Self-Harm and Addiction

Self-harm issues are incredibly challenging for anyone to navigate, and when compounded with addiction, life can become even more complex. However, effective treatments are available to help you overcome this dual diagnosis. Reclaiming control over your life is not only possible but also an achievable goal.

What is self-harm?

Self-harm refers to the intentional act of inflicting harm or injury to oneself. This behaviour is often a manifestation of emotional pain, distress, or an attempt to cope with overwhelming feelings. It can take various forms, including any method that causes harm to the individual. Self-harm is a serious concern and often indicates underlying emotional or psychological struggles that require attention and support.

Are there different types of self-harm?

Self-harm can take various forms, and individuals may engage in different methods of self-injury (Known as Non-Suicidal Self-Injury or NSSI in psychological literature) for several different reasons. It’s important to note that self-harm is not a healthy or constructive coping mechanism and that we are listing the following ways for educational means:

Cutting or self-cutting: This sign of self-harm involves using a sharp object to cut the skin, typically on the wrists, arms, or thighs.
Burning: Inflicting burns on oneself using heat sources such as matches, lighters, or heated objects.
Hitting or punching oneself: Physically hitting or punching one’s own body as a way to cope with emotional pain is a sign of self-harm.
Hair-pulling (trichotillomania): This sign of self-harm involves pulling out one’s own hair, often as a response to stress or anxiety.
Head-banging or hitting: Repeatedly hitting one’s head against a hard surface, which can lead to injuries.
Biting: Biting oneself to the point of causing injury is another sign of self-harm.
Interference with wound healing: Deliberately preventing wounds from healing or reopening existing wounds.

What causes people to self-harm?

Self-harm is a complex behaviour, and its causes can vary widely from person to person. Below are reasons why some self-harm, but be aware that these are not the only reasons why this behaviour occurs.

Emotional Distress

Overwhelming emotions: Individuals facing intense emotions like sadness, anger, or frustration may need immediate release. Self-harm might serve as a way to divert attention from emotional pain to physical pain temporarily.
Distraction mechanism: For some, self-harm acts as a distraction from emotional turmoil. Physical pain may be perceived as more manageable or controllable than overwhelming emotions.

Mental Health Conditions

Depression: People with depression may struggle with a persistent low mood, feelings of hopelessness and self-worth issues, leading to self harming behaviours as a coping mechanism.
Anxiety: Excessive worry and anxiety may drive individuals to self harm as a means to gain a sense of control or relief from their heightened emotional state.
Borderline Personality Disorder (BPD): Individuals with BPD may experience intense and unstable emotions, making them more susceptible to self-harming behaviours as a way to regulate emotions.

Trauma

Abuse and violence: Survivors of abuse or violence may resort to self-harm as a coping mechanism, attempting to regain control over their bodies or as a way to express feelings of anger, shame, or guilt.
Loss: Grief and loss can be overwhelming, and some individuals may turn to self-harm as a way to externalise or cope with the emotional pain associated with significant losses.

Difficulty expressing emotions

Communication challenges: Some individuals may struggle to articulate their emotions verbally. Self-harm, in this context, becomes a non-verbal communication method to express inner struggles or seek attention.

Social and environmental factors

Relationship problems: Strained relationships, conflicts, or a lack of support can contribute to emotional distress, potentially leading individuals to self-harm as a way to cope with the associated pain.
Isolation: Feelings of loneliness and isolation can exacerbate emotional struggles, making self-harm an appealing outlet for those seeking relief or connection, even if through negative means.
Bullying: The experience of bullying can result in a sense of powerlessness and humiliation, leading some individuals to resort to self-harm as a way to regain a sense of control.

Why do self-harm and addiction co-occur so often?

Self-harm and addiction often co-occur due to various interconnected factors, and it’s important to note that each individual’s situation is unique. Here are some common reasons for the co-occurrence of self-harm and addiction:

Coping mechanisms: Individuals may turn to both self-harm and substance abuse as ways to cope with emotional pain, stress, trauma, or mental health issues. These behaviours can provide temporary relief or distraction from overwhelming emotions but could end up leading to a dual diagnosis of self-harm and addiction.
Underlying mental health issues: Conditions such as depression, anxiety, borderline personality disorder, or other mood disorders can contribute to both self-harm and addiction. People may use substances as a form of self-medication to alleviate emotional distress.
Impulse control: Both addiction and self-harm involve difficulties in impulse control. The urge to self-harm or use substances can be an impulsive reaction to emotional turmoil, and individuals may struggle to find healthier ways to manage these impulses.
Trauma and abuse: Individuals who have experienced trauma or abuse may resort to self-harm and substance use as maladaptive coping mechanisms to numb emotional pain or regain a sense of control.
Social isolation: Feelings of loneliness and isolation can contribute to self-destructive behaviours. Substance use might provide a sense of escape, and self-harm may be a way to express emotional pain when verbal communication feels inadequate.

Is self-harming itself addictive?

Theoretical literature proposes that Non-Suicidal Self-Injury (NSSI) could be seen as a behavioural addiction. However, there are debates on this topic.

Studies suggest similarities between self-harm and addiction, noting emotional triggers, strong urges, and criteria overlap with substance dependence. However, unlike substance use, self-harm is primarily perpetuated by negative reinforcement, and its recurrence is better explained by emotional processes rather than addiction mechanisms.

Here is a short round up of some of the available material:

Studies propose a similarity between the emotional state preceding NSSI and aversive withdrawal symptoms in drug users.
Research reports strong urges to self-injure in individuals displaying NSSI.
Some authors indicate reduced endogenous opioids in those engaging in NSSI, with conflicting evidence.
One study explored NSSI under an addictive paradigm in adolescents, using a self-report measure adapted from DSM-IV criteria for substance dependence. Results showed that 81% endorsed more than five criteria in repetitive NSSI.
Another study emphasises that, unlike substance use, NSSI is perpetuated only by negative reinforcement.
The recurrence of NSSI is suggested to be better explained by emotional processes rather than addiction mechanisms.

Source: Blasco-Fontecilla, Hilario et al. ‘The Addictive Model of self harming (Non-suicidal and Suicidal) behaviour.’

Treatment for self-harm and addiction

Prior to commencing addiction treatment, it is crucial to address self-harm issues to enhance the likelihood of a successful rehabilitation experience. This involves consulting with a mental health professional, obtaining a prescription for necessary medications (if required) and participating in therapy specifically targeting self-harming behaviours either before or alongside addiction treatment.

Medications prescribed may include antidepressants, mood stabilisers, or anti-anxiety drugs, depending on the underlying factors contributing to self-harming behaviours. When entering rehabilitation at UKAT, our medical team will take measures to ensure you receive any prescribed medications and provide additional support as needed.

Therapies used at our rehab centre

At UKAT, our rehab treatment primarily addresses addiction and offers essential support for sustaining sobriety. Importantly, the therapeutic approaches utilised in rehab can also have a notable positive influence on self-harming behaviours. This is attributed to the fact that the coping skills, strategies for emotional regulation and supportive networks cultivated during rehabilitation can be advantageous for individuals who self-harm.

At UKAT, our addiction treatment programmes encompass various rehabilitation therapies that also yield significant advantages for individuals dealing with concurrent self harm issues. These therapies comprise:

Dialectical Behavioural Therapy (DBT)

Tailored to address self-destructive behaviours, including substance abuse and self-harm, DBT empowers individuals to develop skills for effectively navigating emotional pain. This heightened resilience aids in breaking the cycle of addiction and self-harm when facing distressing emotions.

Mindfulness-based therapies

With the main aim of creating a non-judgmental awareness of thoughts, emotions and urges, these therapies assist individuals in identifying triggers leading to substance abuse and self-harm. This enables them to accept and observe their distress without engaging in destructive reactions.

Group therapy

Creating a supportive community of peers with similar struggles, group therapy proves especially beneficial for individuals with a dual diagnosis of self-harm and addiction. Within this setting, individuals can learn from each other’s successful strategies for managing harmful urges and find a sense of camaraderie on a shared path to recovery.

Aftercare

UKAT’s commitment extends beyond rehab, offering a continuum of care to promote sustained recovery from both self-harm and addiction. This includes continued counselling, follow-up assessments and participation in support groups. Educational workshops and access to resources empower individuals in managing both self-harm and addiction. Family involvement strengthens support networks, ensuring ongoing assistance for a successful reintegration into daily life post-rehabilitation.

What are the next steps?

At UKAT, we recognise the distinct difficulties that self-harm can pose throughout the addiction recovery process. Our commitment lies in crafting comprehensive, compassionate treatment plans that offer all-encompassing support. If you or a loved one is grappling with self-harm and addiction, there’s no need to delay. Contact UKAT today and allow us to assist you in initiating the initial strides toward a healthier and more content future.

(Click here to see works cited)

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Blasco-Fontecilla H, Fernández-Fernández R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J. The Addictive Model of self harming (Non-suicidal and Suicidal) Behavior. Front Psychiatry. 2016;7:8. Published 2016 Feb 1. doi:10.3389/fpsyt.2016.00008