Understanding Self-Harm in Adolescents: What Can Neuroscience Teach Us?
Understanding non-suicidal self-injury means looking beyond the behaviour itself to the emotions, stress responses and experiences that may lie beneath it.
Neuroscience research has examined the brain systems involved in emotional responses and regulation.
One area of interest is the relationship between the amygdala, which plays an important role in processing emotionally significant information, and regions of the brain involved in interpreting, monitoring and regulating emotional experiences.
Research reviewed by Kaess and colleagues (2021) suggests that some adolescents who engage in self-injury show differences in the way these systems respond to emotional information. Studies have also identified differences in brain responses to social exclusion.
These findings are consistent with the possibility that some young people who self-injure experience emotional or interpersonal situations particularly intensely.
For example, a disagreement with a friend, a feeling of being left out or a critical comment from a parent may trigger a much stronger emotional response than an adult might expect. The young person may experience the situation not as a relatively small disappointment, but as something deeply upsetting or threatening.
This does not mean that every young person who self-injures has an unusually reactive brain, nor does brain imaging provide a simple explanation for why a particular individual self-injures. The research is still developing, and depression, previous adversity and other co-occurring difficulties can influence the findings.
Nevertheless, these studies remind us that what looks disproportionate from the outside may feel genuinely overwhelming to the young person experiencing it.
The goal is not to judge whether a young person's feelings are justified, but to help them understand those feelings and learn how to respond to them safely.
The role of stress and early experiences
Stress is another important part of the picture.
Our bodies have several systems that help us respond to stress, including the autonomic nervous system and the hormonal system that regulates cortisol. These systems help us prepare to respond to challenges and then return towards a calmer state.
Research into adolescents who self-injure has identified differences in some stress responses. For example, some studies have found reduced cortisol responses to laboratory-based social stress. However, findings vary depending on what is measured and the circumstances in which the response is studied.
This distinction matters.
A young person who shows a reduced response to one type of laboratory stress is not necessarily experiencing less stress in everyday life. Different biological measures capture different aspects of the body's response, and a single result cannot tell us how an individual is feeling.
Early experiences may also be relevant.
Childhood adversity is associated with an increased likelihood of later self-injury, and researchers are investigating how prolonged stress may influence emotional development and stress-regulation systems.
However, adversity does not inevitably lead to self-injury, and self-injury does not automatically indicate that a child has experienced trauma. Many different pathways can contribute to the same behaviour.
For international and multicultural families, it is also worth remembering that stress can arise in many forms. Moving countries, navigating a new language, losing familiar friendships, adjusting to a different school system or feeling caught between cultural expectations can all place demands on a young person. These experiences do not necessarily cause self-injury, but they may contribute to a broader picture of emotional strain.
Understanding the young person's individual circumstances is therefore essential. We need to look at their developmental history, current relationships, school experiences, coping skills and sources of support rather than searching for one explanation.
Pain sensitivity: a surprising finding
Another intriguing area of research concerns pain.
Studies have found that people who engage in self-injury may, on average, have higher pain thresholds or tolerate experimental pain for longer than people who do not engage in self-injury.
At first glance, this may seem contradictory. Why would someone who deliberately causes physical pain be less sensitive to pain?
There are several possible explanations, and researchers have not yet established which mechanisms are most important.
One hypothesis involves the body's endogenous opioid system. Endogenous opioids are substances produced naturally by the body that are involved in pain modulation and other processes. Researchers have investigated whether differences in these systems might help explain the relationship between emotional distress, pain sensitivity and self-injury.
However, the evidence does not support a simple explanation in which a deficiency in these substances causes self-injury. Findings are mixed, and measurements taken from blood do not necessarily reflect what is happening in the brain.
It is also unclear whether differences in pain sensitivity precede self-injury or develop partly through repeated experiences.
The important clinical point is that pain sensitivity varies between individuals. We should not assume that a young person who self-injures feels little pain, that they are seeking pain for its own sake, or that one biological mechanism explains their behaviour.
Why the behaviour can become difficult to stop
Research into the biological changes surrounding individual episodes of self-injury offers another possible piece of the puzzle.
Some laboratory studies suggest that pain-related stimulation can coincide with changes in subjective distress and activity in systems involved in sensory and emotional processing. In other words, physical sensations may temporarily alter how a person experiences emotional arousal.
However, much of this research has limitations, including studies involving adults with particular mental health difficulties. It cannot simply be assumed that the same processes occur in every adolescent who self-injures.
Even so, these findings are consistent with an important psychological possibility: a young person may learn that self-injury changes an unbearable internal state, at least temporarily.
This can create a difficult cycle:
A stressful event or painful thought triggers intense emotions.
The young person struggles to regulate those emotions.
Self-injury temporarily changes how they feel.
The immediate relief reinforces the behaviour.
When distress returns, self-injury may again seem like the quickest available solution.
The cycle can continue even when the young person feels ashamed, frightened by their behaviour or genuinely wants to stop.
Recognising this pattern helps us respond with both compassion and clear boundaries. We do not need to approve of a behaviour to understand the role it plays.
What does this mean for parents and caregivers?
The research reinforces the importance of looking beyond the behaviour itself.
If you discover that your child is self-injuring, your first response may be fear, shock, anger or a strong urge to make the behaviour stop immediately. These reactions are understandable. However, a young person who is already struggling with overwhelming emotions may find it difficult to talk openly if they also feel judged, punished or ashamed.
A calm, direct and caring response can help create the conditions for an honest conversation.
You might begin with something like:
“I've noticed that you've been hurting yourself, and I'm worried about you. I'm not angry with you. I want to understand what has been happening and help you find ways to feel better that don't hurt you.”
You do not need to have all the answers in that first conversation. Listening, expressing concern and making it clear that your child does not have to manage this alone are important starting points.
A few principles can help:
Try to understand the function of the behaviour.
Does it tend to happen after arguments, social difficulties, feelings of failure or periods of intense anxiety? Does the young person describe feeling overwhelmed, numb, angry or disconnected? The pattern can provide useful information about what they need.
Take the behaviour seriously without catastrophising.
Avoid assuming that self-injury is simply attention-seeking or that it necessarily means your child wants to die. Equally, never assume that the absence of stated suicidal intent means there is no risk. Ask directly about suicidal thoughts and seek an appropriate professional assessment.
Help your child develop alternative coping strategies.
Depending on their needs, this might involve identifying early warning signs, learning grounding and emotion-regulation skills, finding safe ways to express distress, practising how to ask for help or addressing the situations that repeatedly trigger emotional overload.
Look at the wider picture.
Sleep, nutrition, physical activity, relationships, school stress and opportunities for recovery all contribute to emotional well-being. These foundations do not replace treatment for self-injury, but they can form part of a broader support plan.
Seek professional support.
Repeated self-injury, escalating behaviour, significant distress or difficulty staying safe warrant timely assessment by a qualified mental health professional. Evidence-based psychological treatment can help young people understand their triggers, build coping skills and address the difficulties underlying the behaviour.
If there is an immediate danger, a serious injury or concern that a young person may act on suicidal thoughts, seek urgent medical or crisis support.
What can psychologists do to help?
The research by Kaess and colleagues (2021) identifies stress and emotion regulation as important areas for clinical attention. These are also areas that psychological interventions can address directly.
Depending on the young person's age, circumstances and needs, treatment may involve helping them recognise emotions before they become overwhelming, understand the links between thoughts, feelings and behaviour, develop more flexible coping strategies and communicate their needs more effectively.
Cognitive behavioural therapy (CBT), for example, can help young people identify the situations and thoughts associated with distress and practise alternative responses. Treatments incorporating specific emotion-regulation and distress-tolerance skills may also be appropriate.
For some young people, dialectical behaviour therapy adapted for adolescents (DBT-A) is an evidence-based option for addressing recurrent self-harm and related difficulties.
Parents and caregivers may also benefit from guidance on how to respond during difficult moments, support safety and encourage communication without inadvertently increasing shame or conflict.
Importantly, treatment should be individualised. Two young people may engage in the same behaviour for very different reasons. One may struggle primarily with intense emotional reactions following interpersonal conflict; another may experience depression, trauma-related symptoms or a persistent sense of numbness. Their treatment needs may therefore differ.
Although neuroscience may eventually help researchers identify different patterns of vulnerability and tailor interventions more precisely, biological findings are not currently a substitute for a careful clinical assessment. We cannot determine the best treatment for an individual child simply from a cortisol level, a pain threshold or a brain scan.
Looking beyond the behaviour
Neuroscience can help us understand why self-injury may develop and why it can become a repeated response to distress. It also reminds us that biological processes, psychological experiences and social relationships interact throughout development.
However, there is no single brain-based explanation for non-suicidal self-injury. Research continues to explore which characteristics precede the behaviour, which develop alongside it and which reflect short-term changes surrounding individual episodes.
For parents, caregivers and professionals, we do not need to wait for every scientific question to be answered before offering meaningful support.
We can take self-injury seriously, respond without shame or blame, assess safety, explore what the behaviour may be helping the young person cope with and teach safer ways of managing distress.
Most importantly, we can communicate that a young person does not have to hurt themselves to deserve help, attention or understanding.
At Baumgarten Child Psychology and More, we believe that understanding the individual child is central to effective psychological support. When a young person is struggling, the aim is not simply to stop a behaviour, but to understand what is happening beneath the surface and help them develop safer, more sustainable ways of coping.
If you are concerned about your child’s emotional well-being or self-injury, seeking professional guidance can be an important first step towards understanding what they are experiencing and identifying the support they need.
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