Self-Harm and Addiction

woman with scars from self harmSelf-harm, also known as non-suicidal self-injury, is the act of hurting oneself on purpose (but does not include normal piercing or tattooing).1-3 According to the U.S. Department of Health and Human Services about 1 in 100 people hurts themselves.1

Common methods of self-harm include cutting (not on the wrist), skin carving, burning, biting, scratching, hitting, head banging, and interfering with wound healing.2

Non-suicidal self-injury usually begins in the early teen years (12-14 years) and peaks at 20-29 years of age.3,4 It’s estimated that 7% to 14% of adolescents deliberately injure themselves at least once.2 About 4% of adults engage in self-harm.2

Why Self-Harm?

Self-harm is usually a maladaptive coping mechanism arising from adverse childhood experiences or high levels of subjective psychological distress.2 Non-suicidal self-injury behaviors are employed to relieve intense distressing feelings such as sadness or guilt. The sharp physical pain of self-harm helps to distract from unbearable feelings.2 Self-injury may also occur when a person feels they need to punish themselves or as a vehicle to gain attention so others can see their distress.2

Risk factors for self-injury during adolescence include bullying, negative social interactions, and emotional childhood abuse.5 Childhood sexual and physical abuse may also be a risk factor, although the evidence isn’t as clear.5

Self-Harm and Suicide

Suicide is the second leading cause of death among adolescents.6 Non-suicidal self-harm is not usually done in a suicide attempt, but it may in fact be a predictor of suicide attempts in adolescents and increase the risk for suicidal behavior.6,7

Suicidal thoughts and ideation that predate non-suicidal self-harm may increase the risk in suicidal behavior in teens who are thinking about suicide.4,6

For adolescents, the transition from thoughts of self-injury and behavior to suicide attempts is relatively fast—on average only 1–2 years.4

Therefore, the first 6 to 12 months after the onset of suicidal thinking or engaging in non-suicidal self-harm is a critical period for intervention and prevention of suicidal behavior.4 So, even though death is not the intent of non-suicidal self-injury, it’s important for parents and others to take it seriously and perform ongoing assessment of, and intervention for, suicidal behavior.6

If you or someone you know needs help dealing with suicidal thoughts, help is available 24/7.

Call the National Suicide Prevention Hotline at 1-800-273-8255.

Veterans can also utilize the Veteran Crisis Line via text 838255 or via online chat with a crisis counselor.

Self-Harm and Substance Abuse

Although non-suicidal self-injury may a symptom of those with developmental disabilities, eating disorders, borderline personality disorder, post-traumatic stress disorder or other psychiatric conditions,2,8 it’s estimated that nearly half of adolescents and young adults who engage in self-harm appears to be in the absence of these conditions.8

Substance abuse among those who self-harm is not uncommon.9,10 One study of adolescents who engage in non-suicidal self-injury found that 59.6% met the clinical criteria for a substance use disorder.9 Major depressive disorder and anxiety disorders are even more common than alcohol or drug use in someone who engages in regular self-harm.10

It’s important to keep in mind that although substance use disorders commonly occur with other mental disorders, it doesn’t necessarily mean that one mental illness causes the other.11

Non-suicidal self-harm early in life, however, has been found to have a strong association with substance misuse, self-harm as well as other mental health disorders in the future.12


  1. U.S. Department of Health & Human Services. (2017). What to Look For: Mood Disorders: Self-Harm.
  2. Hornor, G. (2016). Nonsuicidal Self-Injury. Journal of Pediatric Health Care, 30(3), 261–267.
  3. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  4. Glenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., & Auerbach, R. P. (2017). Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents. Journal of Abnormal Child Psychology, 45(5), 971–983.
  5. Brown, R. C., & Plener, P. L. (2017). Non-suicidal Self-Injury in Adolescence. Current Psychiatry Reports, 19(3), 20.
  6. Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794.
  7. Zetterqvist, M. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health, 9(1).
  8. Peterson, J., Freedenthal, S., Sheldon, C., & Andersen, R. (2008). Nonsuicidal Self injury in Adolescents. Psychiatry, 5(11), 20–26.
  9. Nock, M., Joinerjr, T., Gordon, K., Lloydrichardson, E., & Prinstein, M. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72.
  10. Gratz, K. L., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2015). Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index. Assessment, 22(5), 527–539.
  11. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
  12. Mars, B., Heron, J., Crane, C., Hawton, K., Lewis, G., Macleod, J., … Gunnell, D. (2014). Clinical and social outcomes of adolescent self harm: Population based birth cohort study. BMJ, 349, g5954.
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