Understanding Self-Harm: What Mental Health Providers Need to Know

March is Self-Harm Awareness Month, a time to raise awareness about the realities of self-injury and challenge the stigma that often surrounds it. For many individuals who struggle with self-harm, feelings of shame and secrecy can create significant barriers to seeking help. Awareness campaigns throughout the month focus on educating communities about the true nature of self-injury and dispelling harmful myths. These efforts also encourage open conversations, helping to reduce the isolation many individuals feel, and highlight resources that promote recovery and emotional well-being.

As mental health providers, we can use this time to share accurate information, advocate for trauma-informed care, and create safe spaces for individuals and families affected by self-injury. Self-injury is often misunderstood, leading to stigma, fear, and misinformed treatment approaches. As mental health providers, it’s crucial to approach self-harm with knowledge, compassion, and a clear understanding of its function in emotional regulation. In this post, we’ll break down common myths, explore the neurobiology of self-injury, and discuss strategies for supporting clients in distress.

Common Myths vs. Facts About Self-Injury

Myth: Self-harm is an attention-seeking behavior.

Fact: Most individuals who self-injure do so in private and may go to great lengths to hide their wounds. Self-harm is often a coping mechanism for overwhelming emotions rather than a plea for attention.

Myth: Only teenagers engage in self-harm.

Fact: While self-injury often begins in adolescence, it can persist into adulthood. Many individuals struggle with self-harm well into their 30s, 40s, or beyond, particularly if underlying distress is not addressed.

Myth: Self-harm is the same as a suicide attempt.

Fact: Non-suicidal self-injury (NSSI) is distinct from suicidal behavior. While self-harm can increase the risk of suicidal ideation over time, it is typically used as a means to cope with emotional pain rather than an attempt to end one’s life.

Differentiating NSSI from Suicidal Intent

While self-harm can be alarming, not all individuals who engage in it are suicidal. Key distinctions include:

Intent: NSSI is used to cope with distress, whereas suicidal behavior is driven by a desire to end one’s life.

Method & Severity: NSSI often involves superficial injuries, whereas suicidal behavior may involve life-threatening means.

Emotional Aftermath: Clients who engage in NSSI often report temporary relief, while those with suicidal intent may feel hopeless even after self-harming.

That said, individuals who engage in self-harm are at increased risk for suicide over time. Regular risk assessments and open conversations about suicidal ideation are crucial.

Understanding the Neurobiology of Self-Injury

Self-harm activates the body’s stress response and can temporarily alter brain chemistry. When someone self-injures, they may experience:

• Endorphin release: Similar to the body’s response to exercise, self-injury can trigger a rush of endorphins, leading to temporary relief or even a sense of euphoria.
• Pain analgesia: Studies suggest that individuals who engage in NSSI may have a higher pain threshold, possibly due to repeated activation of endogenous opioid systems.
• Emotional numbing: Self-harm may reduce amygdala activity, dampening emotional intensity and creating a short-lived sense of calm.

Understanding these mechanisms can help providers frame self-harm as a biological response to distress—one that clients can learn to regulate through safer means.

The Role of Self-Harm in Emotional Regulation

Self-injury often serves as a way to regulate distressing emotions. Clients may engage in self-harm to:

Reduce overwhelming feelings, such as anger, sadness, or anxiety.

Experience a sense of control when life feels chaotic.

Reconnect with their body when experiencing dissociation or numbness.

Punish themselves due to feelings of shame or guilt.

Understanding the function of self-harm is essential for guiding clients toward alternative coping strategies that meet their emotional needs in healthier ways.

The Link Between Trauma, Dissociation, and Self-Harm

Many individuals who struggle with self-harm have experienced trauma, particularly childhood abuse, neglect, or emotional invalidation. For trauma survivors, dissociation—a feeling of disconnection from their body or emotions—can be a common response. Self-harm may provide a temporary way to “feel something” when emotional numbness takes over. For example, behaviors like cutting, burning, or scratching can break through the numbness and bring a sense of control or presence.

Recognizing these patterns is a crucial step in helping clients heal. Developing alternative grounding techniques, such as sensory engagement, mindfulness practices, or physical movement, can provide healthier ways to cope with overwhelming emotions and reduce reliance on self-harm. These strategies can empower clients to regain a sense of connection with themselves without resorting to harmful behaviors.

The Importance of Validating Distress While Fostering Alternative Coping Strategies

Clients who self-harm are often met with fear, frustration, or even punitive responses from others. This can reinforce shame and drive the behavior further underground. As providers, our role is to:

• Validate their experience: “I can see that self-harm has been a way for you to cope with difficult emotions. Let’s explore what’s behind that.”
• Avoid power struggles: Demanding that a client stop self-harming without addressing the underlying pain is rarely effective. Instead, focus on harm reduction and emotional regulation strategies.
• Introduce alternative coping tools: Encourage the use of skills from Cognitive Behavioral Therapy (CBT), such as identifying and challenging negative thoughts, as well as techniques from Dialectical Behavior Therapy (DBT), like distress tolerance exercises (e.g., ice packs, deep breathing, grounding exercises) and emotion regulation strategies.
• Encourage clients to use distraction or substitution techniques that align with their current emotions: Encourage clients to delay the urge to self-injure by using distraction or substitution behaviors. Match the activity to the client’s current emotional state for better effectiveness. Suggest keeping a list of coping strategies to quickly find a helpful activity in the moment.

Strategies to Help Clients Explore Underlying Emotions

Long-term recovery from self-harm involves more than just stopping the behavior—it requires addressing the emotional pain that drives it. Strategies include:

Helping clients identify triggers: Journaling or using emotion-tracking apps can help clients recognize patterns in their self-harm urges.Exploring self-compassion: Many individuals who self-harm struggle with deep self-criticism. Encouraging self-kindness exercises can help shift this mindset.

Building distress tolerance skills: Techniques such as the DBT “TIP” skills (Temperature change, Intense exercise, Paced breathing) can help clients manage emotional surges.

Addressing underlying trauma: If trauma is present, integrating trauma-informed therapy approaches (such as EMDR or somatic experiencing) can help clients process past wounds in a safe, structured way.

Self-harm is a complex behavior rooted in emotional pain, trauma, and neurobiological responses. As mental health providers, we have the opportunity to support individuals and families by not only addressing the symptoms but also working to uncover and treat the underlying trauma that often drives self-harm. Through education, compassion, and skill-building, we can help clients understand the root causes of their behaviors. By validating their distress, fostering safer coping mechanisms, and reducing stigma, we can guide clients toward healing—one step at a time.

References

Bray, B. (2023). Helping youth who self-harm. Counseling Today. Retrieved from https://www.counseling.org/publications/counseling-today-magazine/article-archive/article/legacy/helping-youth-who-self-harm

Caicedo, S. & Whitlock, J.L. (2009). Top misconceptions about self-injury. The Fact Sheet Series, Cornell Research Program on Self-Injury and Recovery. Cornell University. Ithaca, NY

Kilburn, E. & Whitlock, J.L. (2009). Distraction techniques and alternative coping strategies. The Practical Matters Series, Cornell Research Program on Self-Injury and Recovery. Cornell University. Ithaca, NY

OpenAI. (2024). ChatGPT (Version 4) [AI language model]. Assisted in generating ideas and editing content for improved flow in the blog post on self-harm and self-injury. Retrieved March 10, 2024, from https://chat.openai.com

Pambianchi, H. & Whitlock, J. (2019). Understanding the neurobiology of non-suicidal self-injury Information Brief Series, Cornell Research Program on Self- Injury and Recovery. Cornell University, Ithaca, NY

Prussien, K., Rosenblum, S., & Whitlock, J. (n.d.). What role do emotions play in non-suicidal self-injury? Cornell Research Program on Self-Injury and Recovery. Retrieved from https://www.selfinjury.bctr.cornell.edu/perch/resources/what-role-do-emotions-play-in-nssi-.pdf

Whitlock, J., Minton, R., Babington, P., & Ernhout, C. (2015). The relationship between non-suicidal self-injury and suicide. The Information Brief Series, Cor- nell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY.

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