Self-injurious behavior can be alarming to parents and caregivers. It can also lead to frustrating and painful judgment from bystanders. In most cases, self-harm does not cause severe damage such as concussions or life-threatening wounds, though some autistic people do seriously injure themselves.
SIB is a symptom of an underlying problem. Parents, spouses, friends, and others invested in the well-being of autistic people must look to the underlying motivation. Understanding the emotions and frustrations that trigger self-harm is the fastest route to ending it.
People on the autism spectrum process information, emotions, and sensory input differently from neurotypical individuals. While the experience of every autistic person is slightly different, some characteristics of autism that increase the risk of self-injury include:
Sensory overload
Autism can make a person highly sensitive to sensory input. They may feel overwhelmed by loud noises, find certain textures intolerable, or be unable to concentrate in certain environments. A small change in an autistic person’s sensory environment can feel like torture. Some autistic people engage in self-injury out of frustration when sensory stimuli become overwhelming. Others self-injure as a physical counterweight to painful sensory input.
Lack of control
Both autistic and neurotypical children may self-harm in frustration when they have little control over their environments. For instance, a child forced to play with the toys their parents choose instead of the toys they desire might bang their head. Outdated notions about how to support children with autism sometimes advocate restraint or punishment. This may trigger self-harm in some kids.
Reinforcement
Parents and bystanders may inadvertently reinforce SIB by giving the child more attention while trying to stop the behavior. They might also reward a child immediately after they stop self-injuring. This tactic can backfire and reinforce the action itself rather than the act of stopping.
Pain
Autism is linked to a number of other conditions and symptoms. For example, autistic children are more likely to have gastrointestinal problems. For some children, self-injury is a way of coping with or distracting from pain. A 2017 study argues that some physical symptoms of autism, such as stomach discomfort, are likely due to stress instead of an underlying medical condition. This suggests stressful experiences and chronic stress may play a role in SIB.
Chemical changes
Research suggests SIB and other forms of self-harm may cause the body to release feel-good chemicals called endogenous opioids. This means self-injury can be a source of pleasure. For a person experiencing stress or pain, the pleasurable chemical rush associated with self-injury can be appealing. (This theory applies to both autistic and neurotypical people.)
Environmental changes
Autism often causes a person to crave routine, order, and control. So when their environment changes, their schedule is chaotic, or they can’t go about their usual routine, they may self-harm to cope.
A generation ago, much advice about managing autism-related challenges focused on rewards and punishments. Now, with the advent of autism self-advocacy communities, autistic individuals are able to weigh in on various strategies. The overwhelming majority of autistic people and autism advocates strongly oppose punishments. Many also have expressed concerns about rewards, especially when the person giving the reward does nothing to address the underlying cause of the behavior.
Parents and others who care for an autistic person should view SIB as communication. Some strategies that may help include:
Some autistic people feel an overwhelming impulse to self-harm, even when doing so causes them difficulties at home, work, school, and in friendships or romantic relationships.
The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.Correcting SIB begins with understanding what causes it. Try asking yourself which triggers are most likely to bring about SIB? Then explore how you feel while self-injuring. Does it cause feelings of relief? Pleasure? Distraction? Identifying what you get out of SIB can help you begin cultivating healthy alternatives. For example, meditation might help with feeling calm in response to stress, while exercise might help with feeling jittery or frustrated.
Autistic people often find support and help from autistic self-help and advocacy groups. These groups view autism as an identity rather than a disability or illness. They say autism is a unique lens through which to view the world. Participation in such a group can help an autistic person cultivate new strengths and find healthy alternatives for managing challenging feelings.
No specific medication is approved by the U.S. Food and Drug Administration (FDA) to prevent SIB. A number of drugs, however, may help treat the underlying causes of SIB:
Therapy can help autistic people who self-injure, as well as their spouses, parents, and other loved ones. A therapist may work with an individual to identify triggers for SIB and cultivate healthier alternatives. The right therapist can help an autistic person advocate for themself, building an environment that feels safe and healthy.
Family counseling helps families better understand autism while dispelling myths about the spectrum. This can help parents better support their children, foster communication between autistic and neurotypical siblings, and offer a safe space for every family member to strategize and share concerns.
Couples counseling can help autistic people and their partners understand one another’s emotions. This fosters better communication, reduces frustration, and offers greater intimacy.
If you or a loved one would like support, you can find a therapist here.
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