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Self Harm Series: Part 2

Content Warning: This blog will be discussing Self Harm.

This is the second installment of the four-part series on Self Harm. This post will focus on understanding the neurological aspect of Self Harm, and understanding why it can be difficult for people to stop engaging in Self Harm once they’ve begun. If you or someone you know is in immediate danger, please call 911 or your county’s local emergency number. If you are struggling with thoughts of Self Harm, please contact the Crisis Text Line by texting HELLO to 741741 or call the National Suicide Prevention Hotline at 1-800-273-8255.

Now that we have gained a better understanding of what Self Harm is and how many people are affected by it, let’s look into the neurological side of Self Harm. People who engage in Self Harm do not simply decide to Self Harm; there are inner workings in the brain that reinforces the thoughts and/or actions of Self Harm.

What drives someone to engage in Self Harm?

In order to get a better understanding of the neurological aspect of Self Harm, I spoke with Susan Morozowich, the Founder and CEO of Telebehavioral Health.US. Susan shed some light on neurological reasons that people engage in Self Harm, stating “[Self Harm] comes from feeling nothing or feeling too much.” When people are in challenging environments that can make them vulnerable to thoughts and/or actions of Self Harm, they typically fall into two categories of emotions; feeling numb or depressed or feeling too acutely. This creates a need to relieve the mind of these feelings, and Self Harm is one tool that people use to alleviate the emotions.

How does the brain process Self Harm?

Susan is also a clinician at Telebehavioral Health.US and is well versed in the scientific explanation for how the brain processes Self Harm. She explains that “[Self Harm] is a reward triggers the endogenous opioid system.” According to the National Library of Medicine, the endogenous opioid system is a pain management and reward system that helps relieve pain in the body and affirm these behaviors that deliver the relief. When someone engages in Self Harm, the endogenous opioid system reacts to the behavior by providing pain relief, and the brain begins to associate the Self Harm with the relief that the system creates in response. This perpetuates the cycle, and as Susan remarked “that’s why [Self Harm] is so effective [at alleviating these feelings] and why it’s so hard to stop doing it.”

How does the brain affect the way people engage in Self Harm?

The brain can affect the way that people engage in Self Harm behaviors, from how often the person engages in Self Harm to what forms of Self Harm people engage in. Susan explained that people tend to engage in either “episodic or repetitive” Self Harm, influenced by the brain and the endogenous opioid system. Episodic Self Harm occurs less frequently and is typically engaged in when the feelings discussed in the first section of this post occur and stop when the feelings are relieved. Repetitive Self Harm is more frequent and, according to, occurs as a response to any stressor instead of the feelings that Susan discussed.


Looking at the brain and our reward centers, it is helpful to understand that engaging in Self Harm is more than just a decision. Ultimately Self Harm is a method of coping; it often comes from a place of someone doing their best to cope with feeling too much or too little and not knowing other, healthier ways to manage emotionally painful experiences. Part Three of this series will discuss how to recognize Self Harm behaviors in yourself and in loved ones, and will offer insight into next steps for people who are looking for help.

If you are engaging in Self Harm, you are not alone, and there are people who can help. If you are seeking help, take a look at Susan’s profile at Telebehavioral Health.US or browse through the profiles of all of our licensed clinicians.

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