How depression can lead to self-harm — and how to find support

For some pre-teens, teens, and young adults, self-harm is a way to cope with the emotional pain of depression. Self-harm — also known as nonsuicidal self-injury — is when someone purposely hurts themselves without the intention to end their life. While many people associate cutting with self-harm, it can also include burning your skin, hitting or banging your head, or ingesting toxic chemicals.

Self-harm isn’t a suicide attempt or a cry for attention. It’s a serious and potentially life-threatening issue that needs to be addressed. Research indicates that self-injury is alarmingly common among teens with depression, with studies suggesting that more than half engage in this behavior. 

Coping with trauma and overwhelming emotions is challenging, but help is available. A therapist can provide support and guide you toward healthier and safer ways to manage depression while challenging the thoughts that lead to self-injury.

Can depression cause the urge to self-harm?

Depression can increase the risk of self-harm, but it’s not the only factor, and not everyone with depression engages in self-harm. People with other mental health conditions like social anxiety disorder, borderline personality disorder (BPD), and post-traumatic stress disorder (PTSD) may turn to self-harm as a coping mechanism.

Though it may seem counterintuitive, some people engage in self-harm to cope with depression. Research suggests this happens because of a phenomenon called pain-relief offset, in which the end of physical pain creates a brief sense of emotional relief. Others may feel guilt, shame, or self-hatred and engage in self-harm as a way of punishing themselves.

Self-harm often begins in the teen years and can continue into adulthood when left untreated. Research shows that people who engage in NSSI are at a much higher risk of suicide compared with the general population.*

Risk factors for self-harm and depression include:

• Childhood abuse and trauma: Research suggests that children who experience more frequent, severe, or prolonged sexual abuse are at a higher risk of engaging in self-harm as adults.
• Sexual orientation: Studies show that people who identify as lesbian, gay, bisexual, trans and queer (LGBTQ+) report higher rates of self-injury compared to their straight and cisgender peers, often due to social stigma, discrimination, and lack of support. Both in-person and online bullying were associated with an increased risk of self-injury among those in the LGBTQ+ community.
• Gender identity: Trans youth often face higher rates of self-harm, depression, and bullying, and many struggle to find the support they need. 
• Life and relationship problems: Teens facing family conflicts, school or job difficulties, or strained friendships are at a higher risk of self-harm.
• Eating disorders: Research shows a link between self-harm and disordered eating. Approximately 55% of young people with eating disorders also engage in self-harm. 
• Social isolation: Research highlights a strong link between social isolation and self-harm. A limited social network has been associated with a higher rate of self-harm.
• Mental health conditions: Self-harm behavior is closely linked with mental health conditions like BPD, anxiety, depression, substance use disorders, obsessive-compulsive disorder (OCD), and PTSD. People with these conditions often experience emotions more intensely and may turn to self-harm. 
• Social media use: Studies show evidence that viewing online images of self-harm can, in certain cases, trigger self-harm urges and acts. 

*A note on safety: The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.

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Alternative ways to cope with depression

While self-harm might bring momentary relief, it doesn’t address the root causes of depression and can become an unhealthy way to cope with emotions. Finding new ways of coping with difficult feelings can suppress the urges that lead to self-harm and benefit your recovery process.  

In addition to professional treatment, there are coping strategies you can use to help you feel more in control of your depression and reduce or replace the urge to self-harm, including:

• Using distraction techniques: Sometimes, something as simple as distracting yourself by taking a walk or playing your favorite music can help you to manage your emotions in the moment. Not every distraction technique works for everyone, so it’s important to explore what works for you. 
• Practicing affirmations and coping statements: Try using positive affirmations or coping statements when you feel overwhelmed, depressed, or the urge to self-harm. You can say things like, “Reaching out is a sign of strength, not weakness,” or, “I’ve gotten through tough times before, and I can do it again.”
• Moving in a way you enjoy: Exercise has been shown to benefit depression, boost confidence, and improve self-esteem. Even going for a walk has been shown to help with the symptoms of depression.
• Trying mindfulness: By paying attention to your experience in the present moment, you can prevent dwelling on the past or worrying about the future. Try pausing at different points in your day by taking a few deep breaths and checking in with yourself.

How to share that you’re depressed and self-harming

Talking about mental health and self-harm can be challenging. You may feel isolated, misunderstood, or worried about being judged. However, talking about your experiences can be a powerful step toward healing, allowing you to receive support, feel less alone, and discover healthier ways to manage your emotions.

Here’s how to do this in a way that feels safe and comfortable for you:

• Choose someone you trust. Talk to a close friend, family member, therapist, teacher, or support group. If speaking in person feels too uncomfortable, consider writing down your thoughts and sharing them with a loved one or using a mental health hotline.
• Start small. Begin the conversation by saying that you’ve been struggling. You can share as much or as little information as what feels right to you. 
• Ask for help. If you want to try therapy but aren’t sure where to start, you can ask for someone’s help. See if they can assist you in finding a provider who takes your insurance or help with practical considerations like transportation or child care so you can attend your sessions.

Remember, your feelings matter, and you deserve support. The people who care about you want to help and you don’t have to go through this alone.

Treating depression and self-harming behaviors

Self-harm and depression can be effectively treated through a combination of therapy and, in some cases, medication. Therapy can help teach ways to manage difficult feelings and find healthier ways to process emotions.

Some forms of therapy used to treat self-harm and depression include:

• Cognitive behavioral therapy (CBT): A form of talk therapy, CBT can help people work on the underlying issues that lead to self-harm and develop healthier ways to cope with their thoughts and feelings.
• Dialectical behavior therapy: DBT can help people learn about what might be leading to contributing to their behaviors and improve emotional regulation. 
• Support groups: A self-harm support group provides a safe, confidential space for nonjudgmental peer support, guided by a therapist.

Antidepressants are also sometimes recommended for depression and self-harm. It’s important to work with a qualified mental healthcare provider to determine the right treatment approach for you, whether it’s therapy, medication, or a combination of both. 

Find care with Rula

If you or a loved one are intentionally self-harming, help is available. Many who struggle with self-harm try to hide their behavior, but with the support of a trained therapist, you can find healthier ways to cope with difficult emotions in a safe and nonjudgmental environment. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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