How Is Adolescent Self-Harm Related to Addiction?

Specific Biological Features

Research on self-harming adolescents has identified distinctive biological features. They have a higher pain threshold and lower baseline levels of β-endorphin compared with healthy peers, suggesting decreased pain sensitivity and a possible “opioid deficit.”

Theoretically, lower endorphin levels may mean that physical pain triggers a stronger release of these substances and a subjective sense of relief—so through repeated self-injury, an individual may partially compensate for the missing opioid stimulation. A lower baseline level of β-endorphin could therefore represent a biological risk factor. However, this remains a hypothesis that requires further verification.

Psychological Mechanisms

Self-harm primarily serves as a maladaptive emotion-regulation strategy. Physical pain temporarily distracts from psychological pain and reduces inner tension, so many adolescents report feeling relaxed immediately after injuring themselves. This is a form of negative reinforcement—the reduction of unpleasant emotions strengthens the behavior.

A systematic review notes that self-harm is typically preceded by intense emotional distress, which decreases afterward, completing a cycle of relief followed by the return of tension. Repeated self-harm can thus shift from a conscious coping strategy to a compulsive cycle (emotional overload → urge → injury → relief → renewed tension) that closely resembles addictive behavior.

The review also points out that a minority of patients even describe pleasant or euphoric sensations during self-harm. This suggests that for some individuals, positive reinforcement—experiencing a kind of pleasure from pain—may also play a role.

Research indicates that self-harm meets several criteria for addiction. Patients report strong cravings, an inability to resist urges, and persistence despite negative consequences. A phenomenon resembling tolerance occurs—the same injuries soon fail to provide the same relief, leading adolescents to increase the frequency and intensity of self-harm. During periods without self-injury, “withdrawal” symptoms such as growing tension and anxiety often arise, fueling the compulsion to harm again. In many ways, self-harm displays characteristics of a behavioral addiction.

Implications for Treatment and Prevention

Viewing self-harm through the lens of addiction can inspire new therapeutic approaches. Alongside standard psychotherapy focused on emotional regulation and impulse control, techniques from addiction treatment may also be applied. Pilot studies suggest potential benefits of certain medications used in addiction therapy, though evidence remains preliminary.

Non-suicidal self-injury is not officially classified as an addiction—it remains a complex phenomenon. The addiction model does not fully capture it, but understanding its “habit-like” aspects can help clinicians adopt a more empathetic approach. Labeling an adolescent as “addicted” is not appropriate, as it may lead to stigma and lower self-esteem.

Instead of prohibitive phrases like “don’t do it anymore,” an empathetic conversation and the search for less harmful coping strategies often prove more effective. With proper treatment, the vicious cycle of self-harm can be broken—much like in addiction recovery.

Editorial Team, Medscope.pro

Sources:

1. van der Venne P., Balint A., Drews E. et al. Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury. Journal of Affective Disorders 2021;278 : 199–208, doi: 10.1016/j.jad.2020.09.036.

2. Carenys A. Z., Adan A. Non-Suicidal Self-Injury as a Behavioural Addiction: A Systematic Review. Current Addiction Reports 2025;12 : 67, doi: 10.1007/s40429-025-00680-5.