Self-Harm

Overview of Self-Harm: The tendency or compulsion to hurt yourself – by cutting or burning, for example – is usually a clear sign of intense inner turmoil, anxiety, and suppressed emotions. While this behavior has long been associated with Borderline Personality Disorder, it is more and more being see not just with BPD, but also as an element of depression, severe anxiety, and post-traumatic stress. It is also increasingly noted in adolescents, and sometimes takes a course similar to a drug or alcohol addiction, complete with secret stashes, rituals, and, of course, a cycle of anxiety, impulse, resistance, tension, release, and, often, shame…then back to anxiety, which is somehow relieved by cutting, burning, or other acts involving physical pain – the only apparent escape from seemingly more terrible emotional pain.

The Medical Model and Self-Harm: Self-harm can be very frightening for both the person harming himself and those around him. Some “cutters” take great care to avoid serious injury, using sterile blades, cleaning their wounds carefully, using bandages, and avoiding major blood vessels and muscles. Other people – particularly if inexperienced or extraordinarily emotionally escalated – may fail to take such precautions and severely injure themselves. Either way, habitual self-harm can present a serious risk to a person’s health and level of functioning in the short and long term.

Self-harm behaviors are not the same as suicidal behaviors. People who cut and burn themselves are not attempting suicide. However, people who engage in self-harm behaviors often also contemplate, threaten, or attempt suicide. Self-injurious acts are actually a coping skill, and learning new coping skills can help eliminate the compulsion to harm oneself and the persistence of suicidal thoughts or impulses.

Self-harm is known to be associated with Borderline Personality, but can also occur in other situations. Childhood trauma – severe abuse or neglect – may be a risk factor. However, the causes of self-injurious impulses either with or without a diagnosis of BPD are not universally agreed upon, nor are the appropriate treatments. In recent years, Dialectical Behavioral Therapy (DBT), a kind of cognitive behavioral therapy, has been more widely used with some success. Learning to manage emotions, to pay attention to one’s thoughts and emotions, and to communicate well are important skills for overcoming the ups and downs of self-harm behaviors.

Case Example of Self-Harm:

Cindy, 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. Cindy admits to “occasionally” harming herself. She tearfully discloses that she hates herself for it and “the scars are so ugly”, but reports she can find no other release. Cindy eventually is able to disclose a history of depression and a childhood characterized by emotional abuse (her father, before his divorce from her mother) and, later, social isolation (an overprotective mother). Cindy’s anxiety is overwhelming discussing 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.

Therapy for Self-Harm: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of self-harm. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for self-harm or any other issue, it is helpful to familiarize oneself with these elements.

If there is something important you'd like us to consider adding to this page, please feel free to suggest your ideas.

Self-Harm Article Summaries