Why I Don’t Want You to Self-Harm

Content warning: self-harm

Much of the work I do involves helping teens and adults stop self-harming, and there are many reasons I am emphatically against the practice. I'll also try to be self-aware for a second and recognize that saying “self harming is bad” isn't exactly a daring position to take on my part. It seems pretty obvious why this practice is damaging, and there are some effects that maybe you hadn't thought about yet. Let's first define self-harm, and then I'll detail all the reasons you need to stop. (If you don’t have the energy for all this, feel free to skip down to the numbered list.)

Self-harm is defined as any action that purposefully causes tissue damage to your body. Anything that creates a wound that needs healing. This includes but is not limited to cutting, burning, hitting, scratching, and biting. Frequently this definition is itself deployed as the be-all end-all reason to stop self-harming. According to caring others in our lives and society at large, “It's bad to hurt yourself.” I can't tell you the number of clients I've had who say they only want to stop self-harming because “other people don't like it.” And while I'll accept that reason if that's all the motivation I can get from you in this moment, quitting is usually easier if you have a variety of reasons backing you up.

I also want to underline that the self-harm is not the problem. (This is where I lose some people, so please stay with me.) The self-harm is the ineffective way to cope with the true problem. Let's say I had a fight with a friend and self-harmed afterwards. The real problem is the fight, or my inability to tolerate the emotions from the fight, while the self-harm is the really not helpful way I coped with all that. Yes, the self-harm is problematic, and it's still a step away from the true problem. Does that make sense?

The reason that DBT works so well is that at the same time we remove self-harm as an option for coping (with your commitment and agreement), we are seeking to replace that behavior with more long-term effective ways of solving or coping with the real underlying problem. For example, when I am feeling intense anxiety after a conflict, I can choose to self-harm (with all the negative impacts listed below), or I can choose to use paced breathing, progressive muscle relaxation, distraction, or another coping skill. I can also choose to improve my communication to reduce overall likelihood of intense arguments—and I'm getting a bit ahead of myself here, so let's return to the original aim of deposing self-harm as a coping strategy.

Reasons not to self-harm:

1. Self-harm can be incredibly reinforcing.
   I'm not here to lie to you. (I am here to encourage you to stop.) The reason people self-harm is because in the immediate aftermath, emotion intensity can decrease. This means that instead of engaging in more difficult and more long-term effective coping skills (I'm thinking here about reaching out to friends, breathing or meditation exercises, exercise in moderation, etc.), it gets more and more enticing to just push the “easy button” of self-harm even though you definitely didn't intend for it to be a long-term thing. This “easy button” is problematic for reasons I'll keep listing.

2. You need self-harm more frequently, and it gets more severe.
   This may not match your personal experience, and, for most folks I meet who have been self-harming for a period of time, it rings true. I say this and people nod along, which is sobering because increasing severity and frequency means you're increasing risk of infection, creating more social and familial consequences, and consuming more time with it.

3. Self-harm is not portable.
   Most people self-harm alone. Not when there's intolerable emotions at a business meeting or in class, not when in the middle of a fight at Thanksgiving with family, and not during a panic attack in the middle of Walmart. There's no way to surreptitiously self-harm in the middle of any of these things. So if you are in the midst of really hard emotions and you haven't learned effective coping, you have to wait, wait, wait, wait to manage those emotions until you are alone. Or you have to leave the situation, which is sometimes not even an option. With effective coping like paced breathing, progressive muscle relaxation, imagery, pros and cons, and willing hands (I could keep going), you can stay in the situation, manage your emotion, and do what is needed in the moment. If it happens to be a high-stakes situation (a job interview, for example), no one can even see that you're using the skills just listed.

4. Self-harm increases likelihood of suicide, and not in the way you are thinking.
   I don't mean to suggest you will accidentally die by suicide while self-harming. What I mean is that repeatedly engaging in self-harm behavior desensitizes you to dangerous things. This makes it more likely that you will complete suicide in the long term. Studies show that death by suicide correlates with self-harm, reckless driving, physical altercations, and other situations where a person is accidentally or purposefully desensitizing themselves to danger. And so even for folks who say, “I'm really careful,” and “I don't want to die, but this really helps me feel better,” I point at this data.

5. Self-harm is not solving the problem.
   This is actually one of my favorite reasons to stop, because even people who are incredibly suicidal can see the point of this. Even if I have a person who doesn't care that their family is worried, doesn't care that they see the severity and frequency increasing, and doesn't care that they are more likely to die by suicide, typically a person can get on board with the fact that it just. isn't. helping. Self-harm doesn't create more rewarding relationships. It doesn't fix mistakes. It doesn't change the past or resolve your mental health symptoms. It doesn't solve the problem. And if you and I can agree on that, we have a starting point together. No one wants to feel this way, and if we can replace the self-harm (not to mention the suicide planning or substance use or other unhelpful strategies) with something that will make a difference in your life, then maybe it's worth taking the risk of going to therapy.

Before I end the post, a little validation for those struggling:

I come down pretty hard on self-harm in this post. That doesn't mean I find fault with you for leaning on it or blame you for turning to it. When you feel extremely intense emotions and have urges as strong as 10 out of 10 before you even realize it, it's hard to think of making a change. At the same time, I know that there's help out there and healing from this is possible. For more information, see my page on DBT, as this is typically treatment of choice for ceasing self-harm behavior.

If you would like to stop self-harming or know someone who needs to, I offer in-person therapy in Huntersville, NC, and online therapy in NC and SC. Thank you for the time you invested reading this.