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Summary: While cutting is not a self-harm behavior common in people with autism, other self-harm behaviors are common in people with autism and/or autism spectrum disorders (ASD).

Key Points:

  • Self-harm is a type of behavior that involves causing injury or physical damage to oneself without the intention of dying.
  • The clinical term for self-harm is non-suicidal self-injury (NSSI).
  • Cutting is the practice of using sharp objects to damage/create wounds on the skin.
  • People with autism and autism spectrum disorders (ASD) show increased risk of NSSI, compared to people without autism/AD.
  • Although it does occur in some cases, cutting is not identified as common self-harm behavior in people with autism/ASD.

Autism, Autism Spectrum Disorders (ASD), and Self-Harm (NSSI)

The phenomenon of self-harm in people with autism is complex and influenced by a variety of factors. One challenge in understanding and assessing the prevalence, origin, and factors associated with self-harm in people with autism is the overlap, similarity to, and near identical appearance between some forms of self-harm and a behavior characteristic among people with autism, often called stimming or perseveration:

“Focused and repetitive patterns of behavior, interest, and activity, i.e. self-soothing behaviors considered atypical by people without ASD.”

These behaviors are not the same as self-injurious behavior (SIB), but are rather restrictive and repetitive behaviors (RRBs) that may or may not result in injury. When they do result in injury, it’s often unclear – for a variety of reasons – whether they were performed with the intent to harm oneself, or the injury/harm is and unintended consequence of self-soothing and an attempt at emotional regulation.

In this article, we’ll review the results of recent publication called “Non-Suicidal Self-Injury in Autism Spectrum Disorder: A Systematic Review of Associated Factors and Management Difficulties,” which identifies the problem as follows:

“Although SIB is not exclusive to autism, it constitutes one of the most severe comorbid behavioral problems in children with ASD.”

In the general population, evidence shows the following rates of NSSI:

Among people with autism, the study we cite above reports the following NSSI prevalence rate:

  • Adolescents/young adults: 12% – 46%
  • Among all groups: 24% – 50%

While SIB is more common in children than adults across a majority of studies, the prevalence of NSSI and SIB among people with autism is clearly difficult to quantify, because of the interaction of various factors, significant overlap in appearance, and challenges in accurately identifying the intent behind the behavior.

We’ll take a moment to define NSSI, then return to our discussion of NSSI among people with autism and autism spectrum disorders (ASD).

What is NSSI?

In brief, non-suicidal self-injury (NSSI) means “hurting yourself on purpose,“ but that’s an incomplete definition, and fails to capture the nuance associated with the term. This full definition from the American Psychological Association (APA) is more helpful:

“The condition – clinically known as non-suicidal self-injury or NSSI — is characterized by deliberate self-inflicted harm that isn’t intended to be suicidal. People who self-harm may carve or cut their skin, burn themselves, bang or punch objects or themselves, embed objects under their skin, or engage in myriad other behaviors that are intended to cause themselves pain but not end their lives.”

Self-harming behavior includes, but is not limited to:

  • Cutting/carving
  • Scratching/scraping
  • Burning
    • Often with cigarettes or curling irons
  • Punching/hitting
  • Breaking bones
  • Pinching/biting
  • Picking at/preventing cuts or wounds to heal

The most important thing to understand about NSSI is that it’s rarely done with the intent to die, but instead is a way for people in severe emotional distress to either temporarily soothe that distress with pain, or to signa/call attention to their emotional distress when they’re overwhelmed by it, don’t understand it, and/or don’t have the words, capacity, or safe person or place to express or manage the emotion in any other way.

Among people with autism, NSSI is most often viewed as subtype of self-injurious behavior (SIB). The most common type of SIB among people with autism is head banging, often observed in combination with:

  • Biting
  • Scratching
  • Hair pulling

Experts indicate head banging is more common in children with autism than in children with other intellectual challenges or conditions:

  • Among children with autism: 35–50%
  • Among children with other intellectual challenges: 5-17%

In short, nearly everyone who engages in NSSI – including people with autism – is in some type of extreme or severe emotional state, but most people who engage in NSSI – including people with autism – do not want to die. They want to live, they want others to know something is going on, and they want help.

Self-Harm and NSSI Among People with Autism: Primary Factors

The authors of the study we introduce above examined the results of 16 studies performed between 2000 and 2025 on children, adolescents, and adults with autism. After a thorough review and statistical analysis, they identified the factors associated with self-harm among people with autism.

Self-Harm and Autism: Risk Factors

  • Emotional factors/emotion dysregulation:
    • Alexithymia: inability to accurately identify or describe own emotions
    • Affective distress: also called emotional distress, affective distress means experiencing overwhelming, painful, or difficult to manage emotions.
  • Behavioral factors/behavioral dysregulation:
    • Impulsivity
    • Hyperactivity
    • Aggression
    • Restricted and repetitive behaviors (RRB), see above: repetitive, self-soothing behaviors considered atypical by people without ASD.
  • Cognitive factors:
    • Sensory processing difficulties: people with ASD may have problems with various steps of external stimuli, such as sights, sounds, textures, and smells.
    • Adaptive capacity: problems adjusting to changes in schedule or routine.
  • Social factors:
    • Communication differences: people with autism often display atypical patterns in daily speech
    • Social differences: people with autism often display atypical patterns in interactions with peers, siblings, parents, teachers, and others.
  • Health factors/medical issues:
    • Gastrointestinal problems
    • Sleep problems
  • Demographic factors:
    • Age may have an impact, with younger age and early adolescence identified as the times of greatest risk

The evidence connecting demographic factors with NSSI risk among people with ASD is inconclusive, with age a potential risk factor, as indicated above. There’s no evidence of association between NSSI and ASD for following factors:

  • Sex
  • Ethnicity
  • Socioeconomic status
  • Education
  • Marital Status

In addition, we’d be remiss if we didn’t discuss the association between NSSI and suicidality. Evidence shows NSSI increases risk for suicidal behavior, although NSSI itself is not considered suicidal behavior. Evidence indicates people with autism are at increased risk of suicidal thoughts and behaviors, and people with autism are at increased risk of NSSI. The latter phenomenon is the topic of this article, and the evidence on NSSI, suicidality, and people with autism highlights the importance of identifying and addressing NSSI among people with autism.

Those are the primary risk factors for NSSI and self-harm among people with autism. We’ll close by discussing those factors and what they mean for the treatment and support of people with autism.

Protective Factors and Treatment for Self-Harm in People With Autism

The study authors identify two primary protective factors for self-harm among people with autism:

  • Early intervention. Dialectical behavior therapy (DBT) is the most effective treatment for NSSI in ASD. Patients develop:
    • Distress tolerance skills
    • Stress management skills
    • Emotion regulation skills
    • Behavior regulation skills
  • Evidence shows DBT is effective for reducing emotional dysregulation in adults with ASD who engage in self-harm.
  • Parental involvement. When parents are directly involved in treatment from an early age, it helps people with autism learn to:
    • Identify emotions accurately
    • Communicate emotional distress effectively
    • Manage or change RRB or stimming behavior that causes harm

Here’s how the researchers describe the importance of early intervention:

“In particular, early identification appears clinically relevant, as access to intervention services during the early stages of development has been associated with lower prevalence of self-harm and may reduce the likelihood of persistence over time.”

In other words, the earlier a person with co-occurring ASD and NSSI receive evidence-based support, the better the outcome. To help improve accurate identification and promote timely intervention, another group of researchers published a paper called “Defining Nonsuicidal Self-Injury in Autistic People: A Framework for Assessment Using Key Elements to Aid in Characterization,” in which they offer a new template for identifying NSSI in people with autism:

  1. Not intended to cause death
  2. The physical self-injury/harm is intentional
  3. There is immediate physical injury following the behavior
  4. The physical injury is to the external body, not internal body
  5. The physical injury is self-imposed and not done by another being
  6. It is not a part of social or cultural practices

Guidelines like those can help mental health professionals differentiate between self-harm and perseveration/RBB. They also align with the broad conclusions reached by the researchers in the main article we discuss above:

“NSSI in ASD is a complex, multifactorial phenomenon frequently linked to emotion-regulation needs. Affective imbalance represents a central—though not exclusive—pathway. The review supports standardized terminology, function-based assessment, and clearer differentiation from SIB/RRBs, with implications for individualized interventions and sustained monitoring in persistent or severe cases.”

We’ll close with a reminder for people with autism and their families: effective treatment and support for co-occurring mental health challenges is available, and our ability to support neurodivergent individuals with co-occurring mental health disorders expands and improves every day, with the help of the data and information in new studies like those we share in this article.

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.