Clinical Corner: Understanding & Supporting Individuals Who Self-Harm

Self-harm is a complex and often misunderstood behavior. Many individuals use self injurious behaviors (SIB) as a way to cope with emotional pain, stress, or sensory overload. While it can be difficult to talk about, increasing our understanding creates safety and supports healing.

What Is Self-Harm?

Self-harm (also called non-suicidal self-injury, or NSSI) refers to intentional injury to one’s own body without the intent to die.
Common forms include cutting, scratching, burning, hitting oneself, or reopening wounds.

People often use self-harm as a strategy to cope with overwhelming emotions, tension, or stress. It is not attention-seeking, but rather a private and often hidden behavior used to manage internal distress.

Why Do People Self-Harm?

Motivations vary widely, but research highlights several common functions:

Emotional regulation

Self-injury may temporarily reduce intense emotions (e.g., anger, sadness, anxiety) or help bring sensation when someone feels numb.

Self-punishment

Some individuals harm themselves in response to guilt, shame, or negative beliefs about themselves.

Communication or signaling need

Some individuals use self-harm to communicate distress when they struggle to put feelings into words.

Sensory and neurological factors (especially in autism)

For individuals with Autism, self-harm can stem from sensory overload, understimulation, difficulty communicating needs, or frustration.

Environmental stressors

Family conflict, trauma history, bullying, invalidation, and chronic stress all increase risk.

Who Is at Higher Risk?

Anyone can engage in self-harm, but certain groups experience higher rates:

-Adolescents and young adults

-Individuals with depression, anxiety, and trauma

-Autistic children and adults

-People with limited coping skills or difficulty regulating emotions

-Youth experiencing bullying or social isolation

Autism & Self-Harm

-Self-harm can look different for autistic children and adults. It is often connected to:

-Sensory overload (too much noise, light, or touch)

-Sensory understimulation (seeking strong input)

-Difficulties with communication

-Changes in routine or unexpected transitions

-Frustration when needs are not understood

-Medical discomfort (GI issues, headaches, dental pain, etc.)

Warning Signs of Self-Harm

Caregivers and providers may notice:

-Unexplained cuts, bruises, or burns

-Wearing long sleeves in warm weather

-Avoidance of activities that involve changing clothes

-Sharp objects kept nearby

-Withdrawal, irritability, or sudden mood changes

-Frequent “accidents” used to explain injuries

-Statements of self-hatred, guilt, or emotional overload

Supporting someone who engages in Self-Harm

-Always involve a mental health professional. Therapy has been shown to be effective in reducing self-harm

-Speak with the person in an empathetic, non-judgmental way

-Talking openly reduces stigma and increases safety

For individuals with autism:

-Linkage to behavior services can be beneficial, as behavior assessments can help to understand the purpose of the self-harm.

-Identify triggers by noticing when self-harm happens (such as during transitions, physical discomfort, etc)

-Create sensory friendly environments

-Support communication (use visuals, AAC devices, or simplified language to help individuals express needs)

-Assess for medical causes

When Is Crisis Support Needed?

Immediate support is essential if:

-Injuries are severe

-There is concern for suicidal intent

-The person cannot commit to a safety plan

-Self-harm escalates rapidly

Crisis support options include:

-Crisis Text Line: Text HOME to 741741

–988 Suicide & Crisis Lifeline

-Local mobile crisis teams

-Emergency departments when medically necessary

Individuals do not need to be suicidal to seek crisis support.

Key Takeaways

-Self-harm is a coping strategy for emotional or sensory distress – not manipulation.

-Supportive, nonjudgmental responses are essential.

-Collaborative planning helps individuals replace self-injury with safer coping skills.

-Autistic individuals may have unique sensory or communication-related drivers that require tailored interventions.

-Crisis resources are available 24/7 for immediate support.

Resources:

Help for Self-Harm | Text CONNECT to 741741 for support

The Cornell Research Program on Self-Injury and Recovery

Self-Injury Facts and Prevention

Self Injury in Autism: Causes and Interventions – Autism Research Institute