Psychological Mechanisms of Self-Harming: A Comprehensive Review

Rational emotive behavior therapy (REBT)

REBT suggests that people hurt themselves not because of things that happen in their lives, but because of the irrational views they hold about those things.^[5] Many people with these beliefs expect that others treat them fairly, say things like “I must not fail” or “It's awful if things don't go my way,” and aren't able to handle a lot of frustration ("I can't stand this pain"). People who hurt themselves may do so because they think that having strong feelings is too much to handle or because they think they need to punish themselves to get back in control.^[6]

From the point of view of REBT, self-harm is a behavior that comes from having irrational beliefs that are triggered by events like feeling worthless or having unbearable mental pain, which leads to self-harming behavior.^[7] Self-harm may briefly ease emotional pain, but it reinforces the irrational thoughts that are driving the behavior, keeping the cycle going. REBT helps people develop healthier emotional reactions and ways of coping by focusing on these irrational beliefs and promoting more sensible ones. Research further shows that integrating REBT with mindfulness enhances emotional regulation and cognitive flexibility, both of which are protective against self-harm.^[6]

Cognitive-behavioral theory

Cognitive-behavioral theory (CBT) says that hurting yourself is a bad way to deal with problems because it is based on distorted thoughts and learned behaviors. People may hurt themselves because they have irrational beliefs like “I deserve to suffer” or “Pain is the only way to feel better.” These distortions often come from negative core beliefs about the self that are reinforced by trauma or environmental stresses.^[7]

As a behavioral reaction to cognitive distortions, self-harm provides short-term relief from emotional pain through negative reinforcement. The action might stop ruminative thought processes or take your mind off bad thoughts. Over time, hurting yourself becomes a learned behavior that is encouraged by the fact that it relieves mental pain right away. Attentional biases toward pain and other cognitive processes keep the action going. The idea is that someone who hurts themselves as a way to deal with strong negative emotions like anger, sadness, or worry will feel temporarily better after doing it.^[1]

Psychodynamic theory

According to psychodynamic theory, self-harm is a way of expressing unconscious conflicts or pain that hasn't been dealt with.^[8] It could be a way of punishing yourself symbolically for feelings of guilt or shame that come from early attachment problems or stressful events. People with mental illnesses may hurt themselves to hide their inner psychological pain or as a way to protect themselves from deeper emotional wounds.^[9]

Self-harm is a way for people to get rid of harmful emotions that they are not talking about, letting them show their anger or hate toward themselves. The act may also help the person keep their sense of self-cohesion when they have a problem like borderline personality disorder that causes their identity to be broken up. In a strange way, the physical pain may give people a sense of control or stability by bringing them back to their bodies.^[9]

Emotion regulation theory

According to the Experiential Avoidance Model of emotion control theory, self-harm is a way to deal with feelings that are too strong or too intolerable.^[10] People with mental disorders, like depression or PTSD, often have trouble controlling their emotions, which can make them hurt themselves as a way to escape or lessen their pain.

Self-harm sets off a chemical reaction that releases endorphins, which briefly ease emotional pain and make you feel happy or calm. This process makes people more likely to hurt themselves as a way to deal with stress because they learn that physical pain makes them feel better emotionally. This behavior turns into a habit when someone can't control their emotions, especially if they have borderline personality disorder.^[11]

Interpersonal theory

Joiner and his colleagues' interpersonal theory focuses on the social purposes of self-harm, like telling others about your pain or getting their support.^[12,13] When people feel alone, rejected, or unable to talk about their feelings, they may hurt themselves to show their pain or keep up relationships.^[14]

Self-harm is a way to communicate without words; the injuries are obvious signs of the pain that someone is feeling inside. This could get moms to care for or pay attention to them, which would reinforce the behavior through social reinforcement. But the person's relationships can also make them hurt themselves more if they feel rejected or invalidated over and over again. This idea says that when people feel guilty, ashamed, or useless, they hurt themselves as a punishment. For themselves, far away to talk about how they feel about themselves negatively.^[15]

Emotion dysregulation

Emotion instability is one of the most well-established reasons why people hurt themselves. Teenagers and young adults who hurt themselves often say they have trouble recognizing, accepting, and sharing their feelings.^[11] He discovered that teenage girls who were admitted for psychiatric care had a lot more emotional problems than their peers who were not in clinical settings. These teens were more likely to grow up in families and groups of friends that didn't support them, which made it harder for them to learn healthy ways to deal with problems. Without enough help, teens and young adults may use NSSI as a harmful way to deal with strong emotions like anger, shame, or sadness.^[11]

Interpersonal conflict and social rejection

Another thing that makes people more likely to hurt themselves is social stress, especially being bullied or victimized by peers.Claes et al.^[16], 2015 and Giletta et al.^[14], 2015 both found that teens who were bullied and rejected by their peers were more likely to use NSSI, especially if they also had depressed symptoms. These studies support a transactional model that suggests rejection from others can lead to increased feelings of distress, potentially prompting individuals to harm themselves as a coping mechanism. Researchers also discovered that family disagreements not only made emotional problems worse but also led to conflict between peers. This suggests a broader breakdown in social support networks that makes unhealthy habits like NSSI more likely.^[14]

Nightmares, hyperarousal, and negative affect

Emerging research also shows that trauma-related symptoms, especially nightmares, may be able to uniquely predict the risk of self-harm in ways that involve being overly alert and feeling bad all the time.^[17] He showed that dreams could predict both suicidal and non-suicidal self-harm, even when depression was taken into account. There was a link between having nightmares and feeling more defeated, aroused, and stressed. The results of structural equation modeling showed that negative affect and self-harm-related cognitive cues helped explain the link between nightmares and recent self-harm. This supports the idea that dysregulation after sleep may make it harder to deal with problems and make people more likely to hurt themselves without thinking.^[17]

Impulsivity, BPD features, and relapse risk

Personality flaws, especially traits of BPD and recklessness, have also been linked to NSSI that lasts and comes back. In a longitudinal study by Glenn and Klonsky, only a few factors—including past NSSI behavior, the probability of future NSSI, and borderline traits—were able to predict self-harm a year later.^[1] Other traits that are often linked to engagement, like depression, anxiety, and drug abuse, did not predict future involvement. These results show that some people who have trouble controlling their emotions, chronic emotion regulation difficulties, and unstable self-image, like those with BPD Glenn et al.^[18], 2011, may start hurting themselves on a regular basis. In a clinical sense, this shows how important it is to target relapse prevention, especially for people who have just stopped hurting themselves.

Body objectification and somatic dissociation

Body objectification—the tendency to view one’s body as an object or as something separate from one's life- is another way that people hurt themselves. Researchers discovered that people who didn't like their bodies and had trouble controlling their emotions were much more likely to hurt themselves.^[21] It may be easier to hurt yourself mentally if you internalize cultural or family devaluation of the body. This is called somatic dissociation. People with eating problems also show these kinds of patterns, which suggests that the ways these people hurt themselves may be similar.^[21]