Making Sense of Self-Harm

Most people, including both family members and professionals, are perplexed by self-harm behaviors. They struggle to understand why people engage in these acts. There are numerous theories as to the reasons for self-harm, but the one that seems to fit the most is that self-harm serves an affect-regulation function.

What does that mean? It means that the self-harm does serve a purpose for the individual. In other words, they are not just doing it for no good reason. It helps the person manage his/her emotions. The best way I can think of to explain it is that self-harm seems to be very effective (ie, it works for the intended purpose), but it is also very unhealthy. It helps some people numb their emotions, whereas for others, it helps them feel emotions that have become numbed. Clearly, it is a confusing behavior that requires specialized treatment.

Treatment Approach

My treatment approach for self-harm closely mirrors my treatment for eating disorders. Whether the behaviors are food-related or self-harm based, the underlying issues is the same. In fact, many individuals who have an eating disorder also have a history of self-harm, and vice versa.

Just as individuals with eating disorders are frightened to give up their behaviors, individuals who engage in self-harm are scared they will not be able to manage their lives without the behavior(s) that have helped them to manage their difficult emotions. Many have a difficult time expressing themselves with words, and are not sure how to explain what they are thinking and feeling. As with eating disorders, I believe it is important to identify the “functions” the self-harm behaviors serve and the needs they meet, and then identify healthier ways of meeting those needs.