Why Do We Need to Know ‘Why’?

In February 2025 I invited ‘unanswered questions’ about self-harm and throughout March 2025 I will be responding to these questions in a series of blogs. In these blogs I draw on my personal and professional experience, as well as survivor and academic literature. The purpose of these blogs is to bring together a range of perspectives and pose ideas and questions for further reflection. I welcome feedback and questions – thanks for reading!

The Unanswered Question: Why Do People Self-Harm?

Perhaps this is not an unanswered question as such, but more a question that it seems like has an answer, but when you start looking into it, things are not so clear.

I roll this anecdote out a lot, so apologies to the people who have heard it before, but whenever I get asked ‘why do people self-harm?’ I think back to my interview to run a self-harm helpline. The role was in a small organisation and vacancies there were rare. I had the unusual combination of very specific skills they wanted – self-harm knowledge, volunteer management and helpline experience – and as a friend said to me, ‘This is your job, if you don’t apply, I will for you!’.

I really wanted this role. And this was the first question, the big moment of making my first impression. I needed to get it right and show what I knew. So, why, when they asked me ‘why do people self-harm?’ did I reply: ‘There’s no clear answer to that.’?

Emotion Regulation?

If you were asked to summarise the majority of information easily available about self-harm today, you would be forgiven for thinking there’s a clear answer: self-harm is about emotion regulation, it’s a ‘maladaptive coping mechanism’.

So far, so straightforward, and so handy – if self-harm is about one thing for everyone, then we can find a solution, apply it and we don’t have to think it any further. Self-harm can evoke difficult emotional responses regardless of role or experience, so not wanting to be curious about it is often an instinctive act.

But if there’s one thing I’ve learned over the years, it’s that not being curious is, in the long-term, more problematic. Even if the assumption that self-harm is about emotion regulation resonates with the person seeking support, that in itself doesn’t tell us much. Why do they need to regulate their emotional states? What experiences are they having which are so intense? Which emotional states are they trying to regulate? Is self-harm helping with this and if so, how?

Without asking these questions you will never know if the emotion regulation is related to overwhelming emotional states that are too intense to bear, anxiety caused by intrusive thoughts, fear and terror from flashbacks or any of the many, many other potential reasons. Without asking these questions you will never know if the need to regulate is coming from possibly an inability to function day-to-day, suicidal urges or environmental factors such as trying to cope with abuse, bullying, relationship stress and many more.

These are only a few examples of the possible context behind self-harm where someone is looking for emotional regulation and if this is the depth of possibility in just emotion regulation, then what about the other possibilities? And if we focus on trying to get someone to ‘regulate their emotions’ without examining the context these emotions are happening in, then is that actually going to help? Or does it just send the message that the issue is them being in emotional states that are considered socially problematic.

As well as closing down curiosity about the person’s experience, the assumption of emotion regulation as ‘the answer’ also closes down the person’s own understanding or potential understanding of their self-harm. Presenting emotion regulation as the ‘reason’ frames the person’s experience for them and foists an institutionally convenient explanation on them, while simultaneously shutting down both curiosity and other explanations. It locates the problem in the person, and it is theirs and theirs alone to solve and this ‘knowledge’ should be enough for them to find the solution.

What Do People Who Self-Harm Say?

Prior to the 1990s, pretty much all research in this area was based on clinical impressions and observations, with little to no input from people who self-harmed. One of the, if not the, first pieces of research to carry out wide-ranging interviews with people who had self-harmed was Bristol Crisis Service for Women’s 1995 Women and Self Injury a survey of 76 Women study by Lois Arnold. In this seminal work the most common reasons for self-injury were relief of feelings, self-punishment, control, communication, comfort and to feel real or alive.

Although the majority of participants talked about ‘relief of feelings’, the range of these feelings was broad including: unbearable distress, self-hatred, guilt, dirtiness and powerlessness. The most common were unbearable pain and grief, which were not echoed in more academic work on self-harm which focused on tension and anger. The other key finding of this work was the functions of self-harm for the women who took part. Many participants were very clear on the utility of self-harm in helping them cope with unbearable emotions, dealing with difficult circumstances or as a way to avoid acting on suicidal feelings.

Research since with people who self-harm has explored many different reasons including emotion regulation and survival to feel in control of various aspects of their lives, escape overwhelming feelings, self-punishment, addiction, loneliness and communicate with themselves and others. People who self-harm also report difficulties in relationships, with peers and in education and work settings. There is a range of literature which links self-harm to experiences of deprivation, trauma and adversity, and shows higher rates of self-harm in minoritised communities, especially in certain minoritised ethnicities, sexualities or gender identities.

This list is not exhaustive, and in my own professional and personal experience, there are other experiences such as self-harm in response to hearing voices or command hallucinations; flashbacks; intrusive thoughts common in OCD and self-harm when in a dissociative state which have been less well explored. In addition, the self-harm experiences of neurodivergent people have only recently started to be acknowledged and explored.

Why Do We Need to Know?

For me, what’s key though is why is ‘why’ so important? Isn’t it possible to offer compassion, care and treatment to people who self-harm without having a clear narrative as to why? And when people are being asked ‘why’, are we as a society and individuals open to the possible range of answers?

If we start examining the societal structures and issues that perpetuate the need to self-harm for many people, then it all becomes too big and unwieldy and out of our control. That can make it feel easier to look for a straightforward narrative and straightforward solution and our need to know ‘why’ can become more important than the person in front of us and connecting with their humanity.

What is clear from both survivor and academic work on self-harm, and the experience of many self-harm support services is that the most helpful aspect of any support is the relationship. The focus of any support should be there, on being alongside someone, and being able to hear and accept whatever the answer to ‘why’ is, even if there is no answer.

The truth is that the number of reasons for self-harm is vast. In that job interview I explained that I thought there are potentially as many reasons for self-harm as people who self-harm and probably more, as it can be about different things for the same person at different times. Since then, I’ve also come to understand that some people are very clear about why they self-harm, some are sure at times and not at others and some people don’t know. And that it’s OK to not know.

There can be such a desire and drive to get people to stop self-harm, that finding the ‘why’ to resolve it can seem paramount. If I’ve learned anything in working in this area, it’s that being able to sit with and in uncertainty is one of the most powerful things you can offer in terms of support. And if part of that uncertainty is not knowing ‘why’ about self-harm, then what exactly is the purpose of trying to enforce the conjouring up of a reason to focus on? And who exactly does that serve?