Autism and Self-Injury

I want to talk about autistic self-injury and some of the insights I’ve had recently, as someone who is both autistic and has self-injured and self-harmed at different points in my life.

Autistic people are at a higher risk for self-injury because we need more self-regulation and more self-stimulation. We struggle with filtering and processing information that we’re receiving both from the outside environment, and from the inside of ourselves, and in order to achieve equilibrium, we may need to self-regulate in some way. For many autistic people, self-regulation can result in self-injury.

Being autistic in the today’s society can also, unfortunately, contribute to developing different other conditions which further increase one’s risk for self-injury (anxiety, depression, etc.).

But I do not presume to be able to speak for others. I think that self-injury is something very personal, and the motivation and reasons behind it will vary significantly depending on someone’s experiences and environment.

I want to share my own experience, because when I was younger and had no idea I was autistic, I also didn’t know why I was injuring myself. I couldn’t explain it when I was asked about it.

Now that I’m older, have more self-awareness and more knowledge about both autism in general and about my autistic self, I feel that I can finally understand why I used to do it. And maybe it can help someone else understand themselves, too.

First, I want to differentiate the terms self-injury and self-harm. I think this differentiation is particularly important in the context of autism, but I rarely see it specifically mentioned.

Self-injury, to me, is a more neutral term. It can encompass any type of self-injury, including the kind that has positive motivation and reasoning, as well as the kind which is done without being aware of the fact that it’s self-injury (common in children). An example of this would be self-injury as a type of self-regulation. It doesn’t mean it’s not dangerous, of course. It means that it is done without the particular intent to cause harm to oneself but that the individual has no other outlet. I think that this is actually the most common type of self-injury for everyone, including autistic people.

Self-harm, to me, is a more specific term. It encompasses self-injury (or other behaviour) that is done with the intent to cause harm to one’s body, and where one of the purposes of the injury is harm itself. This type can be done out of punishment, self-hatred, or other destructive emotions that one might want to express on their body. Unfortunately, this is the more common term and is used whether the intention or cause behind the injury is considered or not, which is something I don’t agree with, because “harm” is not a neutral term and it becomes subjective based on point of view.

---

My first self-injurious behaviours happened when I was about 2 years old. I don’t remember them myself, but my mum tells me that I used to have “fits” and would bang my head against the walls and against sharp edges of tables (this was particularly dangerous and I was always stopped).

My reaction to big changes or to having my behaviour regulated by others, was to have “fits.” I can see now that these were autistic meltdowns, and the self-injurious behaviour was a type of self-regulation. It’s also possible that I was doing this as an outlet for my hyperactivity, or because of sensory issues, which nobody understood at the time.

These behaviours eventually ceased, or I learned to do something else to replace them.

The next behaviour I can consciously remember is skin-picking in my early teens. It was compulsive. I would often do it while trying to fall asleep. Looking back at it now, it’s a clear self-regulating behaviour to channel hyperactivity.

I started to both self-injure and self-harm in the more “stereotypical” sense in my mid-teens. It started with scratching using sharp objects, such as safety pins. I’d use them to doodle on my hands and arms. I think this might have been a type of self-stimulation. I don’t really know, because I didn’t know at the time. I didn’t know why exactly I started cutting, either.

I was 16, I was having a horrible time at school, and I had intense emotions that I didn’t know how to deal with. I was struggling with focus, with socialising, with putting on a mask whenever I was around people…

Everything was immensely difficult at the time. But I think that the main reason I started cutting were my emotions. Sometimes I didn’t even know what they were.

Now, I knew the basic emotions, and how to handle them. Happiness, sadness, excitement, frustration….those weren’t the problem.

The problem were the other emotions. They were so intense and I had so many of them. I still do. Existential dread, identity struggles, wondering who I am and why I’m here, struggling with feeling different and out of place and not knowing why, constant fear and anxiety about socialising and being around people, constantly feeling like there was something wrong with me, sensory overloads (which I didn’t understand at the time)…

Many of those emotions were vague and undefined and constantly plagued me.

And on top of all that, there were also other people’s emotions. I had always been a sponge, absorbing things from my environment. I easily picked up on people’s emotions, even when I didn’t know what they were. I would absorb their mood and begin processing it as if it was my own. It was yet another layer of emotional grime that I was already burdened with.

I remember perpetually feeling like there was a noise in my head, some kind of buzzing. Like all the emotions and sensory input created a jumbled, chaotic block of noise. And I had to carry it with me all the time.

At first I started with small cuts. But they quickly progressed to bigger ones, and to more of them.

The only thing I knew was that it gave me some kind of a relief. It replaced the emotional grime with pain and with stinging, and eventually, I started to actually like it.

I would particularly like it when a cut would still sting the next day. It was like a self-managing system that worked in the background. It would sting when I moved, and so provide relief and a distraction from the things in my head. It was also a type of self-stimulation when I felt numb.

At some point, I started to self-harm, too, in the sense that I had developed a huge amount of self-hatred, rejection sensitivity, and body image issues, and I started to self-harm as a form of punishment to my body and a way to release the frustration with myself on myself.

In this case, it was clear to me what I was doing and why. There was an intention and a cause behind it. But when the cause was emotional overload, I didn’t know how to explain it at all.

I couldn’t tell the difference at the time. I just knew that I was constantly anguished by one thing or another.

Self-injury was an outlet, but it made me feel deeply ashamed. It also led to a lot of other issues, like avoidance of sports and gym class, and always wearing long sleeves.

I never treated my wounds. But I was careful not to spill too much blood or have open wounds that wouldn’t close quickly. Even though I didn’t know exactly why I was doing it, even back then I was aware that the point of it weren’t the cuts themselves, so I always opted for many smaller ones that would continue to sting.

After a few years, my mum discovered my cuts. At that point, I had them all over my arms. She asked me why I did it, and I couldn’t explain it.

I had never learned how to talk about my difficult emotions out loud. I had no words to describe things. And even if I had, I don’t think I would’ve been able to, because I really didn’t know exactly why. “It made me feel better,” would’ve been the only answer I could have given. Knowing “why” is something that requires a lot more self-awareness and knowledge about the workings of the brain than I had at the time.

It is only now that I fully understand why. And it took a moment of self-injury for me to realize it.

I haven’t self-injured or harmed in a long time now. As an adult, the last time was probably at least 5 years ago, and even then it was very minor.

Some time ago, I got upset. I had an immense amount of emotions which had been overloading me for months. Then on top of that, I got upset. For some reason it was a lot more upset than I was used to. I tried to stim, but everything immediately felt wrong.

In that moment, I realized that I wanted to self-injure. At first I was confused, because it had been so long since I’d last done it. But then it suddenly made perfect sense. And my teenage self-injury all made sense, too.

I was sitting on my floor, completely distressed, but armed with all the new knowledge about myself and about my autism, I could easily analyse how I felt.

I understood that I was feeling dysregulated and that what I really needed was self-regulation.

But when you’re autistic, self-regulation can be difficult. My understanding of it is that autism is a difference in the nervous system, and when something goes haywire in that nervous system, our emotions can get amplified and become so overwhelming, that they cannot be regulated by any internal mechanism.

This is how I felt at the time. My emotions felt incredibly huge, like they were bigger than my body and like they were expanding. I couldn’t contain them. I needed to do something to them or to myself in order to regulate them. My head felt awful and heavy and full of noise. It felt like there was an incredible amount of pressure inside me and I needed to do something to release it, otherwise I would eventually explode and something even worse would happen. Think of it as a pressure cooker about to explode.

I thought about getting a knife, but as I care a lot more about my body now than I used to, I quickly realised that I shouldn’t cut. I wasn’t willing to have open and untreated wounds anymore, and so the amount of things I would need to do to treat them made it an impossible thing in that moment.

So instead, I hit my head on the door frame.

I can’t say I’m proud of something like that, but it worked. It felt like the act of hitting my head was knocking the noise and the pressure out of it, and after a while, I was able to calm down.

I don’t know why I hit my head when I was two years old, but I can imagine it being for a similar reason. I didn’t know anything about self-regulation as a small child, and I probably also had a harder time processing sensory information. If I needed to hit my head as a fully grown adult in order to calm down, my childhood behaviour isn’t even slightly surprising.

---

Self-injury when you are autistic can be different for everyone. Not everyone self-injures later in life, but I can imagine that many of us resort to some sort of self-injury when we’re children.

Self-injury and violent behaviour in autistic people is something that has been stigmatised and pathologised time and time again. It is one of the reasons why we can be institutionalised, arrested, or even killed. But there is a reason why this behaviour happens.

I’ve been lucky enough that my self-regulatory behaviours haven’t caused harm to anyone else, and haven’t caused a lot of harm to me either (I’ve only been hospitalised once). But I do wish I had understood the mechanism behind it when I was younger.

I wish I could’ve grown up in a way that didn’t require me to hide parts of myself in order to survive. Maybe if I had grown up in a different world, I wouldn’t have needed to self-injure in my teens. And if I still needed to, maybe I wouldn’t have felt so bad about it.

Right now, I can see my self-injury as a tool. It’s not pleasant and it’s not ideal, but it can be helpful, and this should be acknowledged. If I can use safe and non-injurious actions to soothe myself, I will. If there is no other choice, then honestly, I don’t mind using self-injury as a tool. Because I can see it for what it is now.

I know that I have enough presence of mind to be safe and to protect myself. I know that I won’t do it with the intent to cause harm but to soothe and calm down.

I know these things now, after doing extremely hard work on increasing my self-awareness.

But it shouldn’t have to take this long. Autistic people who struggle with self-regulation and end up self-injuring should have access to help and information that is meant for us. We need our internal workings to be better understood and we need to be taught to understand ourselves better. The internal mechanisms matter.

Whenever I read research or articles about self-injury in autism, it’s all written from a very distant perspective that focuses more on the “harm” and the outward behaviours than on their causes.

We need to work on removing the stigma and shame around self-injury in general. It’s a human behaviour that exists for a reason, and sometimes it is the only coping tool that a person has.

I know that what I’m saying isn’t groundbreaking, but it is helpful for me to analyse my self-regulation. So it might be helpful to someone else, too.

The realisation that there is a difference between injury caused by self-regulation and injury caused by self-harm is incredibly important to me, because I don’t actually want to harm myself anymore.

So if I do injure myself in order to regulate my emotions, knowing this difference and how to recognise it, makes the whole event a lot easier to process, and it also makes it a lot gentler on my mental well-being. Likewise, if I ever again injure myself intending to harm, I will know the difference and be able to process it accordingly. And knowing why I might do it can help me take better care of the causes as well, whatever they may be.

Note: This is obviously my personal experience. It’s meant to provide understanding and insight for those who need it, because I think that increasing self-awareness is absolutely vital to our well-being. I’m not encouraging anyone to self-injure, but if you do struggle with self-injury, I hope that gaining more insight into it can be helpful. And please look for safe ways to self-regulate and seek help if you’re able to.