Disarming Self-Harm

Photo Credit: WhoIsLimos

By: W. Scott West, Medical Director


March kicks off Self-Harm Awareness month, starting with Self-Harm Awareness day on the first of March. This is an ideal time to shed some light on self-harm— an issue that is so little understood yet prevalent in our communities.

Did you know that, according to a study done by American Psychological Association (APA), 15% of college students and 17% of teenagers have engaged in self-injuring behaviors in their lifetime? It’s likely you know (and love) someone who has engaged in self-harm.

If you are someone who has not experienced self-harm, it can be difficult to understand why someone might hurt themselves on purpose. It’s important to inform ourselves about self-harm and challenge the stigma around it so we can provide the support and help necessary to treat the mental and emotional pain that underlines these behaviors.


The National Alliance on Mental Illness defines self-harm (also called “self-injury”) as “hurt[ing] yourself on purpose.” In my own experience as a psychiatrist, I’ve seen this take many forms including but not limited to burning, cutting, or carving the skin, punching objects or the body, embedding objects under the skin, piercing the skin, picking at existing wounds, and pulling out hair.

In most cases, self-harm is intended to cause pain but not to end one’s life. In this way, self-harm is not a mental illness in itself, but rather a set of behaviors that point towards deeper psychological distress, which may or may not come in the form of a mental illness. Depression, borderline personality disorder, eating disorders, or OCD are all disorders that can sometimes manifest in self-harming behaviors.


It’s widely understood that Self-Harm is a symptom of psychological distress and is used as a way to cope with emotional pain. Self-Injury can provide a way to reclaim a sense of control over both your body and your feelings.

While all of us experience negative feelings, not everyone self-harms. Why then do some people self-injure? In a study by the APA, researchers found that people who self-harm have learned to associate their self-inflicted pain with pain relief. So, rather than seeking the pain from self-harm, whether consciously or not, many are seeking the sensation of relief that comes after the pain.

This phenomenon is called pain offset relief. Rather than return to the pre-pain emotional state, after injury, people experience “a short but intense state of euphoria.” In this way, self-harm can be seen as a method of coping with pain by, in a roundabout way, inducing the relief that comes after pain.

Why do people self-harm rather than engage in less harmful pain-relieving activities like taking a walk, talking with friends, or journaling? In this same study, it was found that the participants who self-injure had a lower sense of self and expressed that they believed they deserved the pain. When they punished themselves with the pain, they were acting congruently with their negative self-image.

Jill Hooley, head of Harvard’s experimental psychopathology and clinical psychology program, says ‘”the more valuable that people feel, the less willing they are to endure a bad situation,”’ and, ‘”conversely, the worse people feel about themselves, the more inclined they will be to try [painful] methods of mood regulation that most other people would not even consider.”’ This study went on to show that addressing negative self-conception through cognitive-behavioral therapy can help people develop a higher sense of self-respect which leads to them being much less willing to suffer pain and harm.


In my 30+ years’ experience treating patients struggling with clinical depression, I’ve seen self-harm appear in many situations in addition to a low sense of self, including but not limited to:

  • Mental illnesses, especially depression and substance abuse
  • Personal history or self-harm, suicidal ideation, or previous suicide attempts
  • History of trauma
  • Family history of psychiatric disorders, self-harm, or suicidal behavior
  • Peers engaging in self harm
  • Loss of close family members or friends, especially to suicide
  • Major conflicts with close family members or friends
  • Experiencing bullying, either online or in person
  • Struggling with identity, especially sexual or gender identity


It can feel overwhelming to talk about self-harm, whether you’re the one experiencing it or the friend or family member of someone who does. If someone you know brings it up, even as a joke, take it seriously and encourage them to get help. Don’t judge, express disgust, or reprimand. Your friend or family member is in enough distress to hurt themselves and piling on shame will most likely make them less willing to seek help.

If you are someone who self-harms, you’re not alone. Don’t be afraid to talk to someone you trust.

If you need to talk with someone immediately, there are resources where you can call or message somebody who can listen: