Self-Harm

Self-harm, or an injury inflicted on oneself, often by cutting or burning, is generally a sign of intense inner turmoil, anxiety, and/or suppressed emotions. Self-injuring behavior is not the same as a suicide attempt: Though some individuals who self-harm may attempt suicide, in general, acts of self-harm do not indicate a desire to end one's life. A person might harm him or herself to express pain, anxiety, or other emotions or to maintain a feeling of control over his or her body when other situations in life seem outside his or her control. This behavior often develops in adolescence and, if left untreated, may continue for many years.

If you are or a loved one is experiencing a crisis, in danger of hurting oneself or others, or feeling overwhelmed or suicidal, please find help immediately. Contact the National Suicide Prevention Lifeline at 1-800-273-8255 to speak with someone right away, or reach out to one of the other resources listed on this page.

Statistics on Self-Harming Behaviors

An estimated 2 million Americans engage in acts of self-harm. These individuals come from all races and backgrounds, but the majority of those who self-harm are teenagers or young adults. Research suggests that females are more likely to self-harm than males, but this data may not incorporate some types of self-harm that studies show males are more likely to engage in, such as wall punching. College students appear to have a higher risk for self-injury: Research indicates that up to 35% of college students have committed some type of self-injuring behavior at least once.

Psychological Issues Associated with Self-Harm

Self-harm is strongly associated with borderline personality, as self-harm is one of the nine diagnostic criteria for the condition. Individuals who are bipolar, have other personality conditions, or who experience depression, anxiety, manic episodes, or psychosis may be more likely to commit acts of self-injury than other individuals. Childhood trauma such as severe abuse or neglect may also be a risk factor, and studies show that self-harm is also prevalent among individuals who have an eating disorder.

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However, the causes of self-injurious impulses are not universally agreed upon. Individuals who self-harm often report feelings of emptiness, loneliness, an inability to express their feelings, and difficulty in all types of relationships. Some people may also harm themselves in an attempt to cope with the stress or emotional distress that can stem from familial or cultural expectations or the realization of one's identity or sexuality.

Signs and Symptoms of Self-Harm

Self-harm might follow a course similar to that of an alcohol or drug addiction, complete with secret stashes and rituals. The behavior may also follow a cycle: For example, a person may feel anxiety, then impulse, resistance, tension, and release, which may be followed by shame, and then anxiety once again. He or she may feel that cutting, burning, or other acts involving physical pain are the only way to relieve these feelings.

An individual who self-harms may have frequent accidents, claiming or appearing to be clumsy in order to explain wounds or bruises. He or she may wear concealing clothing, even in warm weather, seem irritated, carry sharp objects in his or her personal belongings without an apparent reason, and prefer to be alone for long periods of time. A person who is self-harming may also experience difficulty functioning at work or school and exhibit low self-esteem.

Self-harm can be frightening for the person committing an act of self-harm as well as for those around that person. Some of those who cut or otherwise harm themselves take great care to avoid serious injury or infection by using sterile blades, cleaning their wounds carefully, using bandages, and avoiding major blood vessels and muscles. Other people, particularly those who are inexperienced or emotionally escalated, may fail to take such precautions and severely injure themselves. Either way, habitual self-harm can present a risk to a person’s health and level of functioning in both the short and long term.

Self-Harm Triggers and Practices

People who self-harm may be triggered by many different things. Some possible triggers are anger, shame, high-stress situations, or traumatic events, and some individuals may hear voices or cut themselves while dissociating, not realizing what they are doing. An act of self-harm can serve as an emotional release, help individuals feel as if they are in control of themselves, or serve as a distraction from difficulty in daily life. However, the relief that self-harm offers some individuals is only temporary, and it can prevent those individuals from developing other coping mechanisms. Self-harm does not help a person work through the issues that created the impulse.

Self-harm behaviors are not the same as suicidal behaviors. Individuals who see no possible way to end their current distress or emotional pain often attempt suicide, but people who cut, burn, or otherwise harm themselves are, in general, attempting to cope with the world, not desiring to end their lives. These individuals may often feel numb, in fact, and use the pain of the self-injury to remind themselves that they are still alive.

However, people who engage in self-harm behaviors often also contemplate, threaten, or attempt suicide. They may also engage in dangerous behaviors such as binge drinking, drug use, especially excessive drug use, or risky/unsafe sex. Because self-injurious acts are considered to be a coping skill, learning new coping skills can help eliminate the compulsion to harm oneself and thus reduce the occurrence of suicidal thoughts or impulses.

Psychotherapy for Self-Harm

Self-harm is a form of emotional release, but it can lead to complications if untreated. Therapy can help people who self-injure develop other coping mechanisms to address their emotional pain. Feelings of inadequacy, low self-worth, and self-hatred are some of the emotions that people who self-injure might experience, and a therapist who specializes in treating self-harm will work with an individual to discuss these feelings, identify the source of the emotional pain, and develop strategies to manage and reduce that pain.

Coping mechanisms a therapist might suggest include:

  • Painting, drawing, writing, or listening to music that expresses the pain or emotion one is feeling
  • Writing what one is feeling and then ripping up the paper
  • Taking a hot bath or shower
  • Squeezing or throwing ice cubes
  • Visiting a self-help chat room or message board
  • Exercising
  • Punching a pillow or mattress

Drawing on one's body with marker, rubbing ice on one's skin, or snapping rubber bands against arms or legs can be a safe way to simulate the cutting sensation, and these actions may help some individuals find emotional release without harming themselves.

A therapist may also help a person in treatment learn about and implement self-esteem exercises and behaviors such as meditation, mindfulness, and creative expression that may assist them in becoming able to handle any future triggering situations without acting on an impulse to self-harm.

In recent years, dialectical behavioral therapy (DBT), a kind of cognitive behavioral therapy, has been used with some success. This form of therapy can take place in a group or individually, and attempts to help individuals learn to pay attention to and manage thoughts and emotions and communicate feelings more effectively, skills that may help overcome compulsions to self-harm.
Group therapy, where individuals discuss their condition with others who are experiencing similar concerns, has been shown to be effective for those who self-harm. Family therapy can be helpful when an individual uses self-injury to manage stress that relates to their home life. Self-relaxation techniques such as hypnosis can be of benefit to some people, and medications such as antidepressants or anti-anxiety medication may also help some individuals who self-harm as a response to depression or anxiety.

In all cases, however, the treatment attempts to resolve the issue that gives an individual the desire to harm him or herself.

Case Examples

  • Learning Coping Skills in Therapy: Alina, 23, comes to therapy because she has trouble sleeping and was recently fired from a job for getting too angry. After a few sessions, the therapist notices cuts and burns on her arm, and inquires about these. Alina admits to “occasionally” harming herself. She tearfully discloses that she hates herself for it, that “the scars are so ugly,” but she reports that she can find no other release. Alina eventually is able to disclose a history of depression and a childhood characterized by emotional abuse (from her father, before his divorce from her mother) and, later, social isolation (due to an overprotective mother). Alina’s anxiety is overwhelming following the discussion of these events, and her urge to cut increases. Through therapy, she learns how to maintain emotional equilibrium and develops new coping skills for managing anger, grief, and loneliness.
  • Teenage Boy Self-Harms Due to Anxiety and Stress: Donovan, 17, goes to see his school counselor at the suggestion of his homeroom teacher, who has expressed concern about his vocal outbursts, irritability toward other teachers and his peers, and uncharacteristically poor classroom performance. The counselor asks Donovan about his knuckles, which are bruised and scabbed, but he brushes off the injury until the third session, when he confesses that he often punches the brick wall in his backyard to “relieve stress.” At the next session, he shares with the counselor that he is experiencing significant anxiety because of his attraction to a male classmate. Due to his religious upbringing, he is experiencing guilt and shame and is afraid to confess his attraction to anyone else. The counselor first offers Donovan a referral to a therapist who specializes in youth and LGBTQ issues, encouraging him to make an appointment, and then works with him to identify other ways he can relieve his anxiety and stress until he is able to address them in therapy.

References:

  1. Contario, K., & Lader, W. (n.d.). Self-injury. Retrieved from http://www.mentalhealthamerica.net/self-injury.
  2. Goldberg, J. (2014, February 11). What Is Self-Injury Disorder? Retrieved from http://www.webmd.com/anxiety-panic/guide/self-injury?page=2.
  3. Hardy, L. (2014, August 1). Difference Between Self-harm and Suicidal Behavior. Retrieved from http://www.healthyplace.com/blogs/mentalhealthtreatmentcircle/2014/08/01/difference-between-self-harm-and-suicidal-behavior/.
  4. Kerr, P., Muehlenkamp, J., & Turner, J. (2010). Nonsuicidal Self-Injury: A Review of Current Research for Family Medicine and Primary Care Physicians. Journal of the American Board of Family Medicine, 23(2), 240-259.
  5. Self-harm - Causes. (2013, July 27). Retrieved March 24, 2015, from http://www.nhs.uk/Conditions/Self-injury/Pages/Causes.aspxThe Facts: Self-harm Statistics. (n.d.). Retrieved from https://www.selfharm.co.uk/get/facts/self-harm_statistics.
  6. Smith, M., & Segal, J. (2015, February 1). Cutting and Self-Harm. Retrieved from http://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm.

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Last updated: 07-03-2015

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