ADHD and self-harm: Why people with ADHD are at greater risk

Content warning: This episode discusses self-harm and suicide.

ADHD doesn’t cause self-harm, but the research is clear: People with ADHD — especially women and girls — are significantly more likely to engage in self-harming behaviors, especially during adolescence. 

Why is ADHD so closely linked to self-harm? In this episode, Dr. J breaks down how the core features of ADHD — impulsivity, emotional dysregulation, sleep disruption, and difficulty with the “pause button” — can create a perfect storm for dangerous coping. She explains why big emotions hit harder and faster with ADHD, and how that can lead to self-harming behaviors.

Dr. J also shares evidence-based strategies for building safer ways to cope, including DBT (dialectical behavior therapy), self-compassion exercises, and safety planning. And she talks about maintaining the routines that keep ADHD symptoms manageable. 

If you or someone you know is struggling, the 988 Suicide and Crisis Lifeline is available 24/7.

• Watch: ADHD and emotional dysregulation

• Read: Free resources

Dr. J: Hey, just a heads-up. We're going to be talking about some pretty heavy topics, including suicide. If you or someone you know struggles with these issues, it's important to get information and get help. With ADHD, big emotions come on fast. Things can feel overwhelming. And when that pressure meets impulsivity, it can create a perfect storm for a dangerous coping method: self-harm.

Because when big feelings hit, harming can feel like a way to find release and relief. Now, I want to be clear: ADHD does not cause self-harm. But we know from research that people with ADHD, especially women and girls, are more likely to self-harm. It's a dangerous pattern and one that can be very hard to break.

But understanding and finding healthier ways to manage overwhelming emotions can help. On this episode, we'll explore the link between ADHD and self-harm, how impulsivity and emotional dysregulation play a role, and, most importantly, how to build safer ways to cope.

This is "ADHD and," where we talk about everyday life and ADHD. I'm your host, Dr. J. I'm a licensed psychologist who works with people with ADHD. If you've ever struggled with self-harming behaviors or know someone who has, stay tuned to unpack this pattern with me.

So let's get into what self-harm is and why ADHD is associated with higher rates of it. Self-harm covers a range of behavior, with intention being the differentiating factor. Non-suicidal self-injury has no intent to die and can include things like cutting, hitting, burning, and biting.

Studies show higher rates of self-harm and suicide attempts among people with ADHD compared to neurotypical individuals. Nearly one quarter of women with ADHD have attempted suicide, compared to 3.3% of women without ADHD. And while this is a channel that's dedicated to women, for this one, we aren't going to leave our male listeners hanging, because I know you're out there and I appreciate you.

Women with ADHD are eight times more likely to attempt suicide, while men with ADHD are four and a half times more likely. So regardless of gender, if you have ADHD, you're at higher risk. 22% of girls with combined-type ADHD had made a serious attempt by early adulthood.

8% of those with inattentive-type ADHD made attempts, compared to 6% in the comparison group. 51% of girls with combined-type ADHD reported moderate to severe self-injury like cutting, compared to 29% with inattentive type and 19% of the comparison group. So you're not alone if you engage in self-harm. There are psychiatric conditions commonly associated with ADHD and also factors like impulsivity, which can impact the likelihood of someone engaging in these types of actions.

(03:07) How core ADHD symptoms like impulsivity and emotional dysregulation create a vulnerability to self-harm.

Dr. J: The connection between ADHD and self-harm isn't random. It's driven by the very symptoms that define the condition, creating a perfect storm of vulnerability. Impulsivity turns moments of distress into danger. So when people with ADHD are overwhelmed, they can act on self-harm urges before the critical pause button engages.

Emotional dysregulation makes feeling unbearable. Emotions hit harder and last longer. Depression and anxiety affect roughly half of those with ADHD, compared to 20% without ADHD. Sleep problems create vicious cycles. Between 25% to 50% of people with ADHD have sleep disturbances that significantly mediate the ADHD - self-harm relationship.

Sleep disruption independently increases suicidal ideation while worsening ADHD symptoms, creating negative feedback loops. Substance use also worsens everything. About 15% to 25% of adults with ADHD have substance use disorders, often starting as self-medication, but ultimately worsening emotional regulation and impulsivity.

So what I'm going to say is that you need to seek professional help first. Listen to me. I have nearly 20 years of working with those who struggle with high-risk suicidality and self-harm. You name it, I've seen it. Do not play around with this. Help is available, and you need to go get it.

This might include mental health professionals who understand both ADHD and self-harm and can provide comprehensive assessment and treatment. Consider therapists who specialize in ADHD, particularly those trained in evidence-based practices like CBT and DBT. These are proven to work. And when you're talking about life or death, you want to choose the best available treatments.

Medication evaluation may be appropriate for some people. While medication isn't the only solution, it can help stabilize ADHD symptoms and reduce the emotional dysregulation that often triggers self-harm urges. Work with a psychiatrist who understands the complexity of treating ADHD with comorbid conditions.

Crisis support services should be a part of your safety plan. And we will put in the show notes some of the options, including 988, which is the hotline in the U.S.

(05:27) Dialectical behavior therapy as an effective treatment modality for managing ADHD-related self-harm.

Dr. J: Now we're going to talk about dialectical behavior therapy, or DBT, which is really a game changer for ADHD. Originally developed to treat borderline personality disorder and self-harming behaviors, DBT has been proven to be remarkably effective for ADHD. Research shows DBT reduces self-harm, suicidal ideation, and emotional instability while strengthening impulse control and emotional awareness in people with ADHD.

DBT teaches four core skills modules. The first is mindfulness skills, which help you to stay grounded in the present moment and recognize when impulsive behaviors or intense emotions are arising. Next, we have the distress tolerance model, which teaches skills that are crucial when emotions feel unbearable.

These techniques activate your body's calming system and help you tolerate distress without resorting to self-harm. The next module is emotion regulation skills. And this teaches you to label and understand your emotions accurately. Many people with ADHD struggle with alexithymia, which is a difficulty identifying feelings.

These skills help to reduce emotional intensity without acting on feelings and challenge whether your emotional response fits the situation. Many adults with ADHD report emotional dysregulation as the most impairing aspect of the condition. Lastly, interpersonal effectiveness skills help you communicate needs assertively, set boundaries, and maintain healthy relationships — all areas where ADHD can create challenges. Since peer rejection and interpersonal struggles significantly increase self-harm risk, these skills are essential.

Another tip is creative outlets. Draw, paint, write, make music, sculpt with clay, or engage in any art form that helps you externalize internal pain without causing harm. Creativity in art therapy has been helpful to so many of my patients that struggle with suicidal ideation or self-harm or have trauma histories. It can be wonderfully cathartic. I've been personally writing poetry since the age of 10, so I can speak to the benefits as well.

(07:33) The power of self-compassion and provides practical exercises for emotional resilience.

Dr. J: And by now you should probably know I'm going to talk about it. But perhaps the most transformative practice for people with ADHD is learning self-compassion. Research demonstrates that self-compassion significantly improves mental health for adults, reducing anxiety, depression, and stress while improving emotional regulation and resilience. Studies show that higher levels of self-compassion are associated with these improved outcomes.

There are three components of self-compassion that I want to talk about today. The first is self-kindness — treating yourself with the same gentleness that you'd offer to a friend. So instead of saying things like, "I'm so stupid for forgetting again," try instead, "This is hard and I'm doing my best." Research shows that self-compassion allows you to be good enough, warts and all, rather than demanding perfection.

The next component I want to mention is common humanity. You want to recognize that everyone struggles and makes mistakes. You're not uniquely flawed. Adults with ADHD often feel isolated in their struggles, but remembering that imperfection is universal can reduce shame. And lastly here, mindfulness — observing your experience without over-identifying with painful thoughts or emotions.

This means acknowledging that "I'm having a hard time right now," without spiraling into "I'm a failure and everything is hopeless." So here are a few practical self-compassion exercises that I love. The first is the self-compassion break. Place your hand on your heart, take three breaths and say: "This is a moment of suffering. Suffering is a part of being human. May I be kind to myself."

The next thing is to reframe your inner critic. When you notice harsh self-talk, ask, "What would I say to a friend in this situation?" Use that tone with yourself. And then next is journaling. Write about difficult experiences from a compassionate perspective, as if advising someone that you care about.

While self-compassion doesn't directly impact executive functions in ADHD, especially with the high rates of comorbidity associated with it, it provides increased opportunity for resilience building and emotional equilibrium. Next, you want to maintain a balanced routine. The basics matter enormously for ADHD management and preventing self-harm.

The first thing I'm going to talk about is sleep. Between 25% to 50% of people with ADHD experience sleep problems. And sleep disturbances significantly mediate the relationship between ADHD and self-harm. You want to prioritize consistent sleep schedules, avoid caffeine late in the day, and create calming bedtime routines.

From the nutrition perspective, you want to eat regular meals with protein, minimize sugar and junk food, and stay hydrated. Blood sugar crashes can intensify emotional dysregulation. The next thing I want to mention is exercise. Regular physical activity reduces stress, improves mood, and helps with ADHD symptoms. Even a 20-minute walk can make a difference. Exercising vigorously and regularly is one of the most effective non-medication interventions for ADHD.

Which brings me to medication consistency. If you take ADHD medication, maintain consistency. Gaps in medication can destabilize mood and impulse control, increasing vulnerability to self-harm.

(11:35) A message of hope and shares essential resources for building a long-term support system.

Dr. J: And the last tip for today is to build your support system. Connection is protective. Research shows that reaching out for support is one of the most vital steps in developing healthy coping mechanisms. Tell trusted people about your struggles. This might include friends, family, therapists, or ADHD coaches. Join support groups for ADHD or self-harm recovery. Connecting with others who understand reduces isolation.

You may also want to consider phone coaching. Some DBT programs offer phone coaching to help you use skills in crisis moments. And then lastly here, create an accountability system. Share your goals with someone who can check in with you regularly. I've witnessed firsthand the dark moments that people can go through.

I know how helpless and hopeless it can make you feel. Feelings are not facts. There is a life worth living waiting for you despite whatever circumstances surround you. It won't look like everyone else's, because it's yours. And that's what makes it special.

That's it for this episode of "ADHD and." If you found this helpful, check out our episode on "ADHD and Emotional Dysregulation," where I explain why feelings like anger, sadness, and frustration can feel so strong for ADHD women and how to navigate the impact of these feelings. Thank you so much for joining me. Make sure to subscribe for more ADHD resources and support like this. And in the comments, give some encouragement to your fellow humans.

"ADHD and" is produced by Calvin Knie and Alyssa Shea, who also edits the show. Editorial support is provided by Rae Jacobson. Our theme music was written by Justin D. Wright. Briana Berry is our production director. Jordan Davidson is our editorial director. For Understood.org, our executive directors are Laura Key and Scott Cocchiere. And I'm your host, Dr. J. Thanks for listening and see you next time. For more resources, visit Understood.org. To support our work, visit understood.org/give.