Why Do People Self-Injure?

Nonsuicidal self-injury (NSSI) is a difficult phenomenon to understand. It is the intentional infliction of damage or harm to one’s body tissue without the intent to die (Favazza, 2011). It can consist of behaviors such as cutting, burning, embedding objects under the skin, head banging, scratching, punching hard objects, preventing wounds from healing, and other forms of inflicting pain.

An individual’s first engagement in NSSI often occurs during adolescence and research indicates that about 17 percent of American adolescents engaged in NSSI in the past year (Monto et al., 2018). Additionally, 97.9 percent of counselors reported working with clients who self-injure, making it a common presenting concern in counseling (Giordano et al., 2020).

So, what might compel an individual to intentionally harm themselves? Why is this such a prevalent trend, particularly among youth?

NSSI as Coping

It is important to note at the onset that self-injury often is an individual’s best attempt to cope with significant psychological pain. Thus, NSSI is a way to manage, cope, or regulate significant psychological distress. This function of NSSI (i.e., as a coping strategy) often differs from what people may initially presume—such as the erroneous belief that all acts of self-injury are suicide attempts. By definition, NSSI is distinct from a suicide attempt (i.e., NSSI is self-inflicted harm without the intent to die; American Psychiatric Association [APA], 2013), however, a relationship does exist between self-harm and suicidality (Hamza et al., 2012). The association between the two behaviors makes sense given that those using NSSI to cope with extreme psychological pain often face several risk factors for suicide.

With this in mind, let’s examine a few possible reasons why a person might engage in NSSI:

1. To regulate their emotions. By far, emotion regulation is the most commonly cited motive for NSSI (Doyle et al., 2017). Individuals will self-harm in order to change the way they feel. NSSI can be used to experience relief, escape negative feelings, or induce positive feelings (APA, 2013). When emotions seem overwhelming and unbearable, NSSI can serve as a temporary, albeit maladaptive, coping strategy to manage the distress. For example, a person who engaged in NSSI noted, “cutting substitutes the pain inside with a physical pain that I can control, which is easier to handle. The pain is now real, tangible. It can be seen” (Strong, 1998, p. 43). Engaging in NSSI can activate a person’s endogenous opioid system and cause the release of endorphins (among other neurochemicals), which can produce feelings of calm (Walsh, 2012). In addition, research suggests there is an overlap between the neurocircuitry involved in processing physical pain and that which processes emotional pain (Franklin, 2014). Thus, as physical pain begins to heal, emotional pain can improve as well (Franklin, 2014). Although not a healthy long-term solution, NSSI is most often motivated by a desire to regulate painful, intolerable emotions.
2. To punish oneself. For some individuals, NSSI is motivated by a desire to punish themselves out of anger or disgust (Klonsky et al., 2014). Individuals who are extremely self-critical, self-loathing, or self-blaming, may self-injure to experience the pain they believe they deserve. In addition, individuals who have a particular hatred toward their own bodies may engage in NSSI as a form of self-punishment.
3. As a form of anti-dissociation. For individuals who have a history of dissociating, NSSI may be used as a means to quickly jar them back into the present moment (Nock & Prinstein, 2004). For example, a person with a history of trauma (such as childhood sexual abuse) may have dissociated as a defense mechanism to survive the traumatic events. After the trauma has ended, however, dissociative symptoms may continue, especially when the individual feels anxiety, fear, or panic. The physical pain from NSSI can serve to end dissociative states and help the individual feel a sense of control (Calati et al., 2017).
4. To communicate. Finally, some individuals may engage in NSSI as a way to communicate their experience to others. It is often said that NSSI functions to “make one’s outside match their inside.” If individuals lack the ability to communicate their internal distress or feel as though their pain is unknown to others, they may use NSSI as a way to express their experience. A unique aspect of communication is the role of NSSI content online. There is an abundance of NSSI-related content on social media, discussion boards, informational websites, and video platforms. Indeed, most social media platforms now have community guidelines specifically prohibiting NSSI-related content in response to the upward trend of NSSI posts and pictures. It is possible that adolescents engage in NSSI and post images or text descriptions on social media to (a) feel validated, (b) find a nonjudgmental community, or (c) receive social support (Lavis & Winter, 2020). Indeed, among adolescents in Korea with a history of NSSI, 30.9 percent had seen and 11.6 percent had posted NSSI content on social media in the previous year (Seong et al., 2021). Thus, the communication motive can extend to online communities and social media platforms as well.

How Do We Respond?

NSSI is a complex issue that can be difficult to understand. Rather than taking an evaluative or judgmental stance, we can respond to those who self-injure with compassion, recognizing that they are trying to manage extreme emotional pain. We can open lines of communication about NSSI and ask adolescents in our care if they have ever seen or experienced NSSI.

For those actively engaging in self-injury, a counselor or support group can be a helpful resource. Indeed, counselors and mental health professionals can help those who self-injure understand the function of the behavior and develop alternative strategies to meet the identified need. For example, counselors may ask clients, “When do you feel the urge to self-injure?” and “What does self-injury do for you?” Once the motive is determined, counselors can help clients strengthen coping skills, increase distress tolerance, and enhance emotion regulation skills so they no longer rely on NSSI.

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