Psychological and Psychiatric Causes and Solutions
Self‑harm or Non‑suicidal Self‑Injury (NSSI) refers to behaviors in which a person intentionally harms their own body (such as cutting the skin, burning, or hitting themselves) without the direct intention to die. However, this behavior is strongly associated with an increased risk of suicide.
This phenomenon has a notable prevalence among adolescents and young adults and usually reflects an inability to regulate intense emotions.
1. Prevalence and Clinical Characteristics
- Peak prevalence: ages 12 to 18
- Reported slightly more frequently in girls
- Most common form: cutting
Other forms include:
- Burning the skin
- Severe scratching
- Hitting the body
- Picking at the skin or hair
Important note:
In many cases, the goal is not death but the reduction of psychological distress.
2. Psychological Causes of Self‑Harm
Self‑harm is usually the result of a combination of several factors.
a) Impaired Emotional Regulation
Considered the most significant cause.
The individual experiences intense emotions such as:
- Anger
- Anxiety
- Shame
- Feelings of emptiness
- Hopelessness
Injuring the body can lead to:
- Temporary reduction of tension
- Release of endorphins
- A sense of control
For this reason, the behavior becomes reinforced and likely to be repeated.
b) Expression of Psychological Pain
Some adolescents are unable to verbally express their suffering.
Self‑harm becomes:
- A way to show inner pain
- An indirect request for help
c) Self‑Punishment
(Self‑punishment)
In individuals who experience feelings of:
- Guilt
- Worthlessness
- Shame
self‑harm may be perceived as a form of self‑punishment.
This pattern is common in depression.
d) Emotional Numbness
Some individuals experience emotional numbness.
Self‑harm may help them:
- “Feel something”
- Feel alive.
e) Social and Environmental Influences
Several important factors may contribute to the development or worsening of these behaviors:
- Bullying
- Family conflicts
- Emotional or sexual abuse
- Academic pressure
- Social media influence and modeling
3. Co‑occurring Psychiatric Disorders
Self‑harm is often associated with certain psychiatric disorders:
- Depression
- Anxiety disorders
- Borderline Personality Disorder (BPD)
- PTSD
- Eating disorders
- Substance abuse
- ADHD
4. Important Risk Factors
The risk of self‑harm increases in the presence of:
- Childhood trauma or abuse
- Family problems
- Social isolation
- Identity difficulties during adolescence
- Deficits in emotion regulation skills
- Severe perfectionism
5. Warning Signs
Some signs may indicate possible self‑harm:
- Wearing long‑sleeved clothing even in warm weather
- Repeated wounds on the hands or thighs
- Razors or sharp objects among personal belongings
- Social withdrawal
- Severe mood swings
6. Psychological Treatment Approaches
Treatment usually involves a combination of psychotherapy, skills training, family interventions, and medication under medical supervision.
1. Cognitive Behavioral Therapy (CBT)
Focuses on:
- Identifying negative thoughts
- Correcting dysfunctional beliefs
- Teaching coping skills
2. Dialectical Behavior Therapy (DBT)
One of the most effective treatments for self‑harm.
Four core skills:
- Emotion regulation
- Distress tolerance
- Mindfulness
- Interpersonal effectiveness
3. Emotion Regulation Skills Training
The individual learns to:
- Identify their emotions
- Manage them without causing harm
4. Family Therapy
Very important for adolescents.
Goals include:
- Improving communication between parents and adolescents
- Reducing conflicts
- Increasing emotional support
7. Healthy Alternatives to Self‑Harm (Harm Alternatives)
In psychotherapy, adolescents may be encouraged to use:
- Writing about their feelings
- Physical exercise
- Squeezing a stress ball
- Drawing
- Holding ice in the hand
- Deep breathing and relaxation techniques
These methods can reduce tension without causing physical harm.
8. The Role of Family and Loved Ones
An appropriate response is very important.
Recommendations:
- Avoid judgment
- Listen with empathy
- Create a safe space for dialogue
- Seek help from mental health professionals
Harsh reactions, blame, or punishment may worsen the behavior.
Summary
Self‑harm in young people is usually:
- An attempt to regulate intense emotions
- Or a way of expressing psychological pain
This behavior is a serious mental health warning sign and requires:
- Psychiatric evaluation
- Psychotherapeutic intervention
- Family support
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