Is self-harm addictive?

What Is Self-Harm?

Self-harm is the act of inflicting intentional pain and injury on oneself and the adverse effects it has on one’s own body. It is often an attempt to relieve emotional distress, turmoil, or pain and is widely considered an unhealthy and harmful approach to coping, finding validation, and seeking control due to its potential to cause short- and long-term damage. 

Self-harming behaviors are not performed with the intention to end one’s life — actions like that would be considered “parasuicidal behaviors.” There are other terms that often get grouped with “self-harm,” such as “self-mutilation” — though this generally refer to acts of self-harm that are limited to tissue damage.

If you have or are considering harming yourself, consider calling or texting the Crisis Text Line at 741741 to talk to a qualified counselor.

Why Is Self-Harm Addicting?

Before answering this question, it may be helpful to first explore if self-harm is technically an addiction, as the opinions are mixed. 

An “addiction” refers to the physical and mental dependence on substances or actions. A majority of mental health professionals don’t believe that self-harm is an addiction, citing the specific motivating factors of the compulsion. Many see self-harm as something motivated by a desire to end emotional suffering, whereas an addiction is used to feel pleasure or relief from physical pain, not just the end of suffering. 

Some, though, do believe that self-harm is addicting, citing the overlap of behaviors between the cycle of self-harm and the cycle of addiction. The cycle of self-harm starts with emotional suffering and then leads to emotional overload, panic, self-harm, temporary relief, and shame/guilt. The cycle of addiction starts with internal frustration and then leads to fantasizing, obsessing, substance use, loss of control, guilt, overuse, cessation of use, and passage of time.

What they note as similarities between the two are the build-up of an intense, uncomfortable, and overwhelming emotion, a sense of not feeling in control, use of a substance or self-harming behavior, an attempt at the desired result, feeling guilt and shame, discontinuation, and passage of time. 

Because self-harm is used as a coping mechanism, it can be difficult to stop, as the emotions that the person is trying to mitigate or escape are still occurring. However, by learning to implement different, healthy coping strategies, one can become less reliant on self-harm to relieve their emotional pain. 

Why Does Self-Harm Become Addictive?

The habitual nature of self-harm tends to increase with negative feelings and insufficient coping strategies or outlets. Some people who have self-harmed see the pain as calming, finding that it provides immediate relief from the pressure of intense negative emotions. Certain types of self-harm can also release dopamine in the brain, making the behavior harder to stop.

The combination of how often a person experiences overwhelming negative feelings and the temporary relief from those feelings creates a cyclical pattern of self-harming behavior. 

Factors that may contribute to self-harm include:

• Occupational or academic stressors (school or work)
• Abuse, bullying, or neglect
• Mental health conditions such as depression, anxiety, ADHD, or autism
• Poor self-concept (i.e. low self-esteem, self-punishment)
• Inadequate coping skills such as substance use; difficulty adjusting
• Uncomfortable feelings like feeling invalidated, out of control, guilty, or shameful
• Unhelpful or intrusive thoughts; dichotomous thinking
• Difficulty with interpersonal relationships: relationship problems, uncertainty about sexuality, communication barriers

The lack of proper outlets or healthy coping mechanisms can quickly increase the intensity of these situations in one’s life, making the issues severe enough that someone starts to look for any possible solution. Any of these issues can become incredibly painful on their own, but without a safe way to feel or process them, they become incredibly hard to manage.

How Can You Tell When You Are Addicted to Self-Harm?

Since self-harm seems to somewhat ride the line between addictive behavior and maladaptive coping, it is difficult to say what specifically would point to being addicted to self-harm. 

Perhaps the closest consideration for a diagnosis of self-harm in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) would include “nonsuicidal self-injury.” Nonsuicidal self-injury is not a clinical diagnosis. However, it has been proposed as a condition for further study, with proposed criteria according to the DSM-5. If you fit the criteria and perform the actions listed below, it’s likely that you have a regular habit of self-harming behavior:

1. Performing self-harming behavior that is likely to result in pain, bleeding, or bruising and minor to moderate harm — that is clearly not a suicidal attempt — for five or more days the previous year. 
2. The expectation of the self-harming behaviors is either to feel relief from uncomfortable thoughts or feelings, to settle issues within relationships, or to feel good. 
3. Intentionally associating self-harm with a minimum of one of the following: difficulty managing distressing thoughts or feelings or interactions with people right before self-harming, fixation with the idea of the self-harming behaviors, obsession about self-harming (with or without actions).
4. The self-harming actions are not associated with societal norms such as piercings, tattoos, or other cultural rituals, nor is it limited to scab picking or nail biting. 
5. The self-harming behaviors affect a person’s ability to function in an important area such as in social settings, at school, or at work. 
6. The self-harming behaviors do not present solely during an episode of another condition, or are more aligned with another psychological or medical condition.

There is a subcategory of substance-related and addictive disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) called “behavioral addictions.” Behavioral addictions, such as gambling, refer to non-substance-related repetitive maladaptive behaviors that activate the reward system in the brain. 

Though self-harm isn’t technically included as a “behavioral addiction” as of yet, the subcategory isn’t as developed as other DSM-5 categories, and many such issues that would align with its definition are not included. 

How Do I Help Someone Who Has a Self-Harm Addiction?

To help someone who habitually self-harms, it is strongly recommended to keep communication lines open. Try encouraging them to speak to a mental health professional. You can assist them by talking to them about your concerns, but make sure the conversation happens at a good time for them. 

Because shame and guilt are so intertwined with self-harming behavior, one’s language, tone, and body language should be consistent, open, mindful, and accepting. If the individual engaging in self-harming behaviors is receptive to suggestions, the best thing they can do is start engaging in mental health services with the goal of decreasing self-harming behavior.

You may also be able to assist by identifying a list of appropriate preferred providers’ contact information, as well as supporting them by being present (if desired) when they make their appointment.

Be sure to also take care of yourself. It can feel overwhelming and stressful to help someone who is self-harming, or even engaging in a form of behavior that hurts themselves. You can only support others when you have the emotional support and resources you need.

I Think I Am Developing a Self-Harm Addiction…What Should I Do?

If you’re using self-harm as a maladaptive way to cope with uncomfortable feelings, it could be helpful to talk to a mental health professional. By collaborating with a mental health professional, you can better identify your personal risk factors or triggers that reinforce negative or unhelpful behavior. A therapist who specializes in reducing self-harming behaviors would be the best resource for you — they can assist with identifying ways to reduce the urge and identify more adaptive ways to cope.

If we refer back to the cycle of self-harm, when a person experiences emotional suffering and begins to use helpful or adaptive coping skills, it can interrupt the emotional overload by making the situation more manageable and that can help avoid the panic which leads to self-harming behaviors. What makes self-harming behaviors difficult to manage is their secrecy, accessibility, and the temporary wave of relief from intense emotional pressure. 

The cons of self-harming are physical and psychological consequences. Most instances of self-harming initially result in minor physical injuries. However, the more a person performs that action, the greater the likelihood becomes of scarring, overdose, infections, or damage to nerves over time. 

The psychological effects of self-harming can often be more nefarious than the physical symptoms. When a person self-harms, they tend to do so due to overwhelming feelings of isolation, and thus prefer to be alone. Not feeling understood can contribute to their feelings of loneliness. This isolated, lonely environment can support and foster feelings of being out of control, self-hatred, shame, guilt, stress, deception, depression, and low self-esteem. 

That’s why it’s so important to find someone to talk to about how you’re feeling. Talking with someone, even if it’s only ever a mental health provider, can help you feel less alone and misunderstood, as well as give you tools to break away from self-harming behaviors.

What Is the Effect of Self-Harm Addiction on Young People?

According to the National Library of Medicine, young people are likely to engage in acts of self-harm — around 17% of adolescents self-harm. Adolescence is when self-harm is most likely to begin and when it is at its peak. The period of adolescence begins between 10-12 and ends approximately at age 19, and is marked by significant changes in one’s physical, mental, and emotional characteristics, including one’s sexual interest, which greatly affects an individual’s self-esteem and how they view themselves internally and externally. 

During this period, young people’s thoughts also become more sophisticated through abstract thinking, seeing things from another person’s perspective and reflecting, understanding, and evaluating reality. 

Adolescents prioritize social acceptance and are more likely to engage in acts of self-harm if they are aware of a peer who has also self-harmed. If an adolescent is practicing acts of self-harm frequently, it will obscure the idea of engaging in healthy coping techniques because of the immediacy of the relief it provides them. This is when the individual may become engaged in the previously mentioned repetitive cycle of self-harming. 

Mental health literature identifies various motivations for self-harm based on gender. Adolescent girls are more susceptible to self-harming and have been given more clinical attention than their male counterparts. In the study, boys were more likely than girls to use self-harming approaches to elicit feelings of fear within someone else.

Girls were more likely to use self-harming approaches for reasons that occur within themselves, like self-concept, self-esteem, or self-regulation (intrapersonal). Moreso than with boys, these girls found that self-harming assisted with expressing or decreasing distressing feelings and thoughts, and lessened tension. 

If you or someone you love is engaging in self-harming behavior, consider speaking with or suggesting that they speak with a mental health professional. There are specialists who work specifically with people with self-harming tendencies and have the knowledge and skills to guide and support you.

Treatment Options for Self-Harm

There are many therapeutic options available to treat self-harming behaviors. Treatment will vary based on many personal factors such as age, gender, preferred format (individual vs. group therapy), and so on. 

Mental health approaches such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy, psychodynamic therapy, and family systems are consistently seen to be helpful. 

It can also help to be proactive in one’s efforts to reduce self-harm by learning ways to counter the most intense aspects of self-harm. Some strategies include: 

• Learning adaptive coping skills: Consider listening to music, using emotional outlets (i.e. crying, screaming, journaling), socializing (pets, friends, family), or going outside for a walk or a drive to help you deal with intense feelings like tension or stress. 
• Validating yourself: Consider how and where you can get your feelings and needs met. Be mindful to avoid over-identifying with a feeling, and show yourself appreciation for your progress. Try to observe how you feel and what is needed, and adopt a non-judgemental attitude towards your feelings and needs. 
• Increasing feelings of self-control: Practice managing your impulses and exerting command over your actions. Consider setting daily small and achievable goals, practicing self-care (physical activity, enough sleep, balanced diet), and limiting the daily decisions that you have to make to avoid decision fatigue.

Group therapy is another great option for connecting with other people who share in the struggle. By participating in group therapy, you’ll be able to hear others’ stories and tell your own to people who understand, reducing feelings of shame and isolation.

Whichever option you choose, making the choice to get help is the best and bravest thing you can do to help yourself. You can make your life better, and by finding support, you’ve started that journey.