skin picking can cause small cuts, bleeding, bruising, and sometimes scarring. The skin is often picked at with the fingers, nails, or teeth. Common household tools such as tweezers, small scissors, and straight pins are also used.

This self-harm disorder is similar to repetitive hair pulling. Things like boredom, anxiety, shame, and skin blemishes can precipitate skin picking.

Burning

Burning one’s own skin is also often done to smother or cope with emotional pain. Lit matches, cigarettes, or hot, sharp objects held against the skin are most often used to inflict self-harm.

Who Engages in Self-Harm?

It is estimated that 4% of adults and approximately 15% of adolescents in the United States take part in non-suicidal self-harming behaviors.3

4% of Adults in the U.S. Participate in Non-Suicidal Self-Harming Behavior
15% of Adolescents in the U.S. Participate in Non-Suicidal Self-Harming Behavior

There are two million cases of self-harm reported in the United States every year. 60% of people who engage in self-harm are females.

60% of Self-Harm Victims are Female

90% of people who engage in self-harm behaviors begin to do so in their teen or preteen years.

90% of Self-Harm Starts in Pre-Teen/Teen Years

Approximately 50% of those who begin self-harm behaviors in their adolescence continue to do so as young adults.4

50% of Adolescents Continue to Self-Harm as Young Adults

Why Self-Harm Happens

Cutting, burning, pulling hair and picking skin all cause physical pain, however brief or long that pain might last. Since the majority of people don’t enjoy enduring pain of any kind, there are specific reasons why people choose to self-harm.

These reasons include:

A way to deal with stress, anxiety, and negative feelings

A distraction from having to cope with difficult emotions

The need to feel something physical

To engage in some form of control over their lives

To punish oneself for perceived wrongdoing

To become emotional privately rather than publicly

Adults Who Self-Harm

Although adolescents are most at risk for NSSI, adults also engage in self-harm behaviors. The most common methods that adults use to self-injure are cutting, burning one’s skin, or banging the head against a wall.

Adults who self-injure may do so for a number of reasons:

  • It can be an attempt to keep their loved ones interested in their lives. Adults who self-harm for this reason are often diagnosed as having borderline personality disorder.
  • A traumatic experience (particularly from childhood) can result in self-harm behavior.
  • Stress, painful events in life, and other emotional issues can lead an adult to engage in self-harm.
  • Some adults may self-injure due to a psychotic break.
  • Adults who are addicted to substances are also at risk for self-harming behaviors.

Signs of Self-Harm

Most people who inflict self-harm keep their activities a secret from others.

When a friend or loved one is suspected of engaging in self-harming behaviors, look for the following signs and symptoms:

  • Unexplained scars
  • Fresh and frequent cuts, burns, scratches, and other injuries
  • Cuts on the body that are very straight lines or spelled out words
  • Having sharp instruments readily available (for cutting) or lighters and cigarettes (especially if the person doesn’t smoke)
  • Wearing clothing that covers arms and legs, even in hot weather
  • Low self-esteem issues
  • Having trouble handling emotions
  • Having relationship problems
  • Inability to function properly at work, home, or school

Misconceptions About Self-Harm

There are many misconceptions people have about self-harm behaviors. For example, it is often thought that self-injury is a suicide attempt, when it is actually a way for some to avoid suicide and having suicidal thoughts.

Some preconceived notions about self-harm are:

Only Females Engage in Self-injury

Studies have shown that females are not the only ones who self-harm, although they are the majority. Only about 30-40% of people who inflict self-harm are male.5

30-40% of People Who Self-Harm are Male

Self-Harm is Not Treatable

It is true that NSSI is not an easy addiction to control. This is usually because self-harm is often a symptom of other underlying issues.

Together with treatment for co-occurring disorders, SIB can be treated with cognitive behavioral therapy, dialectical behavior therapy, and group and/or family therapy. If the underlying issue is depression or anxiety, anti-depressants can be prescribed.

Self-harm is generally used as a coping mechanism. Once other methods are found to help with anxieties, fears, and other psychological issues, self-harm can usually be stopped.

People Who Harm Themselves Enjoy the Pain or Can’t Feel It

The truth is that self-injury does cause some physical pain, which is often exactly why a person does it. It is a way of connecting or of actually being able to feel something if someone is feeling emotionally dulled. It is not that the pain is terrifically enjoyable, but it does elicit a sense of calm for some.

Self-Harm is a Suicide Attempt

Self-injury is not an attempt to kill oneself. Rather, it is a way of coping with stress, anxiety, and negative feelings.

People Who Self-Harm Can Stop if They Want To or Outgrow It

Some people can stop NSSI by themselves, but for many others, this is an addiction. Endorphins are released that heighten the feelings felt when inflicting self-harm, increasing the possibility of addiction to this practice. An addiction is not usually simply outgrown, and overcoming addiction is difficult (if not impossible) to do on one’s own.

People Who Injure Themselves are Insane and Dangerous

Many people who engage in self-harming behaviors may suffer from some psychological issues, such as anxiety, depression, past trauma, or eating disorders. However, this does not mean that such labels like insane, crazy, or being a danger to society should apply to them. After all, millions of people in general also are diagnosed with similar psychological issues, yet they are not thought of as being crazy.

People Who Self-Harm are Simply Trying to Get Some Attention

The fact that most people who purposely injure themselves do it secretly and then try to hide the evidence of their scars shows that this is not simply an attention-grabbing activity.

Effects of Self-Harm

There are various consequences that can result from deliberate self-injury. These effects range from physical to emotional to social consequences.

Physically, engaging in self-harm such as cutting, can result in:

  • Permanent scarring on the skin
  • Uncontrolled bleeding
  • Infections 

Emotionally, a person may experience:

  • Intense guilt or shame
  • Feelings of helplessness
  • A diminished sense of self or self-worth
  • Becoming addicted to this behavior

Socially, the effects of self-harm can lead to:

  • An avoidance of friends and family
  • Feelings of being left out, because no one understands
  • Having trouble with interpersonal relationships because lying about injuries becomes the norm

There is also a real risk of accidental death as a result of self-harm, dependent upon the methods used.

Self-Harm and Substance Abuse

Substance addiction is itself a form of self-harm that damages the mind, body, and spirit. When someone is suffering from drug or alcohol addiction, their mental state changes. This can mainly be due to a disruption in dopamine, serotonin, and endorphin levels in the brain.

Strong emotions and mood changes can occur in someone with a substance use disorder. These disruptive emotions often lead to frustration, anger, anxiety, depression, and feelings of self-hatred. Negative emotions such as these can lead to the need for an outlet to relieve stress and anxiety. Some people seek that release through self-injurious behaviors such as cutting, burning, or hair-pulling. Though NSSI is self-destructive, people who engage in these behaviors do so in order to feel better as they try to regulate their negative emotions.

There are approximately 19.7 million adult Americans who are addicted to substances.​​​6 An estimated 16% of adolescents can also be categorized as abusers of drugs.​​​7 About 8.7% of people who engage in self-harm also abuse substances.​​​8

16% of Adolescents Categorized as Abusers of Drugs
8.7% of People Who Self-Harm Also Abuse Substances

Some people who begin to deliberately harm themselves as a way to numb their emotional pain may end up moving on to substance use. Alternately, some who begin using substances in an attempt to self-medicate may decide to self-harm instead of or in addition to using drugs or alcohol.

A Dangerous Intersection

When someone is simultaneously abusing substances and engaging in self-injurious behaviors, the potential for severe harm is present. 

For instance, a person who is abusing alcohol will have physically and mentally slower reaction times. They are also less likely to feel intense physical pain due to diminished nerve endings. These bodily responses to alcohol make NSSI much more dangerous.

Someone who cuts while under the influence of alcohol is more apt to inadvertently make incisions that are too deep. This may cause excessive bleeding that may prove to be fatal. 

Aside from the physical limitations that alcohol and substance abuse present, these drugs also tend to intensify negative feelings like hopelessness, depression, and anxiety. These heightened emotions can lead a person to delve into more extreme self-harming behaviors, possibly even leading to suicide.

Some dangerous substances that are especially linked to self-harm are:

  • Amphetamines
  • Benzodiazepines
  • Alcohol

Amphetamines:

These highly addictive drugs include prescription medications and illegal substances such as crystal meth and cocaine. Someone with an amphetamine addiction can exhibit psychotic symptoms (amphetamine psychosis), although they may not necessarily have a psychiatric disorder.

Someone with an addiction to amphetamines may endure breaks from reality, behave violently, and experience various types of hallucinations. They can also engage in self-mutilation behaviors due to cognitive, visual, or auditory hallucinations that lead to self-biting, scratching, hair pulling or head banging.

Benzodiazepines:

Physicians may prescribe these drugs for the treatment of mental conditions such as post-traumatic stress disorder (PTSD). They are used to produce calmness, lessen anxiety, and help with insomnia.

Among the drugs prescribed for PTSD are alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). A person can become highly dependent on these substances within weeks of regular use. The potential for self-injury and suicidal thoughts are present for those taking these substances for PTSD. Benzodiazepines have the potential to increase acts of impulsive violence that may include self-multilation.9

Alcohol:

This substance reduces a person’s inhibitions, negatively affects judgment, and increases the tendency towards impulsive actions. When a person becomes less inhibited and the central nervous system is depressed, the chances of experimenting with self-injury increase, as does the possibility of going beyond a person’s normal SIB tendencies.

Although self-harm is not necessarily an attempt at suicide, death can occur when drugs are involved. Someone who has a dual diagnosis of alcohol addiction and a mental health condition is doubly at risk for NSSI.

Mental Health Conditions

The fact that someone is deliberately engaging in self-harm without knowingly attempting to commit suicide indicates the presence of a mental health condition.

Self-harm on its own is not a mental illness. However, this particular type of behavior usually results from an inability to cope with disturbing issues, thoughts, or emotions. It indicates a lack of coping skills and is done in an effort to deal with these difficult feelings.

Self-harm can be a symptom of one of the following underlying psychiatric conditions:

Treatments For Self-Harm

Because self-injury behaviors are symptomatic of a psychological or psychiatric disorder, treatment is therapy-based. Medications and counseling that deal directly with any underlying psychiatric conditions are important, as are the following treatments that focus on reducing NSSI.

Psychotherapy is often the most useful tool in helping a person quit self-harm behaviors. There are group and individual therapy programs called Dialectical Behavior Therapy that help people who self-harm to overcome their destructive tendencies. Ways are taught to cope with distress in a healthier manner, such as practicing mindfulness techniques. People who self-harm due to past trauma (such as abuse or incest) can benefit from post-traumatic stress therapies.

Family therapy helps people communicate more effectively with family members in an open and direct manner. Group therapy is a beneficial way of discussing self-injury with others who share this issue. It can help lessen the shame and embarrassment associated with the behavior. It also helps to express emotions in a healthy manner with others.

Hypnosis, meditation, and other self-relaxation techniques aim to reduce stress that often precedes self-harm behaviors. Medication may be prescribed to reduce stress, such as anti-anxiety drugs, antidepressants, or low-dose antipsychotics.

Self-Harm Awareness

In an effort to spread awareness of NSSI and encourage people to become more open about their self-harm behaviors, March 1st has been designated as Self-Injury Awareness Day (SIAD) around the globe.

Breaking down the stereotypes associated with self-harm and educating the medical community about self-injury are some of the main goals of SIAD.

Resources

  1. https://www.ncbi.nlm.nih.gov/pubmed/25881206
  2. https://www.dualdiagnosis.org/self-harm-addiction/
  3. https://www.mentalhealthamerica.net/self-injury
  4. https://www.crisistextline.org/fast-facts/self-harm
  5. http://selfinjury.bctr.cornell.edu/documents/15_misconceptions.pdf
  6. https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report
  7. https://www.cbsnews.com/news/survey-reveals-shocking-levels-of-teen-drinking-drug-abuse/
  8. https://www.ncbi.nlm.nih.gov/pubmed/19936579
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993516/