Self-harm is very common in people with Autism Spectrum Disorders. It is also common in people with learning difficulties and there are a lot of similarities between the two. It is thought that between 20-30% of people with autism will self-harm in some way, but this is often seen as something different to when we hear about someone cutting or burning as a coping mechanism. The medical profession seems to make the same distinction, and usually refers to it as “self-injurious behaviour“ or SIB. It can be treated as a challenging, unwanted behaviour that is part of a condition. This approach perhaps depends on the severity of the diagnosis though, which varies between individuals, as described by the term “spectrum.” Some studies have shown that both the prevalence and the type of self-harm also differ according to severity.
If we are looking for differences between self-harm in an individual with autism, and self-harm in an individual without these traits, the most notable ones are in the type of harm, and its perceived cause. The more classic harming behaviours within autism would include actions like hand-biting, head-banging, hitting fists on self or objects, excessive picking or scratching. Already this looks a little different to the commonly reported cutting and overdosing methods. When these actions occur in a very repetitive or rhythmic way, without an obvious cause, then it is suggested that one reason could be for stimulation. Some people function at a low level of arousal and engaging in self-harm helps to increase this. Alternatively, if the person is sensitive to high arousal, self-harm could act as a release of tension from this. The arousal theories of self-harm are more unique to those with learning difficulties or autism.
Other explanations look at more social causes, such as communication, attention-seeking, or avoidance. Autism is characterised by social deficits and communication difficulties and so it makes sense that a behaviour like self-harm might have a social function for some. For example, it can act as a way of communicating a need, whether that is for attention or for gaining something tangible, and this is reinforced when that need is subsequently met. In uncomfortable situations or if asked to do something unwanted, engaging in a harmful behaviour can help the individual to escape from the experience, or even a way of just letting people know that they don’t like it.
It is also important to acknowledge the frustration that a person must feel if their feelings are not understood, or if they are struggling to interpret the intentions of other people, and this can be experienced across the whole spectrum of autism, regardless of language ability. An expression of this sheer frustration might come out as self-harm, which is actually not too dissimilar to the type of self-harm that other people talk about: A teenager feeling frustrated at being misunderstood, or someone feeling angry and frustrated about the way that they are treated by people, or feeling helpless against more of life’s let-downs. A person with autism can experience all of these - they are often treated differently by society - but can lack the emotional capacity to express or deal with it.
The treatment of Self-Injurious Behaviour in autism depends on the particular function that it is serving for that person. This can be identified by observations and/or conversations with the individual. Behavioural therapies are popular, and involve using positive re-enforcement techniques – rewarding positive/safe behaviours and teaching alternative methods of communication. A stimulating environment may also help to prevent the behaviour, as can medication if the problem is linked to an underlying mental health condition.
Due to communication problems, it can be very hard for parents of a child with autism to know how to help their child, and it can take a long time for the right intervention to be found. Both autism and self-harm are under-researched areas and are not fully understood, so facing the two together can feel scary and isolating. Families and individuals dealing with these issues need lots of support and encouragement, and it’s important they are supported to find it.
If you need more information about autism and self-harm, you may find this article by Lucy Sanctuary on the Network Autism website helpful.