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Understanding Self Harming Behavior in Clients

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SOAPsuds team

Published: 7/7/2025

Self-harming behavior in clients can be one of the hardest challenges a therapist may face. While about six percent of adults report having self-injured at some point in their lives, teenagers seem to engage in it nearly three times more often. No matter the numbers, this is a troubling issue that calls for careful attention. Here's what therapists should know when working with clients who engage in self-harm.

Overview

  • Self-harm, also called non-suicidal self-injury (NSSI), means intentionally hurting oneself without wanting to end one’s life. It is often related to emotional pain, borderline personality disorder, or other mental health concerns.
  • Common forms of NSSI include cutting, burning, picking wounds, inserting objects under the skin, and self-hitting, usually as a way to cope with difficult feelings or emotional numbness.
  • Even though self-harm is not the same as suicidal thinking, it may raise the chances of suicide, making early care and full treatment important for those involved.
  • Helpful treatment methods include Cognitive-Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), mindfulness skills, family support, and sometimes medication, though research into medications for this issue is still limited.

Understanding self-harm

In mental health research, self-harm is often called non-suicidal self-injury or NSSI. The term includes any intentional act of harming the body that is not accepted socially (e.g., tattoos, piercings) and is not meant to cause death. Its most often linked with borderline personality disorder, though NSSI is listed in the DSM-5 as a “condition for further study,” which could lead to it being defined as a separate disorder in the future.

Common self-harm behaviors

  • Cutting is the most widely seen type of self-harm. People often use blades, scissors, or other sharp items to make cuts, usually on their arms or legs. The severity can vary from light scratches to deeper wounds.
  • Burning is also frequently reported. A match, lighter, or even a cigarette is used to cause burns.
  • In some rare cases, people push items like paper clips under their skin.
  • Skin picking is another type of self-injury that often goes unnoticed. Some individuals pick at new or existing wounds to prevent healing.
  • Other behaviors can include hitting oneself, head banging, or pulling out hair.

Why do people turn to self-harm?

There are many reasons people might engage in NSSI. The following factors help explain the behavior:

  • Some individuals find it hard to deal with emotional pain and prefer physical pain over emotional suffering.
  • Others might feel emotionally disconnected and use pain to feel something again.
  • On a biological level, self-harm can trigger endorphins, which make a person feel better, reinforcing the behavior.

More on what leads to self-harming behavior

  • Trauma from early physical or sexual abuse or neglect often plays a part.
  • Depression and low self-image are strongly linked to this behavior.
  • People with eating disorders also show higher chances of self-harming. It can create a sense of control.
  • Bullying or being pushed away by peers makes youth more likely to self-injure. Being isolated is a major risk.
  • However, having strong family bonds and good support can help lower the risk of NSSI.

Is self-harm the same as suicidal thoughts?

Self-harm and suicide thoughts are not equal. Most who self-injure don’t plan to end their lives. Still, self-injury might be an early sign for some who go on to attempt suicide. More than half of children who die by suicide had self-harmed before. NSSI may make the act of self-injury more familiar, which can be dangerous for those having suicidal thoughts.

How to treat self-injury

Treating NSSI can be tough and isn't fully supported by research yet. Still, some approaches have shown promise:

CBT

CBT has been tested the most for treating NSSI. Approaches like problem-solving therapy and Acceptance and Commitment Therapy (ACT) show potential in lowering self-harm.

DBT

DBT, a type of CBT, is especially noted for helping those with NSSI. It focuses on handling emotions, solving problems, and dealing with distress. DBT's ACCEPTS skill is often useful.

The "Dialectical Behavior Therapy Skills Workbook" is a helpful resource with exercises for clients who self-harm.

Medication

There’s limited research, but some medications like SSRIs and SNRIs may help reduce self-injury.

Helpful strategies for therapists

Be open

Clients usually try to hide self-harming behavior and feel ashamed. Therapists need to talk about it directly and without judgment. Offering empathy can reduce shame and build trust for deeper conversations.

Recognize triggers

It’s important to find what leads up to self-injury. Once triggers are clear, therapists can help clients choose healthier ways to cope.

Include family

Involving the family—especially for teens—can help reduce self-injury. Family members should learn about NSSI and show support. Parents need to avoid punishment and instead offer encouragement and understanding.

Practice mindfulness

Mindfulness helps those who feel disconnected. It allows clients to be more in tune with their emotions or shift attention to body and surroundings rather than

Emotional pain. It also encourages facing feelings with less judgment.

Avoiding relapse

Helping clients who self-harm often means staying in closer contact than usual. More sessions or check-ins may be needed. A benefit of full DBT programs is that clients can get phone support when needed between regular visits.

Self-injury is serious and can be distressing for therapists to treat. It requires steady support and careful attention to progress and risk.

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