Self-punishment: a sign of depression, trauma, or OCD?

Self-punishment is a term that refers to behaviors or actions people engage in to inflict pain or harm upon themselves. These actions can show up in all kinds of ways and can include self-harm, negative self-talk, or engaging in risky behaviors. Understanding the underlying causes of self-punishment is crucial for identifying and providing appropriate support to people caught up in these damaging habits.

In this article, we’ll delve into the complex relationship between self-punishment and mental health, specifically exploring its connection to depression, trauma, and Obsessive-Compulsive Disorder (OCD).

Understanding self-punishment

Self-punishment behaviors can be puzzling and even alarming to those who do not understand what can cause them. As a result, people who engage in them are stigmatized. However, it is essential to recognize that these actions are often a manifestation of deep emotional pain and distress. Common self-punishment behaviors include self-cutting, burning, hitting oneself, and persistently negative self-talk or self-criticism. Recognizing these signs—in oneself or others—is vital in providing early intervention and support.

Exploring depression and self-punishment

Depression is a common and serious mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in most activities. It goes beyond life’s regular ups and downs and can interfere with a person’s daily functioning, affecting their work, relationships, and overall quality of life. People with depression may experience changes in appetite and sleep patterns, difficulty concentrating, and feelings of worthlessness or guilt. Some may contemplate or engage in self-harm or suicide.

Depression is believed to result from a complex interplay of genetic, biological, environmental, and psychological factors. Traumatic events, chronic stress, and significant life changes can also trigger or exacerbate depression in susceptible people.

Depression and self-punishment are intricately connected. For people experiencing depression, self-punishment can serve as a coping mechanism for their overwhelming emotional pain. They may believe they are diverting their focus from their emotional suffering by inflicting physical pain on themselves. Moreover, self-punishment can provide a sense of control in a life that feels chaotic and out of control.

“People with depression may also resort to self-punishment due to feelings of guilt and unworthiness,” says Aaron Hensley, MSW, LCSW, a therapist with NOCD. “They might believe they deserve to suffer, leading to a vicious cycle of negative emotions and self-destructive behaviors.”

Unraveling trauma and self-punishment

Trauma is not a mental health disorder in itself but refers to an enduring emotional and psychological response to distressing or disturbing events. It is an intense emotional reaction that can overwhelm a person’s ability to cope, leading to a range of mental, emotional, and physical symptoms. Trauma can result from various experiences, such as physical or sexual abuse, violence, natural disasters, accidents, or the sudden loss of a loved one. Traumatic experiences might occur as one big single event in a person’s life, or as a chronic series of events that accumulate over time.

The impact of trauma varies from person to person, but common symptoms include flashbacks, nightmares, anxiety, depression, dissociation, and difficulty forming or maintaining relationships. Post-traumatic stress disorder (PTSD) is a specific mental health disorder that can develop after experiencing trauma. However, not everyone who experiences trauma will develop PTSD. 

The link between trauma and self-punishment is significant. “Traumatic experiences can profoundly impact a person’s mental and emotional well-being, leading to feelings of powerlessness and shame,” says Hensley. “Self-punishment can emerge as a way to cope with these traumatic memories and emotions. People may attempt to gain a sense of control over their traumatic past by inflicting pain upon themselves. They may also do it because they blame themselves for their trauma or some major negative experience they’ve had.” Sometimes, people may also have internalized hateful messages from their abuser(s) that they deserve punishment.

Recognizing self-punishment as a response to unresolved trauma is crucial in facilitating healing and recovery. Supporting people in processing and addressing their traumatic experiences can help reduce the urge to engage in self-destructive behaviors.

OCD: Obsession, Compulsion, and Self-Punishment

Obsessive-Compulsive Disorder (OCD) is characterized by distressing intrusive triggers known as obsessions—including thoughts, images, urges, sensations & feelings—and repetitive behaviors or mental acts known as compulsions, performed to alleviate distress that arises from these obsessions. For some people with OCD, self-punishment can become a form of compulsion. They believe that engaging in self-punishing behaviors will alleviate their doubts, worries, or anxiety, or will prevent harm from coming to themselves or others, even though the logic behind these behaviors may seem completely irrational to others.

“People with OCD often engage in self-punishing behaviors, which can manifest in two main forms: obsessions related to taboo topics or religious scrupulosity,” explains Hensley. “In the case of taboo topics, people may obsess over certain forbidden or socially unacceptable thoughts, leading them to punish themselves mentally or physically as a way to atone for these perceived wrongs.“

Similarly, those with religious scrupulosity may obsess over being in a state of sin or offending their beliefs, and they use punishment to rectify their perceived transgressions.

“The self-punishment serves the purpose of trying to ‘make things right’ in their minds,” Hensley explains. “They believe that by punishing themselves, they can alleviate feelings of guilt and seek redemption or forgiveness, especially from a higher power. This behavior is driven by a fear of divine retribution or the need to feel worthy in the eyes of God, some other spiritual authority, or themselves.”

As with people with depression or PTSD, self-punishing behaviors in people with OCD can take various forms, such as self-inflicted physical harm, negative self-talk, self-denial of basic needs (e.g., food or comfort), self-blame, or self-antagonizing thoughts. The particular method of self-punishment varies from person to person, but the underlying motivation is to appease their obsessions and reduce anxiety related to their perceived wrongdoings—which may include having distressing or taboo intrusive thoughts in the first place, even though they are entirely inadvertent and unwanted.

It is essential to differentiate between self-punishment driven by OCD and self-punishment linked to depression or trauma. While both may involve self-harming behaviors, the motivations and thought processes behind them differ significantly, as do the approaches that can be used to achieve recovery.

The intersection of depression, trauma, and OCD

It is not uncommon for depression, trauma, and OCD to co-occur or overlap. This has consistently been shown by studies like one published in the Journal of Clinical Psychiatry, which showed that a third of OCD patients also met the diagnostic criteria for depression. Other research has found that between 30 and 82% of people with OCD have a traumatic history. For context, in the general population, only 1.8% of people report having a traumatic past. 

When these conditions occur at the same time, self-punishment tendencies may become more complex and challenging to identify accurately. This convergence can complicate the diagnosis and treatment process, requiring mental health professionals to take a comprehensive and integrated approach to treatment in order to effectively address a person’s unique needs.

Recognizing self-punishment in oneself and others

Identifying self-punishment behaviors in oneself or others can be daunting. For people engaging in self-punishment, it might be challenging to recognize their actions as harmful or seek help due to feelings of shame or guilt. On the other hand, friends and family may not understand the emotional pain underlying such behaviors and mistakenly view self-punishment as attention-seeking behavior or mere disobedience. In many cases, people who are self-punishing may go to great lengths to keep their behaviors a secret from those around them. 

Empathy and non-judgmental support are essential when addressing self-punishment in oneself or others. Encouraging open conversations about emotions and mental health can help break down barriers and encourage seeking professional help.

The role of therapy and treatment

Though self-punishment behaviors can look similar—even identical—the conditions that cause them are distinct and are treated very differently, and they can be effectively distinguished from one another through comprehensive assessment.

Treatment for depression

The most effective treatments for depression typically involve a combination of psychotherapy, medication, and lifestyle adjustments. Cognitive-behavioral therapy (CBT) is widely recognized as a first-line psychotherapy for depression, focusing on challenging negative thought patterns and promoting healthier behaviors. Other evidence-based therapies, such as interpersonal and dialectical behavior therapy (DBT), have also shown positive results.

Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed to alleviate symptoms and restore neurotransmitter balance. However, people’s responses to medications may vary, and it’s essential to work closely with a healthcare provider to find the right fit. In all cases, depression treatment is highly personalized, and what works for one person may not be equally effective for another.

Treatment for trauma

Trauma can profoundly impact people’s mental well-being, but effective treatments, like prolonged exposure therapy (PE), can facilitate recovery. PE is an evidence-based therapeutic approach to treating post-traumatic stress disorder (PTSD). It involves systematically and gradually confronting trauma-related memories, thoughts, and feelings in a safe environment. During PE sessions, the person is encouraged to recall distressing experiences and process associated emotions to reduce avoidance and fear responses.

PE helps people relearn that trauma memories are not an immediate threat, leading to a decrease in hyperarousal and avoidance behaviors. This therapy also incorporates breathing and relaxation techniques to manage anxiety during the exposure process. Studies have shown that PE is highly effective in reducing PTSD symptoms and improving overall quality of life.

It is essential to recognize that trauma treatment must be tailored to each person’s unique experiences and needs. A skilled and compassionate therapist can help guide people through this healing journey, providing the support and tools necessary for recovery.

Treatment for OCD

There are not one but two first-line treatments for OCD: exposure and response prevention (ERP) therapy and certain medications. Over the past several decades, these approaches have been shown to be highly effective alone and when combined. ERP is a cognitive-behavioral therapy that gradually exposes people to their obsessions, providing opportunities for them to resist engaging in their usual compulsive behaviors, including self-punishing ones. Through repeated exposure, patients learn to tolerate distress without resorting to compulsions, reducing the intensity and frequency of symptoms over time.

Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for OCD. These drugs work by increasing serotonin levels in the brain, which can help alleviate the symptoms of OCD—including compulsive, self-punishment behaviors. Interestingly, these same drugs are often used to treat depression, but in OCD, the dosages used for OCD are typically higher. Unlike ERP, medications only treat the symptoms of OCD and do not address the root cause. 

A combination of ERP therapy and medication can be a very effective approach to managing OCD. However, treatment must be tailored to a person’s unique needs, and the severity of symptoms may influence the choice between therapy, medication, or both. Consulting with a mental health professional is crucial to determine each person’s most suitable treatment plan.

Getting help

If you or someone you know is struggling with self-punishment behaviors, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD Care Team to learn more about how a licensed therapist can help. 

While all NOCD therapists specialize in OCD and receive ERP-specific training, many also specialize in treating PTSD with PE and have experience treating people who suffer from both conditions—a complex treatment process that requires an expert, specialized approach.