Self-Harm and Addiction

Self-harm, also known as non-suicidal self-injury, is the act of hurting oneself on purpose (but does not include normal piercing or tattooing).1-3 According to the U.S. Department of Health and Human Services about 1 in 100 people hurts themselves.1

Common methods of self-harm include cutting (not on the wrist), skin carving, burning, biting, scratching, hitting, head banging, and interfering with wound healing.2

Non-suicidal self-injury usually begins in the early teen years (12-14 years) and peaks at 20-29 years of age.3,4 It’s estimated that 7% to 14% of adolescents deliberately injure themselves at least once.2 About 4% of adults engage in self-harm.2

Why Self-Harm?

Self-harm is usually a maladaptive coping mechanism arising from adverse childhood experiences or high levels of subjective psychological distress.2 Non-suicidal self-injury behaviors are employed to relieve intense distressing feelings such as sadness or guilt. The sharp physical pain of self-harm helps to distract from unbearable feelings.2 Self-injury may also occur when a person feels they need to punish themselves or as a vehicle to gain attention so others can see their distress.2

Risk factors for self-injury during adolescence include bullying, negative social interactions, and emotional childhood abuse.5 Childhood sexual and physical abuse may also be a risk factor, although the evidence isn’t as clear.5

Self-Harm and Suicide

Suicide is the second leading cause of death among adolescents.6 Non-suicidal self-harm is not usually done in a suicide attempt, but it may in fact be a predictor of suicide attempts in adolescents and increase the risk for suicidal behavior.6,7

Suicidal thoughts and ideation that predate non-suicidal self-harm may increase the risk in suicidal behavior in teens who are thinking about suicide.4,6

For adolescents, the transition from thoughts of self-injury and behavior to suicide attempts is relatively fast—on average only 1–2 years.4

Therefore, the first 6 to 12 months after the onset of suicidal thinking or engaging in non-suicidal self-harm is a critical period for intervention and prevention of suicidal behavior.4 So, even though death is not the intent of non-suicidal self-injury, it’s important for parents and others to take it seriously and perform ongoing assessment of, and intervention for, suicidal behavior.6

Self-Harm and Substance Abuse

Although non-suicidal self-injury may a symptom of those with developmental disabilities, eating disorders, borderline personality disorder, post-traumatic stress disorder or other psychiatric conditions,2,8 it’s estimated that nearly half of adolescents and young adults who engage in self-harm appears to be in the absence of these conditions.8

Substance abuse among those who self-harm is not uncommon.9,10 One study of adolescents who engage in non-suicidal self-injury found that 59.6% met the clinical criteria for a substance use disorder.9 Major depressive disorder and anxiety disorders are even more common than alcohol or drug use in someone who engages in regular self-harm.10

It’s important to keep in mind that although substance use disorders commonly occur with other mental disorders, it doesn’t necessarily mean that one mental illness causes the other.11

Non-suicidal self-harm early in life, however, has been found to have a strong association with substance misuse, self-harm as well as other mental health disorders in the future.12


  1. U.S. Department of Health & Human Services. (2017). What to Look For: Mood Disorders: Self-Harm.
  2. Hornor, G. (2016). Nonsuicidal Self-Injury. Journal of Pediatric Health Care, 30(3), 261–267.
  3. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  4. Glenn, C. R., Lanzillo, E. C., Esposito, E. C., Santee, A. C., Nock, M. K., & Auerbach, R. P. (2017). Examining the Course of Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors in Outpatient and Inpatient Adolescents. Journal of Abnormal Child Psychology, 45(5), 971–983.
  5. Brown, R. C., & Plener, P. L. (2017). Non-suicidal Self-Injury in Adolescence. Current Psychiatry Reports, 19(3), 20.
  6. Clarke, S., Allerhand, L. A., & Berk, M. S. (2019). Recent advances in understanding and managing self-harm in adolescents. F1000Research, 8, F1000 Faculty Rev-1794.
  7. Zetterqvist, M. (2015). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health, 9(1).
  8. Peterson, J., Freedenthal, S., Sheldon, C., & Andersen, R. (2008). Nonsuicidal Self injury in Adolescents. Psychiatry, 5(11), 20–26.
  9. Nock, M., Joinerjr, T., Gordon, K., Lloydrichardson, E., & Prinstein, M. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144(1), 65–72.
  10. Gratz, K. L., Dixon-Gordon, K. L., Chapman, A. L., & Tull, M. T. (2015). Diagnosis and Characterization of DSM-5 Nonsuicidal Self-Injury Disorder Using the Clinician-Administered Nonsuicidal Self-Injury Disorder Index. Assessment, 22(5), 527–539.
  11. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
  12. Mars, B., Heron, J., Crane, C., Hawton, K., Lewis, G., Macleod, J., … Gunnell, D. (2014). Clinical and social outcomes of adolescent self harm: Population based birth cohort study. BMJ, 349, g5954.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More
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