Why some people turn to self-injury in an attempt to manage emotions …

A person can appear composed in a crowded room, engage in conversation, and meet every obligation — then later that night, methodically cut into their own skin. Not to die, not to rebel, and not for attention. They do it because something inside feels unmanageable, and this act, however destructive, provides a fleeting sense of clarity in emotional chaos.

Non-suicidal self-injury (NSSI) is a behavior often misunderstood by those who haven’t lived with persistent emotional dysregulation. Cutting is only one of its forms; others include burning, hitting, skin picking, or interfering with wound healing. These acts are not typically driven by suicidal thoughts. In fact, research consistently shows that most individuals who engage in NSSI are not seeking death but are trying to manage feelings that seem impossible to contain.

Contrary to common assumptions, people who self-harm do not usually experience pleasure during or after the act. Instead, what compels repetition is the temporary “relief” it brings from overwhelming psychological states. But the relief is not emotional comfort, it’s interruption.

When emotions like fear, shame, anger, or inner emptiness become intolerable, self-injury delivers a sudden and sharply focused physical sensation. That pain competes with emotional chaos in the brain’s neural circuits, narrowing attention and providing a brief sense of clarity or control. For those who feel emotionally numb or dissociated, it can also restore a feeling of presence in their body — proof they are real and alive.

The most widely supported framework — the experiential avoidance model — explains that the behavior works by briefly overriding distress through distraction or grounding. Functional MRI studies have revealed changes in the brain’s emotion-regulation circuitry among those who self-injure, especially in areas related to distress tolerance, impulse control, and interoception. In other words, their threshold for emotional discomfort is often lower, and their ability to manage it without intervention is limited. NSSI becomes a substitute for the internal tools they haven’t yet developed or been taught.

Self-harm is never caused by one thing. It tends to emerge from a combination of psychological, relational, and sometimes neurological factors. A history of trauma is one of the strongest predictors, particularly in the form of emotional neglect or abuse. But even without trauma, self-injury may arise from chronic invalidation, alexithymia (difficulty identifying and expressing emotions), or social isolation.

Adolescents are particularly vulnerable. Studies from 2023 show that up to 17 percent of teens engage in NSSI, with higher rates among females. Youth with neurodevelopmental differences, especially those with autism or ADHD, are also at significantly higher risk, in part due to difficulties with sensory regulation and emotional processing.

Don’t miss the essential spiritual component
Self-injury is not merely a psychological issue; it reflects deep brokenness in the whole person — mind, body, and soul — because humans are created as spiritual beings, made in God’s image. This spiritual reality means that emotional pain often signals wounds that extend beyond what therapy alone can reach.

Counseling provides essential tools for regulating intense emotions, managing trauma, and interrupting harmful patterns. Evidence-based approaches such as dialectical behavior therapy teach skills that help reduce the immediate distress that leads to self-harm. Yet even the best clinical interventions fall short if they neglect the soul’s longing for meaning, identity, and ultimate restoration.

Scripture reveals the profound truth that human suffering is rooted in a fractured relationship with God, a separation that warps the heart and mind. Self-injury can be a manifestation of this deeper spiritual brokenness, where the pain of shame, alienation, and despair overwhelms a person’s ability to find peace.

The Gospel offers hope that transcends symptom management. In Christ, there is the promise of new creation, a renewed heart and mind that can endure suffering without resorting to self-destructive behaviors. The Holy Spirit empowers believers to grow in love, self-control, and peace, healing the soul’s deepest wounds and restoring true wholeness.

Getting help …
There is no single treatment for NSSI, but several evidence-based approaches offer real hope. Dialectical Behavior Therapy (DBT), originally developed for borderline personality disorder, remains the gold standard, particularly among adolescents. DBT teaches distress tolerance, emotional regulation, and interpersonal effectiveness skills that many who self-harm never acquired.

Cognitive Behavioral Therapy (CBT), Mentalization-Based Treatment (MBT), and emotion-focused therapies have also shown strong outcomes. For some individuals, medication may be used to address co-occurring disorders such as major depression, PTSD, or anxiety, but it is not a standalone solution.

Just as crucial is the therapeutic stance: effective treatment requires neither pity nor panic, but calm, consistent support. Most people who self-harm carry intense shame about their behavior. A judgmental response—whether from a parent, clinician, or peer—often deepens the cycle.

Stopping self-injury is not the endpoint of healing, it’s a side effect of learning how to feel without fear. When people develop the capacity to tolerate distress, express emotion, and experience connection, the need for self-harm fades. Not instantly, and not without setbacks. But it fades.

Ultimately, the question is not “Why would someone do this?” but “What pain are they managing alone?” That shift in focus is where meaningful recovery begins.

Scotty