Research indicates that autistic individuals face a heightened risk of self-harm. Unwelcoming environments and difficulties with expressing emotions and communication may contribute to this situation.
Self-harm, often referred to as non-suicidal self-injury, is any self-inflicted damage to the body without the intention to end one’s life. Although the term is typically associated with behaviours such as cutting, self-harm can manifest in various ways. For instance, some forms of self-harm, like pinching or pulling hair, may not show obvious signs.
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental condition usually diagnosed in childhood. Although its exact causes remain unclear, changes in the brain’s structure and function during development play a role in the social, communication, sensory, and behavioural challenges associated with ASD.
ASD exists on a spectrum, affecting individuals differently. Nonetheless, there are common traits and circumstances more frequent in autistic individuals than in the general population.
For instance, ASD may raise the likelihood of engaging in self-harming behaviours.
Is self-harm more common among autistic people?
Autistic individuals appear to face a higher risk of self-harm compared to the wider population.
A 2021 research review found that autistic individuals are three times more likely to engage in self-harming behaviours than non-autistic people.
A 2020 study involving data from more than 14,000 individuals found that 42% of autistic people engaged in self-harm. The study discovered that the most common self-harming behaviour was hand-hitting, while cutting was the least common.
The same study also revealed a higher prevalence of self-harming behaviours in female children, while a 2022 study involving UK teenagers found a higher risk of self-harm among males.
Why is there a link between self-harm and autism?
Anyone can engage in self-harm, which is seen as a maladaptive coping mechanism—a harmful behaviour used to relieve emotional distress.
For autistic individuals, self-harm can be a maladaptive coping mechanism or even a form of communication when traditional methods are unavailable.
Environmental factors
Natalie Bunner, a licensed clinical social worker and board-appointed clinical supervisor from Lafayette, Louisiana, explained that self-harm in ASD is often influenced by persistent environmental factors that make daily life overwhelming.
“Autistic children often reside in spaces that lack awareness of autism realities and respond in dismissive ways, which can negatively affect how they view themselves in the world,” she said. “When the environment consistently judges them from a ‘deficit’ perspective, their sense of self-worth diminishes significantly.”
This pervasive sense of low self-esteem, or feeling inferior to non-autistic individuals, can set the stage for self-harm.
Due to the challenges with social interactions and communication associated with ASD, beneficial coping strategies like spending time with friends or discussing experiences might not come naturally to an autistic person.
Challenges with communication
Bunner also noted that self-harm in ASD can be a means of emotional expression for autistic individuals who may not have other effective communication options.
“Many autistic individuals struggle with disparities between their expressive language ability and receptive language capacity,” she said. “This means they absorb overwhelming information from their environment but struggle to articulate its impact on their wellbeing.”
For some autistic individuals, self-harm provides a direct means of expressing negative emotions such as anger, frustration, sadness, anxiety, and fear.
“During autistic meltdowns, children may hit themselves due to sensory overload, resulting in bruises on their limbs,” said Bunner. “Head-banging when distressed is another form of self-harm. When overwhelmed, their capacity for self-preservation diminishes, making physical self-protection a lower priority.”
Signs of self-harm
Self-harm can be challenging to detect, and its signs extend beyond physical injuries to include concealment behaviours such as hiding marks or becoming secretive.
Signs of self-harm (in anyone) include:
- Punishing themselves for perceived mistakes
- Mysterious scars
- Fresh cuts, bruises, burns, or marks
- Injuries that don’t match their activity level
- Frequently mentioning accidental injuries
- Keeping sharp objects accessible
- Becoming secretive or protective of their space
- Talking about feeling worthless or expressing self-hate
- Wearing long sleeves and trousers even in hot weather
Bunner said one of the first signs of self-harm in autistic individuals is often exaggerated wounding, or the presence of excessive injury from minor natural causes like insect bites.
“For instance, when dealing with anxiety, they may pick at scabs, scratch their skin, or bite their cuticles until they bleed,” she explained. “The behaviour appears compulsive, yet it becomes a strategy to manage emotional stress.”
It’s also worth noting that autistic individuals who are non-verbal and have more significant cognitive delays often do not conceal their self-harming behaviours as non-autistic individuals might. Instead, their self-harming behaviours may include head-banging, biting, hitting, and scratching.
How to support your autistic child who self-harms
Self-harm can be concerning for a caregiver, but it doesn’t warrant punishment. If your child is using self-harm as a way to cope with negative emotions, reprimanding them may only create more negativity and limit their available coping mechanisms.
This doesn’t mean you should ignore self-harm; rather, approach it with support and empathy.
Address the root cause
Self-harm is a symptom, not the underlying problem.
“Be willing to address the root causes of the behaviour,” said Bunner. “Often, parents focus on eliminating self-harming behaviours while avoiding the causes. Honest, meaningful conversations are necessary to uncover the emotional impact on your child.”
Improve the environment
Enhancing your child’s environment can help reduce exposure to unsupportive or discriminatory influences that might contribute to self-harm.
Bunner recommended seeking connections with doctors, therapists, school staff, and other caregivers who embrace neurodiversity and are knowledgeable about the realities of ASD.
Explore alternative coping strategies
Whether self-harm in ASD is a coping mechanism or a form of expression, you can help your child discover helpful alternatives. Begin by discussing emotions regularly. When negative emotions arise, you can suggest activities your child enjoys, such as going outside, listening to music, or playing with a pet.
If you’re unsure how to start this process, a mental health professional can guide your child in developing new coping strategies with ASD in mind.
Treatment options for self-harm in autistic individuals
Treatment for self-harm in autistic individuals follows the same principles as treatment for self-harm in non-autistic people. Your therapist will consider individual ASD needs and symptoms to create a tailored treatment plan.
Medication and psychotherapy can be used to treat self-harm. In some cases, severe self-harm recovery may require a brief stay in a care facility.
Medications can help alleviate persistent mood-related symptoms, such as depression and anxiety. Psychotherapy can help autistic children explore their experiences within the context of ASD while developing new coping strategies for negative emotions.
Resources for getting help with self-harm
For more information about self-harm, to speak with someone confidentially, or to find options in your area, consider the following resources:
- Samaritans Helpline: 116 123
- Papyrus HOPELINEUK: 0800 068 41 41
- YoungMinds Parents’ Helpline: 0808 802 5544
- Mind Infoline: 0300 123 3393
In summary
Autistic individuals are more likely than non-autistic people to engage in self-harming behaviours. Negative environmental conditions and altered means of emotional expression are significant contributing factors to this disparity.
If your child is engaging in self-harm, treatment can help them understand and manage their feelings while learning new and healthy coping strategies.