The causes of self-harm are complicated and intricate. In most circumstances, there is no single reason or cause for self-harming behavior. Before the addition of NSSID in the DSM-5, non-suicidal, self-injury was listed as a symptom of borderline personality disorder. Recent studies support this addition. These studies have found that NSSID is distinguishable from BPD, (Zetterqvist, M., 2015).
While NSSID is listed as its own diagnosis, it does coexist with many other mental health issues. The presence of a single mental health issue increases the risk of developing another. The following list outlines some forms of mental illness commonly linked to self-harming behavior.
Depression and Anxiety
Nearly 20% of Americans suffer from mental illness, depression, and anxiety are among the most common, (Amen Clinics, n.d.). The most frequently cited cause of self-harm is overwhelming emotional pain. The symptoms associated with depression and anxiety, such as; a sense of impending fear, constant worrying, extreme irritability, and feelings of sadness, worthlessness, or hopelessness, could lead an individual to self-harm in an attempt to escape the pain. In a research study conducted by the Journal of Nervous and Mental Disease, it was found that 37% of Americans with depression, not including those with bipolar depression, engaged in NSSI at least one time, (Amen Clinics, n.d.).
The intense highs and lows attributed to bipolar disorder dramatically increase the risk of NSSI. The extreme negative emotions that accompany these lows can be crippling and increase the individual’s risk of suicide. Bipolar disorder and depression were found to have the highest correlation with self-harm, (Singhal et.al., 2014). Somewhere between 5-6% of individuals with bipolar disorder will complete suicide. As many as 50% of those with bipolar disorder engage in self-injury, (Amen Clinics, n.d.).
Borderline Personality Disorder
Although borderline personality disorder does not have the highest correlation to self-harm, it does have the highest correlation for repeated incidences of self-harm. The reasoning behind NSSI for individuals with borderline personality disorder varies as well. While individuals with anxiety, depression, and bipolar disorder typically self-harm to escape emotional pain, individuals with BPD cite coping, impulsivity, and manipulation as reasons for NSSI. Common feelings associated with self-harm and BPD include; unhappiness, dissociation, emotional distress, and fear of abandonment. Roughly 6% of Americans with BPD will complete suicide, (Amen Clinics, n.d.).
Suicide, substance-use disorders, and self-harm often coexist with schizophrenia. The risk of NSSI in schizophrenic individuals with a substance-use disorder is 43.6%. 20% of individuals with diagnosed schizophrenia will attempt suicide, and 5-6% will end their life, (Amen Clinics, n.d.). The presence of delusions and hallucinations increases the risk of suicide and self-harm for those with schizophrenia.
NSSI is often associated with intense emotions, reduced emotional management skills, poor self-image, and low self-esteem. The last three are also directly linked to eating disorders. In fact, eating disorders are often considered a type of self-harm. Depriving your body of food and forcing yourself to vomit are both self-harming behaviors.
Alcohol and Substance Abuse
Substance abuse is a mental health issue in its own right, but it also tends to be an outcome of untreated mental illness. Some of the most common mental illnesses related to alcohol and substance abuse include those listed above. With that said, it is not surprising that alcohol and substance abuse increases an individual’s risk of engaging in NSSI.
Self-harming is especially dangerous when under the influence of alcohol and other substances due to dulled senses, increased impulsivity, and diminished judgment. In a research study of cases where suicide was completed by an individual with alcohol and substance abuse issues, it was found that 22% were under the influence of alcohol, 20% had opioids in their system, and 10.2% had used cannabis before the attempt, (Amen Clinics, n.d.).
While many of these numbers seem very stark, it is important to note that these conditions are often co-occurring. Substance abuse is extremely common in individuals with severe mental illness, (i.e. borderline personality disorder, schizophrenia, and bipolar disorder). Anxiety and depression are extremely common forms of mental illness, but they often coexist with substance abuse. Anxiety and depression also share common symptoms with borderline personality disorder and bipolar disorder.
7 psychiatric conditions linked to self-harm and suicide. Amen Clinics 7 Psychiatric Conditions Linked to SelfHarm and Suicide Comments. (n.d.). Retrieved March 14, 2023, from https://www.amenclinics.com/blog/7-psychiatric-conditions-linked-to-self-harm-and-suicide/
Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014, May). Risk of self-harm and suicide in people with specific psychiatric and physical disorders: Comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine. Retrieved March 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023515/ Zetterqvist, M. (2015, September 28). The DSM-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature – child and adolescent psychiatry and mental health. BioMed Central. Retrieved March 14, 2023, from https://capmh.biomedcentral.com/articles/10.1186/s13034-015-0062-7