Understanding Self-Harm:

Why It Happens, How It Connects to Eating Disorders, and What We Can Do About It

Self-Harm Isn’t Always Suicidal—So What Is It? Many people are surprised to learn that self-harm doesn’t always mean that someone is feeling suicidal. While self-harm can occur alongside suicidal thoughts, it often serves a very different function. In fact, for many individuals, self-harm is not about wanting to die at all, rather it’s about trying to survive painful emotional experiences.

Non-Suicidal Self-Injury (NSSI) is a diagnosis recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It refers to the deliberate, self-inflicted destruction of body tissue without suicidal intent and for reasons that aren’t typically seen as healthy ways of coping. Common examples include cutting, burning, scratching, and hitting or banging body parts. One key distinction between NSSI and suicide attempts is the intent behind the behavior. While suicidal behavior is aimed at ending one’s life, NSSI is typically used as an attempt to manage intense emotions, escape emotional numbness, or express inner pain. Although the physical harm is real, the purpose is often to feel better, not to end one’s life. And this distinction matters because self-harm may look alarming from the outside, but it's often rooted in a person’s effort to regain control, communicate distress, or punish themselves when they feel overwhelmed by shame. It’s a signal that someone is suffering. 

An estimated 17% of adolescents have engaged in some form of self-harm, so understandably this behavior can be very confusing and scary for many families. Parents often cannot fathom why their loved one would intentionally cause injury to themselves if they aren’t suicidal, and that confusion is valid. The Neuroscience Behind Why It Works—Temporarily

So why do people keep going back to self-harm, even when they don’t want to?

It’s because it works, at least in the short term.

The reason many individuals turn to NSSI is that it can create a temporary sense of relief. When someone self-harms, the physical pain can override the emotional pain by affecting how the brain processes stress. Specifically, it reduces activity in the amygdala, the part of the brain involved in regulating emotions like fear, anger, or sadness. At the same time, self-harm can lead to a short-term increase in feel-good chemicals like dopamine and endorphins. This can produce a calming effect, or even an emotional “high,” which some people describe as addictive. The combination of emotional relief and chemical reward reinforces the behavior of self-injury, making it more likely to happen again when distress returns. Over time, the brain starts to associate self-harm with relief, and the behavior becomes a default way of coping with distress. Even when someone wants to stop, they may feel unable to because the behavior does work in the short term. Unfortunately, that relief is temporary, and it often comes with feelings of shame, secrecy, or more serious bodily damage, adding to the emotional pain rather than resolving it. Breaking this cycle takes time. It requires the development of safer, more sustainable ways to cope with overwhelming emotions, and these skills take practice, patience, and a lot of support. Why Self-Harm and Eating Disorders Often Show Up Together NSSI/self-harm behaviors can occur alongside any number of other mental health conditions, including eating disorders. In fact, research shows that about 27.3% of individuals diagnosed with an eating disorder also engage in NSSI.

There are a number of reasons for this overlap. Eating disorders and self-injury often serve similar emotional functions. They both help regulate negative emotions and manage interpersonal difficulties, and  provide a sense of control. For some, these behaviors also act as a form of self-punishment channeling internal pain into something they can visibly see. Furthermore, eating disorders and NSSI have a lot of the same risk factors, including poor emotion regulation, a history of trauma, high levels of self-criticism and negative beliefs about the body. It’s no surprise, then, that these behaviors frequently show up together, reinforcing one another and creating a cycle that can be hard to break without support. Where We Go From Here When supporting someone who struggles with self-harm, the most helpful thing you can offer isn’t control, it’s compassion. Reacting with anger, judgment, or panic may come from a place of fear, but it can increase shame and make things worse. Instead, try to respond with curiosity and care. Validating someone’s pain and offering emotional safety can be powerful steps toward healing.

Therapies like DBT (Dialectical Behavior Therapy) can be especially effective for NSSI because they teach concrete skills for managing distress and navigating difficult emotions. But, it’s also important to remember: people don’t just stop self-harming overnight. Even when the desire to heal is strong, the urges may still come up, and it takes time to feel capable of consistently choosing a different response. Ultimately, with time full recovery is absolutely possible.