Unlike most other mental health disorders, there is no defined treatment for self-harm that has been studied extensively with proven clinical results. Treatment is aimed at recognizing and treating the underlying cause such as low-self esteem, impulsivity, depression, family dysfunction and conflict, poverty or abuse. An individual will often enter therapy with complaints not associated with self-harm. These may include difficulty sleeping or feeling depressed. The self-harm injuries are often noticed or asked about by the therapist during the session and skills are learned over the course of time to prevent this self-harm behavior. Learning healthy coping skills and maintaining emotional equilibrium to help manage the feelings of anger, grief and loneliness can help prevent an individual from cutting in response to these negative emotions. The goals of treatment for individuals who practice self-harm behavior are as follows:
- Identify and manage underlying issues that trigger cutting
- Learn skills to better manage distress
- Learn how to regulate and cope with unhealthy emotions
- Learn how to improve self-image and self-esteem
- Develop skills to improve relationships and social skills
- Develop healthy problem-solving skills
The following are other forms of therapy and coping mechanisms used to address underlying feelings resulting in self-harm behavior.
- Psychodynamic psychotherapy
- Mindfulness-based therapies
- Family therapy
- Expressing feelings through art or music
- Taking a hot bath or shower
- Group Therapy
Cognitive-behavioral therapy (CBT) for self-harm behavior
Cognitive-behavioral therapy (CBT) has shown to have the most successful and promising results for treating nonsuicidal self-injury disorder (NSSID). Cognitive-behavioral therapy (CBT) helps the individual identify unhealthy and distorted thoughts and replaces these thoughts and teaches them skills to induce healthy and positive thoughts and behaviors. Dialectal behavioral therapy (DBT) is a specific type of cognitive-behavioral therapy that can take place in either a group or individual setting to provide opportunities to improve certain existing skills. The four basic skill sets that are taught through this approach are emotion regulation, mindfulness, interpersonal effectiveness and distress tolerance. These learned skills should be practiced in all settings including therapy sessions, at home, at work and in social settings in order for the individual to become adaptable to certain stressors. This type of therapy focuses on negative emotions and thoughts and attempts to conform these thoughts into positive behaviors by teaching individuals to become desensitized to their stressors and experience and evaluate their current situation in the moment through an objective perspective. Channeling feeling of guilt, anger, shame and frustration into constructive activities such as art or exercise can prevent the individual from inducing self-harm. The first step to this approach is having the individual recognize their negative feelings and destructive behavior.
Treatment for self-harm with pharmacotherapy
Medications are not used to treat self-harm behavior however if there is an underlying or co-occurring disorder such as depression or anxiety, medications can be prescribed to treat those specific disorders. Oftentimes, individuals will be diagnosed with substance abuse, as it is common for individuals to use drugs and/or alcohol to cover up their negative emotions. Depending on the specific substance of abuse, medications can be used to help prevent or lesson the withdrawal symptoms. Co-occurring disorders such as substance abuse or depression should be treated in order for the self-harm behavior to improve.