Why People Hurt Themselves

Having worked with so many adolescents and adults who engage in self-injurious behaviors (such as cutting or burning themselves) has helped me to better understand the thoughts and feelings behind the behavior.  One concept that I strongly believe is that people don’t hurt themselves “just for attention” like I hear so many parents say when they discover that their teenager has been cutting themselves.  I also hear things like, “they are just trying to fit in with their friends who cut”.  I disagree with these statements because I have never seen someone who has hurt themselves purely for attention or to “fit in”.  We may do other things for attention or to fit in, but hurting ourselves isn’t one of them.  Haven given lectures to other mental health providers, students, and even to a court room full of family lawyers and guardian ad litem; it has been clear to me that most people do not understand why people hurt themselves.  What makes this even more difficult to understand is that there isn’t just one reason why people hurt themselves, there are many.  Some of the most common reasons why people hurt themselves is because (1) they may be having overwhelmingly negative emotions that they don’t know how to cope with, (2) they may be dissociating, which is feeling like you are not real or feeling numb, (3) they have some need that they aren’t able to get met by another, more healthy way. 

It is always important to figure out why you think the individual may be harming him/her self.  Treatment will vary and family/peer support can be different depending on what purpose the behavior is serving.  Many times the individual who is hurting him/her self does not have the insight or awareness to know why they are hurting themselves.  Initially, it may not be obvious to the mental health professional either.  Completing an evaluation of the self-injurious behavior including; when the behavior started, where does the individual self-harm, how frequently, who is around when the individual harms themselves, what do they use to self-harm, and who they tell about the behavior. 

Once an individual starts to hurt themselves, it can become addictive.  Our bodies have chemicals (opioids) that are similar to pain medications, like morphine.  These chemicals are released in order to help protect us from feeling pain.  When we get hurt these chemicals are released and we experience a “high” like feeling that helps to mask the pain.  This feeling can provide a sense of calmness and distract from negative emotions, thus increasing the likeliness that the individual may repeat the behavior.

For many of the individuals who I work with, who engage in self-harming behaviors, it is about figuring out what need the person is getting met by hurting him/her self.  For many adolescents (and some adults) it can be a way of expressing how much they are hurting.  It can also be a way for them to punish themselves when they feel ashamed about something.  In addition, many individuals have a difficult time coping with negative emotions like anger, sadness, or despair.  For many of my clients, being able to help them find ways to express their feelings in a safe way, can significantly decrease the self-harming behavior.

Knowing that someone you love or care about is hurting him/her self can be scary and sad.  Encouraging that person to get help and support is vital.  It is important to recognize that even if the self-harming behavior seems superficial or minimal, without appropriate intervention, the behavior can become more dangerous and more frequent.