Co-Occurring Self Harm and Substance Use

While there are 2 types of self-harm, suicidal and non-suicidal, we are focusing on the non-suicidal variety in this article. Non-suicidal self-harm is a serious set of behaviors that can occur as a symptom of a mental illness, but more commonly it occurs in the absence of mental illness. It is most commonly done as a way to cope and deal with stress or trauma. This can take the form of cutting, burning, and many other types of injury that may even be fatal, albeit unintentionally. Self-harm is distinct from suicide attempts, as there is no intentional attempt to end one’s life while self-harming, even though thoughts of suicide may be present. While it has long carried a negative stigma, progress has been made recently to demystify and destigmatize this harmful and potentially fatal behavior.

Someone may engage in self-harm for a variety of reasons. When self-harm occurs in the absence of mental illness and is used as a coping mechanism, it is most commonly done as a way to change the way someone feels. This has neurological causes, as intense pain releases natural painkillers known as endorphins that can elevate someone’s mood.

Anyone can engage in self-harm behavior. These types of behaviors are not necessarily population or demographic-specific. The common thread seems to be that someone who does engage in self-harm has suffered from some kind of trauma, neglect, or abuse in the past. That being said, self-harm is “observed” more commonly in specific groups, although this does not necessarily mean that it occurs more often in these groups.

The underlying causes of self-harm are very complicated, but it often has to do with trauma or abuse that someone experienced earlier in their life. On average, adolescents are at a higher risk for self-harm than other age groups, with around 10 to 13% of teens reporting instances of self-harm. Among adolescents, girls are over 3x more likely to report self-harm incidents than are boys. That being said, boys commonly under-report personal or emotional problems, and some of the self-harm behaviors that boys may engage in could be blamed on sports or attributed to boys exhibiting more obvious signs of aggression or frustration, such as punching a wall when angry.

There may be indicators that someone is more likely to engage in self-harm, as these behaviors are commonly a result of past trauma. Studies have shown that young people are:

• Almost 2x more likely to self-harm if they use drugs
• Just over 3x more likely to self-harm if they were bullied in school
• Over 2x more likely to self-harm if they were physically abused
• Over 2.5x more likely to self-harm if they have sexual orientation issues
• Almost 3x more likely to self-harm if their friends engage in self-harm
• Just over 2x more likely to engage in self-harm if someone in their family self-harms

While the exact numbers varied between gender, these reported odds ratios are for the average of both male and female adolescents. While these were very close between gender, for the most part, there were some outlier instances. Boys were much more likely to self-harm than girls in instances of sexual orientation issues (3.82x more likely) and self-harm by family members (8.85x more likely).