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  • Writer's pictureNicholas Nack

What is self-harm? Is it an addiction?

Self harm involves deliberately hurting oneself. This can include using sharp objects, burning, pulling hair out, picking at wounds, and more. Injuries can be minor or severe, some requiring hospitalization. Self-harm is a means of coping with emotional distress. When people are self harming, it is a sign that they are in need of safer and better ways to cope. It is most commonly seen in teenagers and young adults, but it can happen with people of all ages. Partaking in binge drinking or drug use increases the risk that one will self-harm because those activities decrease self-control. Harming oneself can release endorphins which are pain killing hormones, this in turn can improve mood. Self harm can also help people who have trouble feeling emotions feel something and get them out of that state of feeling numb, even though it is only temporary. The shame and/or guilt that people experience as a result of partaking in self-harm can also cause them to self-harm again, making it a cycle. People who self-harm are not necessarily suicidal, but it should still taken seriously as there are risks to the behavior, and there may be a higher risk that the person becomes suicidal. Scars caused by self-harm can be permanent, and there is a risk for severe injury with self harm. Hiding the evidence such as wounds may inhibit them from attending activities or participating in things that they enjoy. It may also negatively impact relationships such as work relationships ("Self-harm," n.d.).

Have you ever wondered if there is a connection between self harm and addiction? There are certainly some similarities between them such as difficulties in quitting, and the fact that the self-harming behavior can have a negative impact on health, social standing, family relationships etc. and yet people will continue to do it. One group of researchers sought to determine whether or not self-harm is an addiction by looking at the nature of craving in addiction. What they found in their study of cravings within non-suicidal self injury(NSSI) and substances was that cravings were significantly lower for the NSSI group than the substance group. While substances are often craved in various contexts, the self-injurious behavior tends to present when an individual is experiencing negative emotions. As a result, the researchers concluded that negative reinforcement was the maintaining factor for the behavior, and as such it is not behaving in the same way that addiction does, and instead falls more in line with models of emotion regulation (Victor et al., 2012, pp. 73-77).

Another group of researchers argue for a different conceptualization of self-harm. They looked at literature and research surrounding the nature of self-harm as well as suicidal behavior and decided to conceptualize it as an addiction. From a self-report study they mentioned, 81% of people who were self harming met more than five criteria for an adapted substance dependence criteria list. They also explain that it is believed that NSSI activates opioid and dopaminergic systems. The continued release of these chemicals, in a similar way to a substance addiction, can produce changes such as tolerance and dependence (Blasco-Fontecilla et al., 2016).

The DSM-V-TR, which is the most up to date diagnostic tool for mental disorders, has a section in the back with conditions for further study. In that section they have proposed a diagnosis called Non-suicidal Self-Injury Disorder. At the current time there is no approved diagnosable disorder for self-injury. It only appears as a symptom of other diagnosable disorders such as borderline personality disorder. This proposed disorder comes from a standpoint that is in line with the research article that took a behavioral approach and did not consider self-harm to be the same as addiction. The DSM-V-TR posits that the behavior is reinforced socially and emotionally(American Psychiatric Association, 2022, p. 923-926). Even so, there are still clinicians who will describe it and conceptualize it in the same way that they do an addiction. Some people feel that conceptualizing it as such makes for a good way to treat it. So what do you think? Is self-harm an addiction?


References

  • American Psychiatric Association. (2022). DSM-5-TR. American Psychiatric Publishing.

  • Blasco-Fontecilla, H., Fernández-Fernández, R., Colino, L., Fajardo, L., Perteguer-Barrio, R., & De Leon, J. (2016). The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Frontiers in Psychiatry , 7.

  • Self-harm. (n.d.). NAMI: National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm

  • Victor, S. E., Glenn, C. R., & Klonsky, E. D. (2012). Is non-suicidal self-injury an "addiction"? A comparison of craving in substance use and non-suicidal self-injury. Psychiatry research, 197(1-2), 73–77. https://doi.org/10.1016/j.psychres.2011.12.011

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