The responses I hear when I ask, "How do you deal with uncomfortable emotions or internal distress?" are often heartbreaking. Just as trauma is the gateway to addiction, so it is to self-harm, or "Non-suicidal Self Injury (NSSI)" in psych-speak.
Self-harm is not an easy subject to talk about. Not for anyone. Not for the one who does this, nor for the ones who love someone who harms, and often not for the mental health professional. The idea that someone self-harms, as a way to deal with life, is a reality truly difficult to comprehend.
The scenarios that lead to some form of self-harm as a way of coping is different and unique, but paradoxically always the same. The result is an overwhelming desire to escape a life that is filled with pain and powerlessness. The hyper-focus on sensation that happens in the act of harming relieves the internal pain. The pain is externalized, and the release of endorphins, dopamine, and other pain suppressing hormones is the outcome that the individual needs.
As with any addiction, the coping strategy becomes entrenched because it works. The individual is removed at least temporarily from a situation in which they feel powerless and have very limited options for coping. No one actually chooses the addiction - what they choose is the way the process or substance relieves or refocuses the pain of their internal landscape providing at least temporary relief.
Understanding the painful reality which undergirds the behaviour and offering empathy, compassion, and unconditional acceptance is the first step to offering the relational connection that begins to build a bridge to alternative options. Just as people are wounded in relationship, so they are healed in relationship. This is the paradox of being human - relationships are the source of our greatest pain AND our greatest pleasure. A very difficult truth to reconcile when pain in relationship is the model you experience in the formative years of life.
The antecedents that might produce self-harming behaviour include but are not limited to such experiences as emotional neglect, emotional incest, physical or sexual abuse, intimate partner violence, and substance addiction. Anyone with adverse childhood relational experiences might self-harm; it's not a behaviour exclusive to cisgender women. Individuals who feel competent and capable, fully resourced, and psychologically resilient aren't given to self-harming.
Let's not forget that someone who self-harms is dealing with feelings of emotional overwhelm so big that deliberately causing injury to the body is preferable.
Help is available, and there's lots of great reading about this issue.
Here are some great resources...
(Video) Self-Harm: The Hidden Pandemic
Take good care,
Susannah-Joy