Self injury, also called self-harm, self-mutilation, or simply cutting, is defined as any intentional injury to one's own body. Usually, self-injury leaves marks or causes tissue damage. Self-injury can involve any of the following behaviors:
- Burning (or "branding" with hot objects)
- Excessive body piercing or tattooing
- Picking at skin or re-opening wounds
- Hair-pulling (trichotillomania)
- Hitting (with hammer or other object)
Most who engage in self-injury act alone rather than in groups. They also attempt to hide their behavior.
Who Is More Likely to Engage in Self-Injury?
Self-injury occurs across the spectrum; the behavior is not limited by education, age, race, sexual orientation, socioeconomic status, or religion. However, self-injury occurs more often among:
- Adolescent females
- People who have a history of physical, emotional, or sexual abuse
- People who have co-existing problems of substance abuse, obsessive-compulsive disorder, or eating disorders
- Individuals who were often raised in families that discouraged expression of anger
- Individuals who lack skills to express their emotions and lack a good social support network
What Leads to Self-Injury?
Self-injury usually occurs when people face what seem like overwhelming or distressing feelings. It can also be an act of rebellion and/or rejection of parents' values and a way of individualizing oneself. Sufferers may feel that self-injury is a way of:
- Temporarily relieving intense feelings, pressure, or anxiety.
- Being a means to control and manage pain - unlike the pain experienced through physical or sexual abuse or trauma.
- Providing a way to break through emotional numbness (the self-anesthesia that allows someone to cut without feeling pain).
- Asking for help in an indirect way or drawing attention to the need for help.
- Attempting to affect others by manipulating them, trying to make them care, trying to make them feel guilty, or trying to make them go away.
Self-injury also may be a reflection of a person's self-hatred. Some self-injurers are punishing themselves for having strong feelings that they were usually not allowed to express as children. They also may be punishing themselves for somehow being bad and undeserving. These feelings are an outgrowth of abuse and a belief that the abuse was deserved.
Although self-inflicted injury may result in life-threatening damage, it is not considered to be suicidal behavior.
What Are the Symptoms of Self-Injury?
The symptoms of self-injury include:
- Frequent cuts and burns that cannot be explained
- Self-punching or scratching
- Needle sticking
- Head banging
- Eye pressing
- Finger or arm biting
- Pulling out one's hair
- Picking at one's skin
Warning Signs of Self-Injury
Signs that an individual may be engaging in self-injury include:
- Wearing of pants and long sleeves in warm weather.
- The appearance of lighters, razors, or sharp objects that one would not expect among a person's belongings.
- Low self-esteem.
- Difficulty handling feelings.
- Relationship problems.
- Poor functioning at work, school, or home.
How Is Self-Injury Diagnosed?
If an individual shows signs of self-injury, a mental health professional with self-injury expertise should be consulted. That person will be able to make an evaluation and recommend a course of treatment. Self-injury can be a symptom of psychiatric illness including:
- Personality disorders (particularly borderline personality disorder)
- Substance use disorders
- Bipolar disorder
- Major depression
- Anxiety disorders (particularly obsessive-compulsive disorder)
How Is Self-Injury Treated?
Treatment for self-injury may include:
- Psychotherapy: Counseling can be used to help a person stop engaging in self-injury.
- Dialectical Behavior Therapy (DBT): DBT is a group- and individually-based treatment program that helps people gain greater mastery over self-destructive impulses (such as self-injury), learn ways to better tolerate distress, and acquire new coping skills through techniques such as mindfulness.
- Post-traumatic stress therapies: These may be helpful for self-injurers who have a history of abuse or incest.
- Group therapy: Talking about your condition in a group setting to people who have similar problems may be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.
- Family therapy: This type of therapy addresses any history of family stress related to the behavior and can help family members learn to communicate more directly and openly with each other.
- Hypnosis and other self-relaxation techniques: These approaches are helpful in reducing the stress and tension that often precede incidents of self-injury.
- Medications: Antidepressants. low-dose antipsychotics, or anti-anxiety medication may be used to reduce the initial impulsive response to stress.
What Is the Outlook for People Who Engage in Self-Injury?
The prognosis for self-injurious behavior varies depending upon a person's emotional or psychological state and the nature of any underlying psychiatric condition. It is important to determine the factors that lead to an individual's self-injuring behaviors, and to identify and treat any pre-existing personality disorders.