What Is Self-Injury?
Self-injury, also called self-harm or self-mutilation, 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)
- Picking at skin or reopening 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 can occur in either sex and in any race of people. The behavior is not limited by education, age, sexual orientation, socioeconomic status, or religion. However, there are some common factors among people who engage in self-injury. 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 Causes People to Injure Themselves?
Self-injury usually occurs when people face what seem like overwhelming or distressing feelings. Self-injurers may feel that self-injury is a way of:
- Temporarily relieving intense feelings, pressure, or anxiety
- Being real, being alive, or feeling something
- Hurting yourself to avoid impulsively hurting someone else
- Being able to feel pain on the outside instead of the inside
- Controlling and managing pain — unlike the pain experienced through physical or sexual abuse
- Providing a way to break 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.
Even though there is the possibility that a self-inflicted injury may result in life-threatening damage, self-injury is not considered to be suicidal behavior.
What Are the Types of Self-Injury?
The most common types 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 pants and long sleeves in warm weather
Scars (from cutting and burning, etc.) on the body
- 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. The mental health professional 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)
- Bipolar disorder
- Major depression
- Anxiety disorders (particularly obsessive-compulsive disorder)
How Is Self-Injury Treated?
Common treatments for self-injury include:
- Psychotherapy can be used to help a person stop engaging in self-injury.
- Cognitive behavioral therapy (CBT) may be used to help an individual learn to recognize and address triggering feelings in healthier ways.
- Dialectical Behavior Therapy (DBT) may be used to teach the individual skills for tolerating emotional distress and coping with interpersonal or other stressful experiences.
- Post-traumatic stress therapies may be helpful for self-injurers who have a history of abuse or incest.
- Group therapy enables individuals to talk about their condition with others who have similar problems. This may be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.
- Family therapy helps the individual address 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 relaxation techniques may be helpful in reducing the stress and tension that often precede incidents of self-injury.
- Medications such as antidepressants, low-dose antipsychotics, mood-stabilizers, or anti-anxiety medication may all be used to reduce the initial impulsive response to stress. There have also been some studies looking at naltrexone (an opiod blocker) which may help to prevent the feeling gthat some people experience after self-harm.
What Is the Outlook for People Who Engage in Self-Injury?
The prognosis for self-injury varies depending upon a person’s emotional or psychological state or other diagnoses. It is important to determine the factors that lead an individual’s self-injuring behaviors. It also is important to identify whether self-injury is one symptom of a particular personality disorder that needs to be treated.