How Are Trauma & Stress Related to Self-Harm?

Untreated trauma and overwhelming stress can put a person at risk for myriad mental and behavioral health conditions, including anxiety, depression, posttraumatic stress disorder (PTSD), and addiction. In this post, we’re going to explore the impact that these influences can have on an often-misunderstood concern: self-harm.

What Is Self-Harm?

Before we discuss the ways that stress and PTSD may be linked to self-harm, we should take a moment to establish what, exactly, we mean when we use this term.

Also sometimes referred to as self-injury, self-mutilation, and non-suicidal self-injury (NSSI), self-harm describes the intentional infliction of pain or damage to one’s own body.

As the term NSSI indicates, self-harm is not considered to be a suicidal behavior. However, people who intentionally harm themselves may be more likely to struggle with suicidal thoughts and actions in the future.

People who engage in self-harm may do so in several ways, including the following

• Cutting, scratching, or burning their skin
• Inserting needles or other objects beneath their skin
• Pulling out their hair
• Hitting their body parts against walls or other hard objects
• Punching themselves repeatedly

The Scope of the Problem

Since people often go to great lengths to hide evidence that they have been engaging in self-harm, it can be difficult to determine how widespread this problem is. According to several studies, the behavior seems to be most common among adolescents, with adolescent girls having the greatest risk:

• A 2012 study of 665 adolescents (aged 7-16) in the United States revealed that 8% of the students had engaged in self-harm at least once in their lives. The rate of self-harm was highest among ninth-grade girls, with 19% of this demographic telling the researchers that they had intentionally harmed themselves.
• In 2013, a yearlong study of 3,964 British adolescents aged 12-16 found that 27% of young people had considered self-harm and 15% had harmed themselves over a 12-month period. Similar to the U.S. study, this effort found that the prevalence of self-harm was highest among girls aged 13-14.
• The American Psychological Association reports that about 15% of college students have engaged in self-harm. Among all adults aged 18 and older, experts estimate that the lifetime rate of self-harm is about 5%.

Why Do People Harm Themselves?

There is no standard, all-encompassing reason for why people engage in self-harm.

• In some cases, self-harm is a symptom of a mental health condition such as bipolar disorder, schizophrenia, or schizoaffective disorder.
• In other cases, people harm themselves in a misguided attempt to cope with stress and pressure, or to punish themselves for perceived failures or flaws.
• It is also possible for a person’s self-harm to be the result of both a mental health disorder and the presence of overwhelming stress.

In recent years, several studies have explored the impact that stress can have on a person’s risk for self-harm. Many of these research efforts have also looked at the combined influence of PSTD and stress. We’ll review a few of these reports in the next few sections.

Stress & Self-Harm

In April 2022, the journal Nature Human Behavior published one of the larger recent research projects involving stress, self-harm, and thoughts of suicide. Conducted by a team from the University of Washington (UW), this report was a meta-analysis of data from 38 separate studies involving more than 1,600 subjects.

As described by Kim Eckart of UW News, the team that conducted this meta-analysis reached two general conclusions:

• Many people who harm themselves and/or think about ending their own lives do so as a means of easing stress.
• The relief that people feel after self-harming or considering suicide suggests that therapy and other types of interventions can be beneficial.

“By analyzing data of individual participants in these studies, the UW researchers found that high levels of emotional distress precede both self-injury and suicidal thoughts, followed by reduced stress,” Eckart wrote.

Kevin Kuehn, the UW doctoral student who led this meta-analysis, told Eckart that his team’s findings don’t mean that experts need to develop new ways of treating people who struggle with self-harm and suicide. Instead, he believes the focus should be on connecting more people with the existing services that could literally save their lives.

“The good news is that we have effective behavioral interventions, such as cognitive behavioral therapy and dialectical behavioral therapy, which teach skills for managing intense emotions to replace self-injurious thoughts and behaviors,” Kuehn said in Eckart’s article. “Increasing access to these types of treatments is likely to reduce the prevalence of them.”

PTSD & Self-Harm

Eight years before the UW study, a team from the University of Mississippi Medical Center explored the association between PTSD and self-harm.

This study, which appeared in the Journal of Affective Disorders in September 2014, involved 246 patients of a residential addiction treatment facility. Almost half of the study’s subjects had a lifetime history of PTSD, with about 30% currently experiencing PTSD symptoms.

The research team wrote that they selected this population because people who have substance use disorders (addiction) also have high rates of PTSD, suicidal behaviors, and self-harm.

The research team found that self-harm was much more common among individuals with PTSD:

• 31% of subjects with a history of PTSD also had a history of self-harm.
• 21.5% of those who did not have PTSD engaged in self-harm.

When reviewing the experiences that preceded patients’ development of PTSD, the researchers found that sexual assault trauma was associated with the largest number of self-injurious behaviors and the greatest frequency of suicide attempts. The team theorized that loss of trust, isolation, and shame – all of which are common among sexual assault survivors – may be to blame for these outcomes.

As was also the case with the UW researchers, the University of Mississippi Medical Center team used their findings to call for expanded access to treatment.

“Specifically, our exploratory analyses suggest that interventions aimed at increasing emotional awareness and acceptance and teaching patients more effective emotion regulation strategies may be particularly useful for reducing [self-harming behaviors] among these patients,” they wrote.

Stress, Trauma, & Self-Harm

The two studies that we discussed in the previous section explored how stress or PTSD can put a person at risk for self-harm. In this section, we’re going to look at a research effort that assessed the impact of one specific form of traumatic stress – the COVID-19 pandemic.

This research was conducted by psychologist Finiki Nearchou, PhD, of University College Dublin. It appeared December 28, 2022, in the Journal of Child and Adolescent Trauma.

Nearchou’s research involved data from 625 people aged 17-25. The data was collected from October 2020 to May 2021, a time that Nearchou described as “a period of prolonged and strict lockdowns” in Ireland. Her research focused on the effect of COVID-related traumatic stress on rates of depression, self-harm, and suicidal behaviors.

Trarmatic Stress, NSSI, and Suicidal Intent

• 45.5% of her study’s subjects said they had engaged in non-suicidal self-injury, and 17.8% said they had harmed themselves with the intention of ending their lives.
• These rates were significantly higher than a pre-pandemic study, which found that 38% of young adults in Ireland had engaged in NSSI and 12% had a history of self-injury with suicidal intent.

From her analysis of the data, Nearchou drew the following conclusions:

• High levels of COVID-related posttraumatic stress doubled young adults’ risk of self-injury (both with and without thoughts of suicide).
• Depression had a greater impact on non-suicidal self-injury than posttraumatic stress did.
• Among those who engaged in self-harm with suicidal intent, posttraumatic stress and depression were equally influential. This may suggest that posttraumatic stress from the COVID pandemic caused a worsening of depression symptoms.
• Personal resilience (as determined by the Child & Youth Resilience Scale Measure) did not influence self-harm rates among those who were experiencing both depression and posttraumatic stress.
• Caregiver resilience (such as strong family support) was linked to a 20% decrease in risk of self-harm.

Treatment for Mental Illness, Posttraumatic Stress, & Self-Harm

The studies that we referenced in this post provide support for the following statements:

• Self-harm remains a prevalent problem, especially among adolescents and younger adults.
• Mental health concerns and posttraumatic stress can significantly increase a person’s risk for self-harm.
• People who have access to appropriate support are less likely to harm themselves.

The urge to self-harm can cause you to isolate yourself from friends, family members, and others who care about you. If these urges are accompanied by a mental health disorder, a history of untreated trauma, or exposure to overwhelming stress, you may feel that no one could possibly understand what you’re going through.

The Crownview Psychiatric Institute team understands. Perhaps more importantly, we can address the mental health concerns that have negatively impacted your life, so that you can regain control of your thoughts and overcome the compulsion to harm yourself.

To learn more about how CPI can help you or a loved one, please visit our Admissions page or contact us today.