Are self-harm and PTSD linked?

Self-harm is when a person intentionally hurts their own body. Anyone can engage in self-harm, but having a mental health condition may increase your chances ^[1] of behaviors like skin cutting, burning yourself, and banging or punching walls. In some cases, self-harm may be a sign or symptom of an underlying mental health condition, like post-traumatic stress disorder (PTSD). 

Unmanaged PTSD and self-harm can have serious consequences, including an increased risk of suicidal thoughts and behaviors.* If you’re struggling to cope with past trauma, know that talk therapy can help you address your emotions, reduce self-harming behaviors, and feel more in control of your life. 

*A note on safety: The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911.

Can PTSD cause self-harm?

PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. A traumatic event can be any experience that challenges your ability to feel safe and secure — ranging from single events like a car accident to ongoing experiences like chronic abuse or neglect. 

For some people with PTSD, self-harm is a way to cope with difficult feelings and memories related to their trauma. For example, self-harm is associated with a history of childhood sexual assault ^[2]. Self-harm is also prevalent in the military community, with some research documenting that more than half of U.S. veterans seeking treatment for PTSD also engaged in self-harm ^[3]. 

Several PTSD symptoms may contribute to a person’s risk self-harm, including: 

• Emotional dysregulation: It’s common for people with PTSD to have trouble regulating their emotions. Some research ^[3] has found that emotional dysregulation plays a role in self-harming behaviors among people with PTSD. 

• Loneliness and isolation: It’s normal to want to be alone when you’re suffering or in distress. However, isolation can lead to loneliness, which is known to worsen PTSD symptoms ^[4] and may lead to self-harm. 

• Low self-esteem: Experiencing a traumatic event can affect your confidence, self-esteem, and sense of self — all which may contribute to behaviors like self-harm. 

• Hyperarousal symptoms: PTSD can cause people to feel like they’re living in a constant state of alertness. As a result, they may self-harm to find temporary relief from feeling tense or on edge.

It’s also worth noting that PTSD can co-occur with other conditions that are associated with self-harm, including depression, dissociative disorders, substance use disorder, and borderline personality disorder.

What self-injury looks like with PTSD

Not everyone with PTSD will engage in self-harming behaviors, but those who do may use it as a coping mechanism for overwhelming emotions, such as anger, irritability, and hopelessness. Conversely, people who feel emotionally numb may self-harm as a way to “feel something” or to punish themselves for their trauma response. Others may self-harm to block intense flashbacks, intrusive memories, and nightmares related to their trauma.

Many people who self-harm will hurt themselves in more than one way ^[5], including:

• Cutting their skin 

• Burning their skin

• Pulling their hair 

• Compulsively picking at their skin 

• Hitting or banging their head

• Scratching so hard they draw blood 

• Intentionally breaking bones

• Drinking toxic substances, like bleach or detergent

Managing PTSD and self-harming behavior

If you’re struggling with self-harm or other symptoms of PTSD, it’s important to get help. Without treatment, PTSD can affect your mental health, relationships, and overall quality of life. And although self-harm is usually done without suicidal intent, resarch shows that both self-harm ^[6] and PTSD ^[7] are associated with an increased risk of suicidal thoughts and behaviors.

The path to recovery starts with finding a compassionate, trauma-informed therapist who makes you feel understood and supported. Once you find the right fit, you’ll have a safe space to process your experience and develop healthier coping skills moving forward. If PTSD is associated with self-harming behaviors, your provider will create a comprehensive plan to address both concerns. 

There are several effective therapy techniques for PTSD and self-harming behaviors, but two of the most common are: 

• Cognitive behavioral therapy (CBT): CBT focuses on the connection between your thoughts, feelings, and behaviors. Using tools like cognitive restructuring, CBT can help people recognize harmful and irrational thoughts and replace them with more positive and encouraging alternatives. For someone with PTSD, CBT provides an opportunity to reconsider how they think about and cope with past traumas.

• Dialectical behavior therapy (DBT): DBT is another type of therapy that helps people process trauma — especially complex trauma like childhood abuse ^[8]. Through techniques like mindfulness and emotional regulation, you can learn to manage overwhelming emotions like anger, fear, and shame. Distress tolerance, another DBT skill, shows you how to tolerate distress instead of using harmful coping mechanisms like self-harm. 

When healing PTSD with self-harm, it’s also important to spend time with people you trust. Whether it’s a friend, neighbor, or coworker, social support can increase self-esteem and resilience. Your therapist may also suggest joining group therapy or a trauma support group for a chance to learn from and grow with people with similar experiences.

Clinician’s take

If you have a loved one who self harms, you can offer a nonjudgmental space where they feel heard and validated. Encourage professional help, check in regularly, and remind them that they are not alone. This can make a meaningful difference in their healing journey.

Ashley Ayala, LMFT

Clinical reviewer