Understanding Self-Harm: Functions, Myths, and Compassionate Responses

Self-harm — the deliberate, non-suicidal infliction of injury to oneself — is a far more common behaviour than many people realise, affecting approximately one in five young people and a significant proportion of adults across all demographics. It is frequently misunderstood as attention-seeking, manipulative, or a failed suicide attempt, but these characterisations are inaccurate and unhelpful. Self-harm is overwhelmingly a private behaviour, typically hidden from others, and serves specific psychological functions that are important to understand in order to address the behaviour compassionately and effectively.

Research has identified several functions that self-harm can serve. Emotion regulation is the most commonly reported function: when emotional pain becomes intolerable, the acute physical pain of self-harm can provide temporary relief, create a sense of control over overwhelming feelings, or convert emotional distress into something tangible and manageable. Self-punishment is another common function, particularly in individuals who hold deeply negative beliefs about themselves. Dissociation management involves using self-harm to feel something when emotional numbing or dissociation has created a frightening sense of unreality. Communication of distress is a function in some cases, where the individual has no other way of expressing the severity of their suffering.

Understanding the function of self-harm is clinically essential because effective treatment depends on addressing the underlying need that self-harm is meeting, rather than simply removing the behaviour. If self-harm is serving an emotion regulation function, therapy will focus on developing alternative strategies for managing intense emotions (such as distress tolerance skills from DBT). If self-harm is driven by self-punishment, therapy will address the underlying self-directed hostility through cognitive restructuring and compassion-focused approaches.

If you are currently self-harming, your therapist will work with you to develop a safety plan that includes strategies for managing urges, identifies alternative behaviours that can meet the same underlying need, and establishes a plan for accessing support during moments of crisis. The goal of therapy is never to judge or shame you for self-harming, but to understand its function in your life and help you develop safer and more sustainable ways of managing the distress that drives it.