Self-Injurious Behaviour in Mental Health

Recognizing Self-Injurious Behaviour

Self-injurious behaviour refers to any intentional action that causes harm to one’s own body. While it may manifest in different ways, it often stems from complex mental health issues, developmental disorders, or difficult feelings that a person struggles to cope with. For some, it is a means of expressing emotions that feel overwhelming or impossible to articulate, especially when communication skills are limited. Understanding the signs of self-injurious behaviour is crucial in providing timely and effective support.

These behaviours can range in severity from repetitive actions like skin picking or scratching to more harmful acts such as head banging or self-biting. Young people and children, particularly those with developmental disabilities or anxiety, may engage in these actions as a response to stress, sensory stimulation, or unmet needs. Recognising the patterns, underlying causes, and associated risks can help families, caregivers, and professionals focus on interventions that address the behaviour and its root causes.

Types of Self-Injurious Behaviour

Self-injurious behaviours can take many forms, often varying based on individual circumstances. Common types include:

• Head Injuries: Repeatedly hitting the head against hard surfaces, which may indicate frustration or sensory-seeking behaviour.
• Skin Picking or Excessive Scratching: These actions may be tied to anxiety, stress, or sensory processing challenges.
• Self-biting or Hand-biting: Often seen in children or young people with developmental disorders, this behaviour might reflect unmet needs or physical pain.
• Eye Poking or Facial Scratching: Actions that may cause harm to delicate areas, often linked to developmental disabilities.
• Using Sharp Objects to Inflict Harm: A more severe form of self-injury often associated with depression or overwhelming feelings.

Causes and Triggers of Self-Injurious Behaviour

Self-injurious behaviour often arises from a combination of factors, reflecting the complexity of mental health and developmental challenges. For many, these behaviours act as coping mechanisms for managing overwhelming emotions or physical pain. Difficult feelings such as anxiety, depression, or stress may leave a person seeking relief through self-injury. Sometimes, the behaviour responds to unmet communication needs, particularly among individuals with developmental disabilities or limited verbal skills, where expressing feelings or needs becomes challenging.

Environmental and social factors also play a significant role. For instance, a child might engage in self-harm, such as head banging or hand biting, to seek social attention or as a reaction to changes in their environment. Excessive stimulation or, conversely, a lack of stimulation can also trigger behaviours like skin picking or self-biting, as these actions might provide sensory feedback or self-stimulation. Family dynamics, relationships, and unresolved conflicts can further heighten stress, increasing the likelihood of self-injurious actions to manage emotional discomfort.

Biological and neurological factors can also contribute to self-injurious behaviour. For individuals with developmental disorders or disabilities, such as autism, self-injury might be linked to sensory processing difficulties or an inability to regulate emotions effectively. In other cases, medical conditions like chronic pain or neurological imbalances might prompt these behaviours as an attempt to redirect or cope with physical discomfort. Identifying these triggers and understanding the underlying causes are essential first steps in developing effective strategies and interventions to support the person and reduce harm.

Behaviours of Concern as a Way of Communication

Self-injurious behaviours are often a form of communication, especially for individuals who face challenges expressing their needs, emotions, or pain through traditional means. For children and young people with developmental disorders or disabilities, these behaviours might replace verbal communication, acting as a signal for discomfort, distress, or unmet needs. For example, actions like head banging or hand biting might indicate frustration, physical pain, or an overwhelming sensory environment. When words fail, behaviours of concern become a way to convey messages to caregivers, family members, or professionals.

The link between communication difficulties and self-injurious behaviour highlights the importance of interpreting these actions not just as symptoms of distress but as attempts to interact with the world. For instance, a child engaging in excessive scratching or skin picking might be expressing anxiety, while a person using sharp objects to harm themselves may be signalling deeper emotional turmoil. These behaviours can also reflect a need for attention, a desire to escape from a stressful situation, or an attempt to manage internal chaos. Recognising these patterns allows for more compassionate responses, focusing on addressing the underlying communication needs rather than merely stopping the behaviour.

Common Mental Health Challenges Associated with SIB

Self-injurious behaviour (SIB) often coexists with various mental health challenges, highlighting its complex nature and the importance of understanding the underlying conditions. Mental health issues such as depression, anxiety, borderline personality disorder (BPD), and post-traumatic stress disorder (PTSD) frequently contribute to self-injurious actions, as these conditions can intensify difficult feelings and hinder coping mechanisms.

Depression

Depression is one of the most common mental health conditions associated with self-injurious behaviour. People experiencing persistent low mood, feelings of worthlessness, or hopelessness may turn to self-injury as a way to cope with emotional numbness or to feel a sense of control. Acts such as skin picking or using sharp objects can create a temporary distraction from overwhelming sadness or emotional pain. However, this relief is often short-lived, perpetuating a harmful cycle.

Self-injurious behaviour in those with depression often signifies an urgent need for intervention and support. Approaches such as talk therapy, antidepressant medication, or cognitive-behavioural therapy (CBT) can help individuals develop healthier coping mechanisms while addressing the root causes of their depressive symptoms. Encouraging open conversations and providing emotional support can further reduce the stigma and isolation often associated with self-injury.

Anxiety

For individuals with anxiety, self-injurious behaviour may serve as a maladaptive coping mechanism to manage overwhelming worry or physical symptoms of stress. Behaviours such as hand biting, scratching, or excessive skin picking often emerge as a response to intense nervousness or sensory overload. These actions can create a sense of control or provide temporary relief, albeit at the cost of physical harm.

Anxiety-related self-injury often requires strategies that target both the behaviour and the underlying anxiety. Techniques such as mindfulness, relaxation exercises, or therapeutic interventions can reduce stress and help individuals develop healthier ways to cope with their feelings. Creating a supportive environment where the person feels safe to express their concerns and emotions is also essential in addressing the anxiety that fuels self-injury.

BPD

Self-injurious behaviour is a hallmark symptom of borderline personality disorder (BPD), often reflecting the intense emotional dysregulation and impulsivity characteristic of the condition. People with BPD may engage in self-harm, such as cutting or burning, as a way to release pent-up emotions or to distract from overwhelming psychological pain. This behaviour is frequently linked to feelings of abandonment, rejection, or interpersonal conflict.

Treating self-injurious behaviour in BPD requires a tailored and empathetic approach. Dialectical behaviour therapy (DBT) is particularly effective in helping individuals develop skills to regulate emotions, tolerate distress, and build healthier relationships. Support from mental health professionals, coupled with a strong network of family and friends, plays a vital role in fostering recovery and reducing the reliance on self-injury as a coping mechanism.

PTSD

Post-traumatic stress disorder (PTSD) is another mental health condition closely associated with self-injurious behaviour. For individuals with PTSD, actions like head banging, sharp-object use, or self-biting may be an attempt to manage flashbacks, intrusive thoughts, or intense feelings of fear and helplessness. The physical pain of self-injury can momentarily distract from emotional pain or serve as an anchor in the present moment when dissociation occurs.

Interventions for PTSD-related self-injury focus on addressing the trauma at the root of the behaviour. Trauma-focused therapies, such as eye movement desensitisation and reprocessing (EMDR) or trauma-focused cognitive behavioural therapy (TF-CBT), can help individuals process their experiences and reduce distress.

Self-Injurious Behaviour in Mental Health Crisis Situations

In mental health crisis situations, self-injurious behaviour (SIB) often escalates as individuals struggle to cope with overwhelming emotions, stress, or trauma. These behaviours can serve as an immediate outlet for intense feelings of fear, frustration, or despair, especially for those who lack other coping mechanisms or effective communication skills. Actions such as head-banging, self-biting, or using sharp objects to harm oneself may emerge suddenly, reflecting a desperate attempt to manage internal chaos or regain control during a crisis.

During a mental health crisis, self-injurious behaviours often pose significant risks to the person’s physical and emotional well-being. For some, SIB is a response to a sense of disconnection or dissociation, providing a tangible anchor to reality. For others, it might serve as a way to signal distress when they cannot verbalise their feelings. Recognising the signs of self-injury in a crisis and understanding its potential triggers—such as past trauma, relationship conflicts, or overwhelming life stressors—are critical for delivering timely and compassionate support.

Preventing SIB and Support

Preventing self-injurious behaviour (SIB) begins with understanding its root causes and addressing the underlying emotional, social, or sensory needs that may drive it. Early intervention is crucial, particularly for children or young people with developmental disorders, anxiety, or other mental health challenges. Identifying potential triggers, such as stress, frustration, or unmet communication needs, enables caregivers and professionals to implement proactive strategies that minimise the likelihood of SIB. These strategies may include creating structured environments, offering sensory tools for self-stimulation, or teaching alternative methods of expressing difficult feelings.

Supporting people who engage in self-injurious behaviour requires a compassionate, person-centred approach. Building trust and fostering open communication are essential, as they encourage individuals to share their emotions and experiences without fear of judgment. Introducing behavioural interventions, such as Positive Behaviour Support (PBS), can help individuals learn healthier ways to cope with distress while reducing reliance on harmful behaviours. Family members and caregivers also play a vital role in prevention, offering emotional support and collaborating with professionals to tailor interventions to the person’s needs.

Long-term prevention efforts should focus on empowering individuals through skill development, including enhancing communication skills and teaching emotional regulation techniques. Access to mental health services, such as therapy or counselling, can provide a safe space to explore underlying issues like anxiety, depression, or trauma.

Interventions to Address Self-Injury

Interventions to address self-injurious behaviour (SIB) focus on reducing harm, understanding triggers, and providing individuals with healthier ways to cope with distress. Immediate strategies often involve creating safe environments to minimise risk, such as removing sharp objects or introducing protective equipment. Behavioural interventions like Positive Behaviour Support (PBS) can effectively understand the purpose behind SIB and develop plans to meet the person’s needs in non-harmful ways. Proactive techniques, such as teaching coping skills or alternative sensory stimulation, help address the underlying causes of the behaviour while promoting emotional regulation.

Involving a multidisciplinary team is key to a holistic intervention strategy. Psychologists, occupational therapists, and speech and language therapists work together to create personalised care plans that account for the individual’s emotional, physical, and communication needs. Family members are also integral to the intervention process, as their involvement helps create consistency and provides emotional support. Interventions tailored to the person’s specific circumstances and consistent monitoring and adjustment can significantly reduce self-injurious behaviours over time.

Therapies and Approaches That Reduce SIB

Occupational therapy (OT) and applied behaviour analysis (ABA) have effectively reduced self-injurious behaviour. Occupational therapy focuses on enhancing sensory integration and teaching individuals alternative ways to manage sensory overstimulation or under-stimulation. By introducing tools like weighted blankets, fidget aids, or calming routines, OT helps individuals develop healthier sensory regulation skills, reducing the need for self-injury as a coping mechanism.

Applied behaviour analysis, on the other hand, focuses on understanding the function of the behaviour and implementing evidence-based strategies to replace it with positive actions. ABA therapists work closely with individuals to identify triggers and reinforce behaviours that promote well-being and safety. Additional therapies, such as speech and language therapy, can address communication challenges that may drive SIB, while mental health counselling offers a safe space to process emotions and trauma. By combining these approaches, individuals receive comprehensive care that not only reduces harmful behaviours but also enhances their overall quality of life.

Mental Health Support and Crisis Intervention with Nurseline Community Services

At Nurseline Community Services, we are committed to providing compassionate, person-centred support for people experiencing mental health challenges, including those engaging in self-injurious behaviour. Through our Community Transition Services (CTS), we help people move seamlessly from hospital settings to supportive, home-like environments where they can regain stability and thrive. Our multidisciplinary team—including mental health professionals, occupational therapists, and behaviour specialists—works collaboratively to create tailored care plans that address both immediate needs and long-term goals. By integrating evidence-based practices, such as Positive Behaviour Support (PBS), we ensure that each person receives the right support to promote their safety and well-being.

In one recent case, a young person transitioning from acute care demonstrated significant improvement through our structured support. By identifying triggers for their self-injurious behaviour and implementing personalised interventions, including sensory tools and communication strategies, they were able to develop healthier coping mechanisms. This transformation highlights the importance of tailored approaches that empower people to lead fulfilling lives.

If you’re looking for comprehensive mental health support or crisis intervention for yourself, a loved one, or someone in your care, Nurseline Community Services is here to help. Contact us today to learn more about our services and how we can make a positive difference.