Research suggests that autistic people have a higher risk for self-harm. Negative and unsupportive environments and challenges with emotional expression and communication may contribute to this disparity.

Self-harm, which is sometimes called non-suicidal self-injury, is any act of self-inflicted damage to your body without the intent to end your life. While this term is often associated with behaviors such as cutting, self-harm can take many forms. Some self-harming behaviors, such as pinching or hair pulling, may not have obvious signs.

Autism spectrum disorder (ASD) is a common neurodevelopmental condition typically diagnosed during childhood. While its exact causes aren’t clear, changes to the brain’s structure and function during development contribute to the social, communication, sensory, and behavioral challenges in ASD.

ASD occurs on a spectrum of severity and can affect people differently. But there are some common features and circumstances that occur more often in autistic people than in the larger population.

For example, ASD may increase the likelihood of engaging in self-harming behaviors.

Autistic people appear to have a higher risk for self-harm than the larger population.

According to a 2021 research review, autistic people are three times more likely to engage in self-harming behaviors than non-autistic people are.

A 2020 study that included data from more than 14,000 people found that 42% of autistic people engaged in self-harm. The researchers found that hand-hitting was the most common self-harming behavior and cutting was the least common.

The 2020 study found a higher prevalence of self-harming behaviors in female children, while a 2022 study involving teenagers in the UK found a higher risk for self-harm among males.

Anyone can engage in self-harm. It’s considered a maladaptive coping mechanism — an unhelpful behavior you engage in to relieve emotional distress.

For autistic people, self-harm can be a maladaptive coping mechanism, but it might also be a form of communication when standard communication methods aren’t available.

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 enabled by persistent environmental factors in ASD that make everyday life overwhelming.

“Autistic children often live in spaces that are under-informed on the realities of autism and respond in rejecting ways, which can negatively impact how they see themselves in the world,” she said. “When the environment is chronically judging them from a ‘deficit’ perspective, their sense of value diminishes significantly.”

This pervasive sense of low self-worth, or feeling “less than” non-autistic people, can set the stage for self-harm.

And because ASD involves challenges with social interactions and communication, beneficial coping strategies such as spending time with friends or talking through experiences might not come naturally to an autistic person.

Challenges with communication

Bunner added that self-harm in ASD can also be a means of emotional expression for autistic people who may not have other effective communication options.

“Additionally, many autistic people struggle with gaps between their expressive language ability and receptive language capacity,” she said. “This means that they are taking in overwhelming information from their environment yet struggle to effectively articulate the impact of said information on their well-being.”

For some autistic people, self-harm is one direct way they can quickly and easily express negative emotions such as anger, frustration, sadness, anxiety, and fear.

“During autistic meltdowns, children tend to hit themselves due to sensory overload, which leaves bruising on their limbs,” said Bunner. “Head-banging when distressed is another self-harming behavior. Due to their diminished capacity to self-preserve when overwhelmed, protection of their physical body is no longer priority.”

Self-harm isn’t always easy to spot, and signs of self-harm go beyond the injury itself to include behaviors of concealment, such as hiding marks or becoming secretive.

Signs of self-harm (in anyone) can include:

  • punishing themselves for perceived mistakes
  • having mysterious scars
  • having fresh cuts, bruises, burns, or marks
  • sustaining injuries that don’t align with 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 pants even in hot temperatures

Bunner said that one of the first signs of self-harm in autistic people is often exacerbated wounding, or the presence of excessive injury from minor, natural causes such as insect bites.

“For example, when dealing with anxiety, they may pick at scabs, scratch their skin, or bite their cuticles until bloody,” she explained. “The behavior presents as compulsive, yet it has become a viable strategy to circumvent emotional stress.”

It’s also important to note that autistic people who are nonverbal and have more significant cognitive delays often do not hide their self-harming behaviors, as non-autistic people often do. Instead, their self-harming behaviors are more likely to include head-banging, biting, hitting, and scratching.

Self-harm can be alarming to a caregiver, but it doesn’t warrant punishment. If your child is self-harming as a way to cope with negative emotions, reprimanding them only creates more negativity and can further restrict their available coping options.

That doesn’t mean you should ignore self-harm, but it does mean you should approach it from a position of support and empathy.

Start at the source

Self-harm is the outcome, not the underlying issue.

“Be willing to address the root causes for the behavior,” said Bunner. “Many times, parents are preoccupied with eliminating self-harming behaviors while avoiding what is causing them in the first place. Intentional, crucial conversations are necessary to get to the core of what is emotionally impacting your child.”

Improve the environment

Improving your child’s environment can help reduce their exposure to unsupportive or discriminatory influences that might enable self-harm.

Bunner recommended connecting with doctors, therapists, school staff, and other caregivers who embrace neurodiversity and are actively knowledgeable about the realities of ASD.

Explore alternative coping strategies

Whether self-harm in ASD is a coping mechanism or a means of expression, you can help your child find helpful alternatives. You can start by regularly discussing emotions. When negative ones arise, you can suggest an activity your child enjoys, such as going outside, listening to music, or playing with a pet.

If you’re not sure how to begin this process, a mental health professional can help your child develop new coping strategies while taking ASD into consideration.

Treatment for self-harm in autistic people uses the same principles as self-harm treatment in non-autistic people. Your therapist will accommodate for individual ASD needs and symptoms to create a custom treatment plan.

Medications and psychotherapy are used to treat self-harm. For some people, severe self-harm recovery may require a brief stay in a care facility.

Medications can help relieve persistent symptoms related to mood, such as depression and anxiety. Psychotherapy can help autistic children explore their experiences in relation to ASD while developing new coping strategies for negative emotions.

To learn more about self-harm, speak with someone confidentially, or find options in your area, consider the following resources:

Autistic people are more likely than non-autistic people to engage in self-harming behaviors. Negative environmental conditions and altered means of emotional expression are two important 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, beneficial coping strategies.