Understanding Self-Harm from a Nervous System Perspective

Understanding self-harm through a nervous system lens changes everything — and in this episode, Amanda breaks down what's actually happening in the brain and body when this behavior shows up, why it works as a short-term regulation strategy even when it comes at a high cost, and what genuinely helps address the root of the pattern rather than just the behavior itself.

3 Takeaways:

1. Self-harm is a nervous system regulation attempt. Understanding this is not permission to continue it — it's the foundation for approaching it without shame.
2. The nervous system underneath self-harm is physiologically dysregulated, not just psychologically. Healing has to target the nervous system itself, not just thoughts or behaviors in isolation.
3. Effective alternatives work when they do the same jobs as self-harm — building discharge pathways and widening the window of tolerance. That takes time and often professional support, and healing is genuinely possible.

CLICK HERE for the full show notes, resources, and 3 tangible takeaways!

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Resources:

• 988 Suicide and Crisis Lifeline: call or text 988
• Crisis Text Line: text HOME to 741741

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Research referenced in this episode:

• Cornell Research Program on Self-Injury and Recovery — The Neurobiology of NSSI
• PMC/NIH — Self-harm and emotional regulation research
• MedlinePlus — Self-harm overview
• Nature Mental Health (2025) — Electrodermal activity and self-harm

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Disclaimer: This podcast is for informational and educational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment.

Website: https://www.regulatedliving.com/podcast

Email: amanda@regulatedliving.com

Instagram: @amandaontherise

TikTok: https://www.tiktok.com/@amandaontherise

Transcript

SPEAKER_00 0:00

Welcome to Regulate and Rewire, an anxiety and depression podcast where we discuss the things I wish someone would have taught me earlier in my healing journey. I'm your host, Amanda Armstrong, and I'll be sharing my steps, my missteps, client experiences, and tangible research-based tools to help you regulate your nervous system, rewire your mind, and reclaim your life. Thanks for being here. Now let's dive in. Before we get into today's conversation, I want to name up front that we are talking about self-harm. If that is a topic that feels raw or close for you right now, you are not alone. And most importantly, if this is something that impacts you personally, I want you to stay safe. If you are currently struggling, I have put resources in the show notes, and I want to encourage you to reach out to a mental health professional who can support you directly because today's episode is educational. It is designed to be compassionate. It is not meant to be a substitute for professional individualized support. So what I hope to offer today is a framework, maybe a new way of understanding what is happening in the brain and body when this behavior shows up. Because for someone, my hope is that this new understanding may be a first step towards changing it. Now, today's topic is another one that came from a listener question. And it's one that I've been sitting with for a while because I wanted to do it as right as I could. So this listener wrote in, quote, would you mind covering self-harm or other dysfunctional regulation attempts from a nervous system perspective? I'd like to learn more about it. When does it step in? Why does it regulate emotions? And what are better ways to cope? End quote. So first off, I love the way that they ask this question and the lens that they are already applying to it. They call it a regulation attempt, which is accurate. And I think it already takes some of the taboo off of the topic. This is a sign of pain. This behavior is a sign of attempted regulation. Now, we are not going to talk about this from a clinical sense or a way that pathologizes or shames this behavior. My whole approach to mental health is that our symptoms make sense and self-harm is no exception to that. I think when we understand what the nervous system is actually doing with this behavior, it stops being something that's so terrifying and so confusing and can be something a little more tangible to work with. So today we're going to cover what might be happening in the nervous system and the brain when self-harm enters the picture, why it works even temporarily as a regulation strategy. And then maybe most importantly, what we can do instead that actually addresses the root of what's going on rather than just trying to white knuckle through this experience. So there's a lot of ground to cover. And I know this is a really heavy topic. So please, please, please opt out of this conversation if you need to. Now let's jump right into some of the common assumptions about self-harm. First is that the person is attention seeking. Other assumptions might be that they are broken or damaged or beyond help. Assumptions generally focus on misinterpreting the behavior as manipulative, suicidal, or a quote, phase, rather than understanding it as a complex, often private coping mechanism for overwhelming emotional pain. So it is a behavior, a coping behavior. And more specifically, it is an attempt at nervous system regulation that happens to come at a very high cost. This is the through line of just about every single thing that I teach. Your nervous system is always trying to solve a problem, to seek out a sense of safety or control. It is always doing its best with what it has in the body that it's in, given the experiences that you've lived through, the circumstances and resources that you currently have. When the regulation tools available to somebody are not sufficient for the level of distress that they are in, the nervous system is going to find another way. And sometimes for some people, that way is self-harm. Now, throughout this conversation, I want to be careful and clear. I am not saying that self-harm is okay or that we shouldn't work to change it. Of course, we want to do that. That goes without saying. But understanding that it is a response to dysregulation, not some pathological personality defect, changes how we approach it. And it changes how the person experiencing it may feel about themselves. Shame is the biggest barrier to change. And when we can hold something this tender with curiosity instead of judgment, we pull a plug on that shame. And that is when real healing becomes more possible. Now, the research really backs up this notion that self-harm is an attempt to regulate. A major meta-analysis confirmed that the most common function of self-harm is to modify the intensity or the duration of emotions. So people who engage in this behavior are almost always doing it to regulate something overwhelming. And research is really clear that it usually shows up most often in response to one of two different states: overwhelming emotional flooding or emotional numbness. And while those things might sound like opposites, they are both forms of severe dysregulation. This behavior is oftentimes used to release feelings that have nowhere else to go, to interrupt some kind of emotional flooding, to feel something when they feel nothing, or to feel something physical when emotional pain feels too abstract or unbearable. So both of these states are where the nervous system finds itself stuck and unable to cope. In both cases, our nervous system is going to reach for something, anything that is going to shift that experience. Intense, unmanageable emotion is what typically precedes self-harm. And this behavior functions as a way to interrupt that state, to change what the nervous system is experiencing. And at its core, this behavior is just a dysregulated nervous system doing something, anything with its dysregulation. That's it. Let's get a little bit more now into the science about what is happening inside when somebody self-harms, because I think this deeper understanding and context is where real compassion can kind of get its legs. So there are a few brain regions that come up consistently in the research on self-harm. The amygdala, the prefrontal cortex, and our body's stress response system. The first is the amygdala. So this is the part of your brain that does threat detection. It is constantly scanning incoming information and asking, is this dangerous? Do I need to respond? In people who self-harm, research shows that the amygdala tends to be more reactive. So it fires more strongly, it fires at more things in response to emotional stimuli. So think about it like a smoke detector that is calibrated just way too sensitively. It doesn't just go off when it senses smoke, but it goes off every single time that you put toast in the toaster because it's anticipating smoke. So what we see in individuals who self-harm is that their amygdala has a similar sensitivity. It fires not just when there is actual danger or threat, but any time that there might be. So think about this like your logical brain. This is the part of your brain that handles cognitive control, conscious decision making, and a lot of emotional regulation function. This is the part of the brain that steps in and says, Hey, hey, friend, I see what's happening here. Let me help you choose how to respond. But when the amygdala is flooded, the prefrontal cortex kind of goes offline. It really struggles to do its job. I've talked about this before on the podcast. It's called like it, your brain flips its slid. You stop sending as much electrochemical energy to your prefrontal cortex. Your amygdala says, hey, this is really dangerous. Higher functioning. We don't need you. We're going to operate from a place of survival mode. So think about a high stress moment where you could not think straight. Or how about the time you got in an argument? And it was like an hour after that argument that you were like, oh my gosh, that's what I'm, that's what I wanted to say. Those were the perfect words for what I was trying to express. When our threat response is that activated, that higher order logical thinking, it gets sidelined. So you literally cannot reason your way out of a body, of a nervous system, of a brain that senses crisis. Now, the third piece of this is our body's stress response system, specifically something called the HPA axis. And this governs cortisol and our physiological response to threat. So research shows that some people with a history of self-harm, they have a blunted cortisol response to new stressors. So why does that happen and what does that mean? Most people don't just come this way. This happens when somebody has carried too much unprocessed stress or trauma for too long. Essentially, what happens is that the body has been in a state of high, high, high alert for so long that it's shifted its baseline. So essentially, when the stress response system has been blunted from chronic overload, our nervous system loses some of its natural ability to signal, process, and recover from stress on its own. The built-in mechanism that is supposed to help your body regulate, to help your body move through being stressed and then come back to a baseline, it's not working the way that it should. And so the nervous system then goes looking for something external to do that job, to help that process. And for some people, self-harm becomes that something external. And that something for somebody else could be any other number of dysfunctional regulation attempts, things like restrictive eating or purging, substance use, compulsive overexercising, reckless behavior. So while I am highlighting self-harm in today's conversation, a lot of the research shows similar things happening behind the scenes for many of these other behaviors as well. Another thing that can happen when we've been stuck in a heightened sympathetic nervous system state, aka activation, anxiety, fight or flight, for a prolonged period of time is something called elevated electrodermal activity. Stick with me for a minute. I know that these words take us deep into a science rabbit hole. So electrodermal activity is essentially a readout of how activated that branch of your nervous system is because sweat gland activity is directly controlled by our sympathetic nervous system. So more activation, more conduits, higher readings. And a 2025 study published in Natural Mental Health found that young people with a history of self-harm show heightened electrodermal activity. And this heightened reactivity seems to be a factor in the transition from thinking about self-harm to actually engaging in it. And so when we put a lot of this research together, what you get is a nervous system that is easily flooded, has fewer internal breaks available in those moments of dysregulation, finds physical sensation to be a reliable regulatory shortcut, and has learned through repetition, through experience, through cognitive exposure to reach for that shortcut. That is the full picture. What the science is telling us is that most often self-harm is not attention seeking. It is not a personality defect, it is a dysregulated nervous system reaching for a regulatory strategy, a harmful one, one that we want to move away from, but a regulation attempt nonetheless. So coming back to this listener's question, this message to me, one of the things that they asked was, why does it regulate emotions? And I just gave you some of the neuroscience, but I want to make it even more practical. This feels uncomfortable to name out loud, but self-harm works. It works in the short term. And that is why it can be so hard for somebody to move away from it. So we're gonna spend the next few minutes talking about why and how it works. First, the pain acts as an interruption to the internal experience that feels uncontrollable. So pain is a really powerful physiological signal that demands our system's full attention. So when somebody is flooded with overwhelming emotion, rage, shame, grief, panic, physical sensations, specifically physical pain, can cut through and redirect that attention. And while it doesn't resolve the underlying feeling, it can create enough of a shift to bring somebody down from an acute emotional peak. Another reason that it works is what's happening in the pain and reward system. So research suggests that self-harm may trigger a release of endorphins, which can reduce temporarily distress and create a sense of calmer relief afterwards. So there's something hormonally, something physiologically, chemically shifting in our pain and reward system. Another reason is for some people, it serves as a form of self-communication. It serves as a way of making internal pain visible and real. So when emotional pain feels invisible and no one around you sees how bad it is, making it external in some way can feel like the only way to prove to yourself or others that something is actually wrong. And the last reason that I'll talk about that makes it, you know, quote, work is that it creates a sense of control. And this is deeply connected to what we need in order to feel safe. So I talk a lot about the three C's of safety, the three things our brain and our nervous system source for to determine safety or threat. And those are context, choice, and connection. When somebody is overwhelmed and feeling like nothing is within their control, self-harm can feel like an assertion of agency. I choose this, I have control over at least this one thing. And that sense of choice, even when it comes through harmful means, can be regulating. And it's a paradox, but it is a completely coherent one when you understand what our nervous system is looking for, what our brain and body need in these moments that are so overwhelming. And the core problem with all of this is that when a behavior works, even temporarily, even partially, even with significant cost, the brain and the nervous system, they learn it. They learn that it works. And our stress is either processed or stored. And when we act on the urge to self-harm, a version of that stress cycle completes. Then the behavior gets reinforced. And this is why it is a pattern that can be so genuinely difficult to shift without real tools and real support and deeper context and compassion and understanding. Now, before I shift into talking about what better coping might actually look like, I want to wrap this up by sharing the key factors research consistently points to in people who are the most vulnerable to using self-harm as a regulation tool. And these are people who experienced trauma, abuse, or chronic stress in childhood. It's individuals with a history of emotional invalidation, meaning that the people around them consistently dismissed, minimized, or punished their emotional experience. People who are most vulnerable to self-harm are people whose nervous systems were never taught or supported in developing other regulation skills. That resetting from stressful events was never modeled for them. And in people struggling with depression and anxiety, which are oftentimes co-occurring conditions to self-harm. The other is people who were exposed to self-harm in their peer groups because the nervous system can actually learn this strategy through exposure, through suggestion. Understanding these things, understanding the science and the risk factors is important because it tells us something about what the work of healing needs to target. It's not just thought patterns, it's not just finding better coping skills, it's the underlying physiological reactivity and the root of the emotional distress tied in oftentimes with the very real possible lack of a safe support system. So with that, let's talk about what better coping might actually look like or the path to finding better coping mechanisms. And when I talk about, quote, better coping, I really want to challenge how we usually think about this. Because the answer is not just do X, Y, or Z instead of self-harming. That approach treats self-harm as a bad habit that needs to be swapped out. And I think it completely misses the underlying dysregulation that makes this behavior necessary or why somebody turned to it in the first place. Genuine alternatives to self-harm, at least at the beginning, they have to do the same job. They have to provide a discharge for nervous system activation. They have to interrupt a flooded or dissociated state. They need to provide real relief from overwhelming emotion and ultimately be available to the individual in the moment that that urge arises. That's a pretty demanding list. And it is why vague advice, like, oh, just go for a walk or call a friend instead can fall really flat. If those interventions worked in the moments of intense flooding, people would already be using them. So here's how I think about this from a nervous system perspective. A primary priority is learning to recognize the buildup before the flood. Self-harm often feels like it happens suddenly, but there's almost always a ramp-up period. So this gradual escalation of distress that wasn't noticed, that wasn't interrupted, maybe because of lack of awareness, maybe because even within that gradual escalation, there aren't things to turn to or pull to. You don't have resourcing available to you. One of the most important things that somebody can build if they're looking for a long-term healing for self-harm, it's to build the capacity to track your own nervous system states across a day earlier in the process. You need to know, ooh, I can feel the flood is coming. Prevention most often is going to live in this, what I call like a pre-escalation window. And when you have awareness for that pre-escalation window, can you start to experiment with? Can you start to learn or use other regulation tools while your nervous system is still in a more workable place? And while some of you might be able to explore and increase your awareness around this kind of pre escalation window on your own, this is actually where it can be the most important to find a good therapist, a good practitioner. To explore. Okay, what does it feel like before? What are the patterns around? Can we start to build a little bit more just cognitive awareness of what gets us from this place to that? And then I think about this in terms of a reactive and a proactive approach. You've heard me use these terms a lot here on the podcast: reactive regulation, proactive regulation, a reactive or a proactive approach. So reactive is what we turn to. It's when we're already in those moments when activation is high, when the urge is present, when you are already overwhelmed and you need something right now, right now, right now, right now. It's really intense. You're in that moment. And these reactive tools, they're not about fixing the root cause. They are about creating enough space to not act on the impulse of self-harm in that moment, but to act on an alternative. And so this is where we need to think in terms of somatic discharge because the nervous system needs somewhere for that activated energy to go. High intensity movement, running, jumping, cold water on your face, cold shower, holding an ice cube in your hand, intense vocalization, burst of physical exertion. These can create similar physiological discharge or distraction in a way that doesn't carry the cost of self-harm. One of the most common alternatives that I've seen and I saw growing up for people who are struggling with self-harm, specifically cutting, would be to have a rubber band on your wrist and to snap it instead, or to hold an ice cube in your hand. And the conversation around those two specific alternatives is often pretty divisive. There's two sides to that. You know, why are we going to replace one form of self-harm with another form of self-harm? One form of pain with another form of pain. And where a lot of practitioners come in and somewhere in the middle is we're looking to mitigate harm. Is the rubber band holding an ice cube a lesser version of harm than what they are alternatively doing? And if so, can that be a potential bridge in the moment while they are learning less harmful reactive regulatory activities in the moment to take the edge off while they are getting the support to do some of the deeper root cause stuff? So reactively regulating, it could look a number of different ways. It also might look like orienting. Can you use your senses to anchor in the present moment and to signal safety to your nervous system? What can you see? What can you hear? What can you feel? What's in your hands right now? Can you keep something in your pocket? Now, this is something considerably easier to do the earlier you can catch yourself on the way to being flooded. Now, if it's available in the moment, turning to connection is one of the best things that we can do. Reaching out to somebody safe, even just to say, hey, I'm struggling right now. I don't want to talk about it. I just need you to know I'm struggling. You can even say that to a pet. Maybe you even voice it into your own voice memo. Maybe you hop into my DMs or an email, and it's just a hey, I'm struggling and I'm putting it out into the world somewhere safe so that it can be seen, so it can be held, so I can give this intensity someplace to go. Co-regulation is one of the most powerful tools that we have. A present, attuned person, pet, resource can genuinely help your nervous system borrow from theirs when yours is spiraling or when yours is offline. I also want to be real when I'm talking about fine connection or turn to some of these reactive regulation tools that play on the same physiology as because sometimes those things aren't going to be available to you, or sometimes there is less negative repercussion for someone to self-harm quietly behind a closed door than to slam one or to scream or to share something vulnerable with someone. I had a friend growing up who I eventually found out was self-harming. In hindsight, I can see now that while things often looked perfect for her, the big house, the nice parents, the good grades, her parents were gone all the time. There was so much loneliness in her life while she simultaneously was expected to get the best grades, perform well in her sport, never be mad or talk back. Now, when none of your feelings can come out, the only place for them to go is to get buried inward. This friend was a teenager with an underdeveloped brain, feeling constantly monitored with expectations of perfection from likely well-meaning but emotionally suppressive and completely absent parents. Again, I am not saying self-harm is the way to go here. But with this context that I have laid out, I look back at this friend and this behavior, and it makes so much sense. And I just want to wrap my arms around them and hold them tight. Okay, coming back for a moment to talk about better ways of coping. So we talked about learning to recognize that buildup before the flood and then the reactive approach of finding other physiological ways to discharge or distract. These are bridging strategies, these are things that are going to be uniquely personalized that you are going to need to discover what works best for you through some experimentation and likely professional support. And the goal with these is to help you slow down in moments of crisis to give you another form of intensity or distraction to turn to without the same cost. But these approaches do not change the underlying pattern themselves. Changing the underlying pattern is what I often call proactive work. And it looks like both physiologically building more regulation capacity over time and psychologically stepping into deeper healing work. So physiologically, we can build what we call a wider window of tolerance, meaning that there is more that we can handle before we hit that breaking point. And we can do this by tending to foundational habits of more regulated living: sleep, movement, nourishment, regulation practice, connection, vagal toning, stress management. And I know that there is nothing novel about what I'm saying with that list, but when the foundations are better tended to, you have more cognitive and emotional capacity. These are the inputs that determine whether your nervous system has the capacity to meet what life brings back to this friend. Because this friend was in sports and extracurriculars and needed to get good grades. I know that she was sleeping like six hours a night. A teenager sleeping six hours a night, she was also self-harming by undernourishing. She is going to be already depleted before hard things come. Amygdala's firing, prefrontal cortex, offline. We are not going to make healthy decisions in that state. When somebody is chronically under-resourced, whether that's chronically underslept, isolated, running on stress, there's going to be no buffer for any trigger, any stressor that hits that system. So building these supportive habits is not optional when we talk about long-term healing. This is structural healing. It is what expands that window of tolerance over time so that the same stressors, the same triggers do not always land the same way in our system. If you are somebody or if you know somebody who is engaging in self-harm right now and stopping that behavior feels a little out of reach, or maybe you or they have tried and tried and tried, never is the goal to not try to find a less harmful alternative. But maybe for a moment, instead of trying to do the same, same, same, same, same, same things to stop doing a behavior that you're you keep end up doing anyways, what if we switched focus and said, okay, if stopping doing the unhealthy, harmful thing isn't working for me right now, is there another area in my life where I could maybe start doing something that is helpful, something that is healing? Is there one of these foundations that I feel like I could tap into, step into? Or if you are a support person, can I help this person? Are they sleeping well? Are they nourishing themselves? Is there a way that I can take the load off logistically, even, to create a sure or a stronger foundation for them to operate from, to help them establish a more resourced baseline to work from. And then there's probably the most important work for long-term recovery here, which is to do the deeper work of processing these underlying wounds. Self-harm is often an attempt to cope with things that happened: trauma, chronic invalidation, unmet emotional needs, a lack of control in your current circumstances. The regulation tools address the symptom. The healing work address what the symptom is pointing to. What is self-harm actually trying to protect you from? What is the feeling underneath? What did your nervous system learn about emotion and safety that made this behavior feel necessary? What beliefs are running in the background? And this is the work that often involves a therapist, somebody trained in somatic approaches, trauma processing, parts work, DBT, EMDR. There are a number of different approaches to deep healing because different approaches resonate differently. They work differently for different people. These all have strong evidence based specifically around self-harm. Now, before I let you go today, I want to speak directly to anyone listening who has been in this place or is in this place right now. You are not broken. Your nervous system is not broken. It simply found a strategy that worked. Not a good strategy, not a safe strategy, but a strategy that made sense given what it was working with. And strategies can change. Sometimes they need to change. New tools can be built. Your window of tolerance can expand. I have seen it happen. I believe it is possible, and there is hope. There is healing. And if you are someone who knows someone who is struggling, a friend, a student, your own child, maybe there's a little more context or understanding from today's conversation that can help you step towards supporting them in a new way. All right. Our three takeaways from today. Number one, self-harm is a nervous system regulation attempt. This research, it consistently shows that this is a function to interrupt emotional flooding, to discharge activation, to make invisible pain visible. When we understand this, it is not a permission to continue this behavior, but I believe that it is a foundation for approaching it and healing it without shame. Number two, the nervous system underneath self-harm is physiologically dysregulated. This is not just about psychological thought patterns. When healing, working with somebody who understands an hypersensitive, heightened amygdala reactivity, what a blunted stress response means, and measurable elevated physiological arousal. These are all real features of the nervous system. Real features that have become reliant on self-harm to regulate. So this means that healing has to target the nervous system itself, not just thoughts or beliefs or behaviors in isolation. We've got to find deeper resourcing, deeper ways to regulate and access a felt sense of safety. Those three C's: context, choice, connection. Takeaway number three: effective alternatives work, at least initially, because they do the same jobs. The goal is to build discharge pathways, to widen your window of tolerance, and to create enough baseline regulation that your nervous system has a moment of real alternative options. Finding those, discovering those, working with those, take time, practice, and often professional support. I believe healing is genuinely possible. If you have follow up questions to this conversation, if you have anything you'd like to share, my inbox is always, always open. And until next week, friends, I am sending hope and healing your way.