Self-harm may resemble a behavioral addiction in several ways, especially when someone compulsively uses behaviors to provide relief.
Self-harm, also known as non-suicidal self-injury, is deliberately injuring yourself without life-ending intent. It can involve repetitive or episodic behaviors, but it isn’t classified as an addiction in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
The DSM-5-TR, which provides clinical criteria for diagnosing mental health conditions, limits addiction to substance use disorders and gambling.
Addiction, in general, remains an understudied field. The DSM-5-TR mentions that other behavioral addictions, such as shopping addiction, likely exist, but there’s currently not enough scientific evidence to include them under the official banner of addictive disorders.
It may be possible to be addicted to self-harm, but the answer isn’t clear according to diagnostic guidelines.
Addiction is a compulsive drive to engage in something despite negative consequences. It’s caused by changes in your brain’s reward system that push you to seek pleasurable effects and avoid withdrawal symptoms.
While addiction is typically discussed in relation to substances, many experts believe that behavioral addictions have similar effects on the brain. Like drugs, certain behaviors may trigger your brain’s chemical reward system, creating a situation where you start to crave the relief or reward of the behavior.
Monica Amorosi, a licensed mental health counselor from New York City, indicates that it’s up to the clinical judgment of the therapist to determine whether a behavior fits into the category of a behavioral addiction and whether the lived experience of their client matches a situation of addiction.
“For some, self-harm can be just as strong of a behavioral addiction as shopping, gambling, or sex,” she says. “It can release intense chemicals that become required for regulation, it can cause relief or release; it can become compulsive and out of control.”
Carolyn Weimer, a licensed professional counselor from Pittsburg, Pennsylvania, adds that these patterns of compulsive or repetitive self-harm that resemble addiction are sometimes referred to as non-suicidal self-injury disorder.
But that doesn’t necessarily mean self-harm is always, or even commonly, an addiction. Weimer says addiction and self-harm usually have different underlying motivations and treatment approaches.
“Addiction typically involves the compulsive use of substances or behaviors to achieve pleasure or [physical] relief, while self-harm is often driven by emotional pain and a desire for emotional relief,” she explains.
Many self-harming behaviors are already secretive and are not limited to situations of behavioral addiction. You’re not necessarily going to notice “new” types of marks or find addiction-specific self-harm tools.
In general, watching for self-harm addiction means looking for signs of self-harm, such as:
- a high rate of accidental injuries
- unexplained marks and scars
- excessive use of first-aid materials
- a habit of wearing high coverage clothing even in hot temperatures
- the presence of a supply of sharp items
- negative self-talk
- emotional instability
Self-harm is a coping mechanism. It’s an unhelpful, or maladaptive, way of neutralizing emotional distress.
“For reasons that may be hard to understand, self-harm is a regulating tool for some, a calming tool for some, and a punishing tool for others,” says Amorosi.
“When you do it for a long time or struggle with behavioral control, it can become ingrained as a habit, it may be required to regulate, and someone may not be able to stop themselves from doing it.”
People may use self-harm to manage emotional distress for various reasons. For some people, it provides a sense of control when things feel out of control. For other people, it stops negative thoughts and feelings in their tracks, offering a way to regulate emotions and self-soothe.
Self-harm might also allow emotional expression, providing a way for someone to communicate emotional pain when it isn’t possible to do so verbally.
Treatment is available for self-harming behaviors. The best way you can support someone who self-harms is to connect them with professional help.
Mental health professionals can provide alternative coping strategies for dealing with emotional pain and help uncover the roots of negative thought processes.
In addition to providing resources for your loved one, Weimer recommends:
- educating yourself about self-harm
- listening without judgment
- checking in regularly
- joining your loved one in a support group
- creating a safe space to communicate openly about self-harm
Above all else, compassion is essential.
“They are just trying to find a way to live with less distress,” Amorosi says. “Threatening them with the hospital or intense therapy will likely make them not trust you and is also likely not even appropriate care. What they need is someone to understand them.”
Psychotherapy can help you change self-harming behaviors. Using several frameworks, therapists can help you explore the source of your emotional distress and identify unhelpful ways of thinking.
You can then take steps to restructure your thought patterns and cultivate new, beneficial coping strategies to take the place of self-harm.
Common therapeutic approaches used in self-harm treatment include:
In some cases, your doctor may prescribe medications to support your treatment and manage severe mood symptoms.
At their core, self-harming behaviors are coping mechanisms for negative thoughts and emotions. They do not usually fall into the category of addiction.
However, for some people, self-harm can become a compulsive way to find relief that’s characteristic of behavioral addiction.
Each person’s experience with self-harm is unique. It’s the responsibility of a mental health professional to determine whether self-harming behaviors and your lived experience fit the criteria for addiction.