What is Self-Harm, Why Does It Happen, and What to Do about It

Non-suicidal self-harm (NSSI) is a very common phenomenon in multiple diagnoses; however, most people self-harm– some people just do it in more obvious or less socially acceptable ways than others.

Self-harm is any behavior that can cause pain, injury, or discomfort. Not all self-harm is intentional. Not all self-harm is dangerous.

Everyone Self-Harms or Has at Some Point

Have you ever been so angry that you have punched a wall, bitten that space between your thumb and index finger, or banged your head on a desk or book? Have you ever skipped meals because of your weight or eaten to the point of misery? Bite your nails to the quick? Pull your hair? Work out way too hard? Stay up way too late too many nights in a row?

All of those things are technically self-harm. They all serve a purpose. Our minds respond to what our body does and sometimes our behaviors are meeting subconscious neurological needs. These self-harming behaviors are typically performed to release neurotransmitters that help to regulate sensory systems.

If you’ve ever had a serious injury or surgery, you might have had the morphine pump attached to your IV bag with a button to push when pain became unbearable. Self-harming is like that.

But, not all self-harm is created equal, and different types serve different purposes. It is helpful to divide self-harm into two categories.

Acute Self-Harm and Chronic Self-Harm

Acute self-harm is like a crime of passion. It is done in the moment to reduce overwhelming sensory stimuli (cutting, head-banging, biting, etc.). Chronic self-harm, on the other hand, (skin-picking, nail-biting, teeth grinding, etc.) is an ongoing and habitual way to try and balance chronic sensory dysregulation.

I didn’t mention substance abuse or eating disorders because they can fall into either category. Binge-eating, using drugs (illegal or prescription, beyond normal prescribed dosages) or binge-drinking can acute if it is a means to stopping overwhelming feelings that can’t be calmed by other methods. But, those behaviors can become habitual and no longer serve the same purpose as acute self-harm.

Both types are neurologically driven and provide a way to meet a need.

Chronic Self-Harm

Chronic self-harm is a way of attending to generalized discomfort of unknown origin. This is common with sensory processing disorder and alexithymia. It is a quite-literal manifestation of being uncomfortable in one’s own skin.

Stopping chronic forms of self-harm often lead to different forms of self-harm because the underlying needs driving compulsive behaviors are not met. You might be hungry or dehydrated, constipated, overly-full, stressed, bored, over or under-stimulated.

If you’re autistic or have an underlying neurological or psychiatric condition, your existence might be characterized by constant low-grade, complex trauma for social and neurological reasons. The best approach to dealing with chronic self-harm is trying to meet your needs through trial and error, if possible and within your means.

You could try a sensory diet, set timers to remember to use the restroom, eat, drink water, etc. Give yourself permission to unplug from sources of stress (like Twitter or toxic relationships) if you need. If you can, see an OT to get a sensory profile.

If you can, moderate exercise has helped many people with sensory processing disorder. Screen time can also be taxing for many because of the visual overstimulating and difficulty with processing text.

This is a wonderful article about skin-picking, but it also addresses other forms of chronic self-harm.

How to Stop Biting Your Nails and Picking at Your Skin

Acute Self-Harm

Acute self-harm happens as a result of what would be best clinically described as a neurological storm– or a neurostorm. You feel a desperate discomfort that is completely uncontrollable and nothing “typical” can stop this overwhelming feeling. You can’t think of a way to meet your needs because you’re really not in the head space to problem-solve.

You might become easily dysregulated because your serotonin or dopamine is disrupted. This isn’t a sign of weakness. You might have a medical need as real as needing an allergy inhaler.

If serotonin reuptake inhibitors like Prozac don’t help, you could ask your doctor for an atypical anti-depressant like Wellbutrin which may help you to better regulate dopamine. Please note that these medications do not work instantly and are often a trial-and-error to get the right balance.

Acute self-harm triggers the brain to release endorphins that act like morphine. Sometimes, it can bring your runaway train to a stop long enough for you to orient yourself. The pain releases endorphins that act like morphine and slows the imbalance causing you to feel so intensely uncomfortable.

Also, causing oneself to bleed can achieve this effect. Acute self-harm is a tool of desperation from someone whose brain is out of electrochemical sync, and it’s not a suicide attempt. It’s quite the opposite, in fact, and is a measure to try and feel better when a person can’t find a way to stop intense suffering.

Managing NSSI

There are safer ways to manage those neurostorms, but they need preparation in advance. If someone is in that state of agony, they have likely tried to reason, take deep breaths, etc. and nothing has worked. Self-harm is the result of an internal emergency.

So, it is helpful to prepare in advance if you or someone you love is prone to these “neurostorms.” I recommend making a “meltdown box” with a very basic list of reminders and some items that might help to weather the storm.

Everyone’s comfort items will be different and tailored to the person, but here are some ideas to get you started.

Meltdown box contents:
1. A reminder to go to a pre-curated playlist of songs that have historically helped to stave off meltdowns (do NOT put trigger songs on that list)
2. A reminder to try the tips listed below
3. Numbers to call if you are in a crisis situation
4. Objects of comfort for you
5. A list of shows/movies/videos that are likely to make you laugh
6. Noise-cancelling headphones are miracle workers


Meltdowns are traumatic themselves. They can cause PTSD because they are so intense. The reason that people slam a hammer onto their hand, cut gashes in their arms, or bang their heads on the wall is because the external pain is much easier to tolerate than the internal neurostorm.

Trying to escape a meltdown is not a moral failing. It’s survival. The fact of the matter is, self-harm works when other conventional methods can’t stop that runaway train that is a brain in neurostorm.

Self-harm isn’t ideal, but until you’re in a place where you have a plan of action, adequate treatment, or reliable support network, reading this article isn’t going to be enough for you to overcome meltdowns and master weathering neurostorms. You need adequate tools.

Harm Reduction is the Goal

I’m not even going to tell you that you should stop self-harming, because maybe you can’t right now. I’m going to try and give you tools for harm reduction with the hopes that you are able to find a great support network and a path for keeping regulated.

If you have to self-harm, biting your arm or punching your leg is better than concussing yourself by banging your head– or breaking your hand on a brick wall.

Staving off Meltdowns Safely

If you’re able, intense physical exercise and getting to the “runner’s high” is a release of those numbing endorphins. Punching a punching bag (with gloves) is a safe option. Just go to the point of exhaustion, and it will help. If you dance, dance HARD (have your playlist ready).

Go do hard yard work. I was once accused of trying to bury a body for shoveling up my yard in the middle of the night.

A very good way to stop your neurostorm is to fill a basin (like a plastic storage tub or a large sink) with ice water & dive your head downward into it like you’re diving into a pool, then leave your face in there until you need to come up for air. You might need to do it more than once. This signals the brain to prepare the body to conserve resources as if to prep for hypothermia.

Your heart rate slows. Your breathing calms. Your stress hormones pause.

A simpler method can be to hold an ice cube in a sensitive place like in your armpit. Your brain doesn’t need pain so much as it needs intensity to stop the storm.

Screaming or singing at the top of your lungs can give you the same neurochemical release. You might need to do it into a pillow if the neighbors are asleep.

If you are so inclined, you could even keep a jar of extremely hot pepper or hot sauce in your fridge. Just, warn your relatives and guests that it’s not the chips-and-salsa kind of condiment.

My brother still hasn’t forgiven me for that last one…

Better than the Alternative

These interventions leave no scars. They aren’t perfect, they’re not sustainable for any span of time, and they are not guaranteed to stop your neurostorm. They’re just better than dangerous means.

Self harm isn’t a reliable or healthy way to manage meltdowns, but if you are feeling so dysregulated and overwhelmed that external pain is way less miserable than what you’re experiencing, prepare to focus on safer interventions that reduce the possibility of scarring, infection, accidentally causing life-threatening injury, causing a concussion, or other serious consequence.

Planning to Not Melt Down

No matter how centered you are, no matter how well you plan, and no matter how wonderful your therapist is, if you have a brain that has these neurostorms (which I believe are a type of non-epileptic seizure), then they may not be altogether avoidable. But, you can do a lot of things to reduce the risk of them.

  1. Absolutely, with no guilt, fire your current therapist if they are not able to help you navigate self-harm or if they treat you like you are insane if you try to talk about it. Find a therapist who is specialized in trauma spectrum disorders. If you have meltdowns, you’re traumatized.
  2. Focus your self-care on building resilience against social triggers– like other people being verbally abusive towards you. You get to author yourself, and no one else can tell you who you are or what you are worth.
  3. If you’re in an actively-abusive situation, try reaching out to local resources to see if they can help you. If you’re having a hard time finding a job, try to connect with your district’s vocational rehabilitation unit. If you have a disability, they will often provide you with job placement services and work with you to get accommodations.
  4. Work on setting healthy boundaries for yourself and others. You may have relied too much on others to meet your needs, and that is something that will never be a long-term fix. It will require you and the other person(s) to dig deeper beyond healthy boundaries trying to just keep the situation stabilized. When that other person becomes uncomfortable or fails to come through, the consequences can be devastating.
  5. Once you are calm and in a good place, write down the trigger for those moments when you self-harmed or thought of self-harming. You might be able to identify a pattern of what is really triggering you, and that can help you plan to avoid or better manage those triggers.

It’s Okay. Don’t be ashamed.

You may be feeling intense shame about self-harming. Don’t. You were doing the best you could to deal with overwhelming agony that you couldn’t do better to process and stop while in the moment. You are as guilty of moral failure as a person who had a seizure. You couldn’t control it.

You’re not a freak for self-harming. You’re a person who likely has profound trauma and who isn’t getting adequate support or doesn’t have adequate tools to manage rogue neurostorms.

I’ve self-harmed many times. It stopped when I was in a supportive place where my needs mattered, when the autistic community taught me about meltdowns and how to manage them, and when I learned all I could about the neurology of a meltdown or “neurostorm.”

It’s a form of self care to have a meltdown plan.

For Loved Ones

If you’re a parent or loved one of a child or adult who self-harms, don’t freak out. Don’t shame or scorn that person. Tell them that you want to help them understand the feelings they were having and try to find better ways to cope. Let them know that “neurostorms” are inevitable, and give them ownership of self advocacy.

Always, always, approach providing support by empowering the person seeking support to to come up with solutions on their own terms, with you serving — not as a dictator– but as a port in a storm. Help them find healthy ways to manage their overwhelming emotions.

Ask them what would help.

Just feeling supported and loved– as opposed to judged, condescended to, and loved (yes, you can love someone and still be overbearing and harmful)– will be extremely helpful. If you see self-harm, don’t over-react. Ask them if they are feeling suicidal.

Ask them if they would like to go to the hospital. If the answer is no, then be okay with that unless they are in need of emergency medical care.

They might not know what they need, so let them know that you understand that something might not work, and you’re willing to keep trying until something does work. You could ask them about some of the following before self-harm happens and when they are in a good place:

1. Would you like a punching bag or drum kit to help you pound out those big emotions?
2. Do you feel like being wrapped in a weighted blanket would be helpful?
3. Would being held make things better, or would you prefer not to be touched?
4. Can I help you find a cool, quiet room so that you can lie down?
5. Would you like some noise cancelling headphones?
6. Could I fix you something to eat or drink in those moments?
7. Can I get you some noise cancelling headphones so you can listen to music?

The self-harm is not the lasting danger to the person, but the trauma from the neurostorm.

What Not to Do

Don’t freak out. At first, it might seem like a big deal. Focus on the inner pain and not the outer cuts or bruises. Self-harm is a symptom, and shaming someone for it will make it worse.

Tell them that it’s okay, but that you would like to find healthier ways to prepare for the next storm that won’t leave them with scarring, infection, or other long-term consequences.

Being given control, acceptance, respect, and support will reduce meltdowns proactively because knowing that there is someone out there on their side who isn’t judging them and who empathizes with the amount of distress they are feeling and wants to help– that’s what will make the difference.

Lastly, know that meltdowns are similar to night terrors. They are full of confusion, and the person experiencing them isn’t able to just choose to calm down. The person may be disoriented, irrational, and their ability to control themselves is diminished.

Don’t take their behavior or words in these moments personally. They’re in a nightmarish turbocharged version of fight-or-flight. Being a calm, supportive person can mean all the difference.

Further Reading

Alexithymia is common among autistics, ADHDers, and people with trauma. Learn more about what it means and how it presents in daily life. Not understanding one’s feelings or why they are happening is distressing.

No, Really, I’m Fine (on Alexithymia)


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6 Responses

  1. Thank you, this is very comprehensive. I’ll bookmark it for future reference.

  2. shhhhh don’t tell. This is such a hidden behavior and an almost forbidden subject for discussion, even on autism forums. Thank you for opening a dialogue and providing good sound information for those struggling with many forms of self harm. I have shared this several times already, it is something sorely needed in many of the groups I participate in and many of the people I care deeply about.

  3. Really helpful thank you Terra. I have self-harmed since I was a child and am now getting more of a handle on it. Also planning recovery tats!

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