Understanding Non-Suicidal Self-Injury & Addiction
Non-suicidal self-injury (NSSI) is the deliberate act of injuring one's own body (cutting, burning, scratching, hitting, picking at skin or wounds) without the intent to die. While self-harm is not a diagnostic disorder in the DSM-5, it is a significant symptom that occurs in the context of multiple psychiatric conditions, particularly borderline personality disorder, depression, anxiety, PTSD, and autism spectrum disorders. NSSI serves multiple functions for the individual: it provides acute emotional relief through release of endorphins, creates a sense of control in situations where the person feels helpless, serves as a form of self-punishment in response to shame or guilt, communicates distress to others, or provides a way to transform emotional pain into physical sensation that feels more manageable.
The co-occurrence of self-harm and substance use disorders creates a complex clinical picture. Both behaviors serve emotion regulation functions, both involve risk-taking and body harm, and both create shame and secrecy. Individuals may use substances to suppress the urge to self-harm, while others use substances to disinhibit and facilitate self-harm. The functions of self-harm may be replaced by substance use or vice versa. Importantly, self-harm often indicates the presence of an underlying mental health condition (particularly borderline personality disorder or childhood trauma) that requires treatment alongside the substance use disorder.
At Trust SoCal, our dual diagnosis program recognizes self-harm as a symptom that communicates serious emotional distress, providing specialized treatment that addresses the underlying conditions driving both self-harm and substance use.