Why do some substance abuse populations need to inflict pain on themselves? The reasons behind the need to self-harm are extremely complex and largely misunderstood. For each person the causative surroundings are different. However, usually they include difficult personal circumstances, past trauma (including childhood sexual and emotional abuse), or economic or social deprivation together with some level of mental disorder (including depression/impulsiveness, suicide and eating disorder). A persons self-harming behaviour may often be associated with the misuse of drugs or alcohol. The fact is that deliberate self-harm is a way of expressing and dealing with profound agony. It is a sign of the emotional pain. It is a coping strategy; if you dont have a language to say what is going on inside you, you dont know how to endure what you are feeling. It is a signal that something is wrong rather than a primary disorder.