More than half of autistic children and young people aged between two and 19 engage in some form of self-injurious behavior, one study found, while a similar rate of autistic adults report a history of it, too. This kind of behavior — which can really be anything a person does that's dangerous to their physical wellbeing — is scary to witness. It comes in numerous different forms, however, and has just as many possible causes.
Harmful stims: Self-injurious behavior as a form of stimming
When you hear the term "self-harm", you probably immediately think of cutting, while other behaviors like a person burning themselves with cigarettes may also come to mind. This is for good reason — self-harm is defined as physically harmful behavior a person inflicts on themselves on purpose, but without the intention of committing suicide.
Not all self-injurious behavior autistic people may engage in fits this definition. Stimming, short for self-stimulatory behavior, is something everyone engages in but that autistic people have a particular need for. It involves self-soothing through motion, sound, touch, and visual input, among other things, and it's what the current diagnostic manual (DSM-5) would describe as repetitive and stereotyped motor movements or behaviors.
Stimming intensifies during periods of stress (and also during periods of great excitement), but that doesn't mean an autistic person means for a harmful stim to cause them injury. Rather, once discovered, stims can be hard to get rid of. The best path foward in this case is to try to replace the dangerous stim with one that isn't physically risky.
Self-injurious behavior as a means to communicate
In other cases, autistic people who cannot communicate easily in ways those around them can understand — including those who are non-verbal, have selective mutism, or struggle with verbal expression — use behavior that can cause them injury as a means to communicate.
One study theorized that frustration that arises when other people don't understand what the person is trying to communicate can directly result in self-injurious behaviors. The fact that very young children, who have not yet had the chance to acquire communication skills, are more likely to try to communicate through harmful behaviors backs this idea up.
Autistic people may also engage in intentional self-harm
It would be an understatement to say that being autistic in a neurotypical world — one in which many people don't understand you, are frightened of you, look down on you, victimize you, and don't allow you to reach your full potential — is hard. Factors like social isolation, loneliness, and depression go a long way towards explaining why autistic people without learning disabilities have been found to commit suicide at up to nine times the rate of neurotypical people. The same feelings also contribute to a high risk of intentional self-harm.
What are the risk factors for self-injurious behaviors in autistic people?
Research has identified that autistic people are more likely to turn to self-injurious and self-harming behaviors if:
- They struggle more with adapting to change, and, in other words, have a stronger need to stick to established routines and rituals. In this case, unsettling changes can induce self-injurious behaviors.
- They have intellectual disabilities.
- They have a harder time communicating verbally.
Since more research is necessary in this area, numerous other factors can contribute.
How to minimize self-injurious behavior?
Harmful stims that don't constitute intentional self-harm can, with time and effort, be replaced with new stims that aren't dangerous. Autistic people can try out new stims, including those using stim toys, and try to commit to switching to other stims they like when they catch themselves engaging in a self-injurious one.
Self-injurious behavior caused by a need to communicate could be addressed through finding more effective communication tools, whatever they may mean for a particular person. Writing, the use of pictures, and augmentative and alternative communication methods in general, can help. People around can learn to recognize signs of stress and learn to better help an autistic person before they reach the point of no return when they may resort to dangerous behaviors.
Depression, anxiety, and loneliness have no easy answers, but therapy, including cognitive behavioral therapy, can be an incredibly helpful step — providing the therapist has a deep understanding of autism.