Repeated self-harm may change the brain’s natural pain-relief system, making it less responsive over time, so individuals need to hurt themselves more severely or frequently to feel the same sense of relief.
Evidence from Studies
No evidence studies found yet.
What Would Prove This
Per GRADE and EBM methodology, here is what ideal scientific evidence would look like to definitively prove or disprove this claim, ordered from strongest to weakest.
Whether chronic NSSI is consistently associated with altered mu-opioid receptor availability compared to non-injuring controls and whether receptor changes correlate with NSSI frequency or severity.
A systematic review and meta-analysis of all PET studies measuring mu-opioid receptor availability in individuals with chronic NSSI (>1 year, >10 episodes/month) versus healthy controls and psychiatric controls without NSSI, with standardized ligands (e.g., [11C]carfentanil) and region-of-interest analysis.
Whether reducing NSSI frequency leads to normalization of mu-opioid receptor availability in adolescents with chronic self-injury.
A double-blind RCT of 50 adolescents with chronic NSSI (>10 episodes/month) randomized to 6 months of Positive Affect Treatment or standard DBT, with pre- and post-intervention PET scans of mu-opioid receptor availability in the orbitofrontal cortex and nucleus accumbens as primary outcomes.
Whether baseline mu-opioid receptor availability predicts future escalation in NSSI frequency or severity over time.
A prospective cohort of 80 adolescents with recent-onset NSSI (<1 year), undergoing baseline PET imaging of mu-opioid receptors, followed for 2 years with monthly NSSI frequency tracking and severity scoring, controlling for depression, trauma, and substance use.
The association between NSSI frequency and mu-opioid receptor availability in adolescents with chronic self-injury.
A cross-sectional PET study of 60 adolescents with NSSI, measuring mu-opioid receptor availability in the orbitofrontal cortex and correlating it with self-reported NSSI frequency and severity over the past 6 months.
A theoretical proposal that opioid dysregulation explains the escalation of NSSI in anhedonic individuals.
An editorial proposing the opioid dysregulation hypothesis as a mechanism for NSSI escalation, as presented in this article.