Self-harm and Complex Trauma

CPTSD Foundation
8 min readNov 13, 2023

This article includes an honest discussion about self-harming behavior, a topic that is highly triggering to some. Caution is advised.

Self-harm is something people do when they are so overwhelmed by emotions that they do not know what to do. Indeed, self-harming behavior does bring a measure of ease, lessening the immediate overpowering thoughts and emotions, but it also causes significant distress and can be fatal.

This article, the second in our series on self-harm, will talk about complex trauma and other ways than self-harm to feel better in the moment.

Complex trauma is the exposure to many interrelated traumatic experiences usually occurring in childhood. Exposure to these traumatic events often causes many problems for the survivors as they have had to adapt to surviving traumatic events.

The traumatic events that are complex trauma are longstanding and recur and are inflicted by someone else during the person’s formative attachment relationship years. Too often, the children are exposed to familial dysfunction, with their parents or guardians being the ones to perpetrate abuse against them.

People who have survived complex trauma have a mixed bag of outcomes as adults, often leading them to have a psychiatric diagnosis or misdiagnosis, relational problems, functional impairments, and problems in school or college.

Too often, the diagnosis is overlooked and assumed to be something else. It is not uncommon for researchers and treatment settings for survivors to be assigned several comorbid psychiatric diagnoses to try to account for the number of neurobiological effects and adaptations survivors manifest.

Neuroscientific research has shown that the brains of survivors of complex trauma have been fundamentally changed. Brain functions that are changed include:

  • Neurochemistry of the brain
  • Brain development
  • Alterations in identity
  • Alterations in behaviors

To fully understand complex trauma, one needs an appreciation of how interconnected trauma exposure and adaptation to it are complex in their construct.

Self-harm and Adverse Childhood Experiences

After growing up in an environment full of violence and abuse, survivors of complex trauma often find themselves feeling the urge to self-harm. Known as adverse childhood experiences (ACEs), they were popularized by a study done in the 1990s by American researchers Shanta Dube and Vincent Felitti. The two researchers asked adults involved in a health insurance investigation about obesity by Kaiser Permanente to complete a questionnaire asking if they had experienced several childhood experiences.

The study used over 17,000 people and found that with each additional adverse childhood experience, the more likely the survivors were to have attempted suicide by 50–70% (Dube et al., 2003).

Shockingly, the study also found that the more ACEs survivors had experienced, the higher the risk for several adverse physical and mental health problems they had, including self-harm (Dube et al., 2001; Felitti et al., 1998).

ACEs are gauges of child maltreatment and how much a house is dysfunctional. Commonly, ACEs include sexual, physical, or emotional abuse, neglect, parental separation or divorce, and witnessing domestic violence in the home. Other adverse childhood experiences that are used are low economic status or poverty, bullying, and other experiences of victimization.

Many people believe that only privileged white teenagers self-harm, but that is not the truth. Self-injury, in all demographics and statistics, shows that some populations are at higher risk than others, including the following.

Women and Men. Women are more likely to self-harm than men. However, males consist of 35% of the total known self-harm cases and are less likely to report self-harm than women.

Older Adults. Older adults make up 65 per 100,000 people and experience increased incidents of self-harm by 31% among 75–84-year-olds and 76% among people who are 85 or older. Self-poisoning is the most common method of self-harm among the elderly.

Young Adults in College. 15% of students in college report harming themselves. Students are faced with the stress of attending college, which acts as a trigger for self-harming behavior. Other contributing factors might be unexpressed intense emotions, emotional numbness, and feelings of powerlessness.

Adolescents. Children and teenagers have the most significant rate of self-harming behaviors. Too often, adolescents do not have the vital tools that come with age and wisdom and cannot cope with their emotions.

It is critical to note that self-harming behaviors can quickly explode into suicidal ideation and actions and should never be ignored. Teens will not ‘just grow out of it’; they need intervention to help them remain healthy (Dennis et al., 2005).

Professionals and Self-Harm

Physicians, psychotherapists, lawyers, pilots, and all professionals are not immune to self-harming behavior. Usually, professionals can cope with their jobs and the stress. However, sometimes, the stress of being a person in authority becomes overwhelming, and they cannot, for various reasons, manage their stress appropriately.

Internal self-dialogue is difficult for professionals, who are often perfectionists, so they choose to injure themselves to feel better.

Professionals who are perfectionists put themselves in a position of having higher stress beyond the everyday stress of others. This perfectionism puts them at a much higher risk of self-harming. Below are some contributing factors for professionals to self-injure.

  • Having depression, PTSD, or other personality disorders
  • Experienced childhood trauma
  • Are addicted to or misuse alcohol and drugs, including prescription drugs
  • A low-self esteem

The next time you visit your therapist or doctor, remember they are like everyone else, vulnerable to overwhelm.

Warning Signs That Someone is Self-Harming

By now, you may be concerned about yourself or someone else you suspect is injuring themselves. You have reason to worry, as self-injury can lead to death. Most of the time, people who engage in self-harm will target places that are hidden, such as the front of the torso, the arms, and the legs.

There are many methods that people use to self-injure, including.

  • Burning oneself
  • Cutting
  • Punching oneself
  • Biting oneself
  • Pulling out their hair
  • Piercing their skin with a sharp object (not related to cosmetic piercings)

Self-harm should never be dismissed as it is a cry for help to those around them. If you are a friend or family member, do not be afraid to approach the subject of self-harm with your loved one. You may save their life.

Treatment Options to End Self-Harming Behaviors

Learning healthy coping skills is key to maintaining an emotional equilibrium. Managing emotions such as anger, loneliness, and grief will help those who self-injure to reach for a coping skill rather than cut themselves.

While people who self-harm are coping with intense emotions inappropriately, there is hope with the proper types of therapy and a lot of self-care.

Treatment goals for individuals who self-harm might include the following.

  • Learn how to cope with unhealthy emotions and regulate them.
  • Learn how to improve their self-image and raise their self-esteem.
  • Identify and manage triggers that lead to self-harming behaviors.
  • Develop better relational and social skills.

Below are some of the forms of therapy that someone who self-injures might use to address the underlying feelings and emotions that can result in self-harming behavior.

  • Psychotherapy
  • Family therapy
  • Mindfulness-based therapies
  • Meditation
  • Group therapy
  • Art or music therapy

It is critical to seek help if you injure yourself.

Ending Our Time Together

This topic is challenging to write about, especially in the face of my own self-harming history. It may take more than a series of articles on self-injury to end the pain and danger of self-harm.

By the way, self-harm is NOT a mental illness, although it can undoubtedly accompany depression, borderline personality disorder, or bipolar disorder.

Why do I write about self-harm? Because it is a common coping mechanism, many people turn to when overwhelmed. In therapy, you face yourself and learn your flaws and blind spots. Therapy stirs up emotions that are overwhelming, not to mention any trauma memories survivors have internalized.

I have learned that I do not deserve to hurt myself and that I am worthwhile just as I am, no matter what I face in life. Granted, it took many years of therapy to learn that lesson, but I have dissociative identity disorder, and it is much more challenging than usual to gain insights.

The next time you have the urge to harm yourself, think of this article and remember that you are worthwhile and wonderful as you are.

I believe in you. No, I really do.

“Let’s sit down, close our eyes, and reassure our hearts and minds that everything will be fine. This feeling will pass if we allow it to melt away, and taking this moment will help us prepare for whatever comes our way.” — Lyra Brave.


Dennis, M., Wakefield, P., Molloy, C., Andrews, H., & Friedman, T. (2005). Self-harm in older people with depression: comparison of social factors, life events, and symptoms. The British Journal of Psychiatry, 186(6), 538–539.

Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Jama, 286(24), 3089–3096.

Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H., & Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive medicine, 37(3), 268–277.

Felitti, V. J., Anda, R. F., Nordenberg, D., & Williamson, D. F. (1998). Adverse childhood experiences and health outcomes in adults: The Ace study. Journal of Family and Consumer Sciences, 90(3), 31.

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CPTSD Foundation

Successfully equipping complex trauma survivors and practitioners with compassionate support, skills, and trauma-informed education since 2014.