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. Social support can also contribute to recovery.
If you or a loved one is in crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-8255.
TREATMENT FOR SELF-HARM
Therapy is the most common treatment for self-harm. In therapy, you may discuss any feelings of inadequacy or self-hatred that drive self-harm behaviors. A therapist might work with you to identify the source of your emotional pain, such as childhood trauma. You and your therapist can then develop strategies to manage and reduce that emotional pain.
In recent years, dialectical behavioral therapy (DBT) has been used to treat self-harm behaviors with some success. DBT is a kind of cognitive behavioral therapy which can take place in a group or individually. DBT can teach you how to be mindful of your thoughts, recognizing which situations trigger strong emotions. It can also help you communicate feelings more effectively. These skills may help you overcome compulsions to self-harm.
Other treatments for self-harm include:
- Group therapy, in which you would discuss your condition with others who are experiencing similar concerns. Group therapy can help reduce the stigma and loneliness that may come with self-injury.
- Family therapy can be helpful if you use self-injury to manage stress that relates to your home life.
- Meditation and other self-relaxation techniques can benefit some people.
- Medications such as antidepressants may help if you self-harm as a response to depression or anxiety. Medication is typically used in tandem with psychotherapy.
In all cases, treatment attempts to resolve the issue that gives someone the desire to harm themself. Treatment tends to be most effective when you are actively committed to the recovery process. It is also important to create an aftercare plan to support your new, healthier behaviors.
SELF-HELP FOR SELF-INJURY
If you self-harm, there may be times when the urge to injure yourself is stronger. Although it may be difficult, if you endure the discomfort, your urge to self-harm will eventually fade. The longer you can resist, and the more often you resist, the easier denying those urges will become.
A therapist may help you practice ways to handle your emotions without hurting your body. Different coping mechanisms may work better depending on your motivations for self-harm.
If you self-injure to express your feelings, then your therapist may recommend other ways to vent your emotions, such as:
- Writing down what you are feeling, then ripping the paper up.
- Blowing off steam through exercise or punching a pillow.
- Listening to music that expresses the pain or emotion you feel.
If you self-injure to calm down or release tension, you can:
- Knead a stress ball, clay, or actual bread dough.
- Warm your body through a warm bath or blanket. If the bathroom is where you often self-harm, then a blanket will likely be better.
- Practice breathing exercises. Slow, deep breaths can let your body know it is time to calm down.
- Distract yourself by talking with a friend. You don’t have to talk about self-harm – any subject will do.
- Cuddle or play with a pet if you have one.
- Chew on something with a strong taste, such as peppermint or chili pepper.
In the beginning, you may struggle to rely on these strategies alone to cope with your feelings. If you feel compelled to endure pain, you can substitute cutting or burning for safer behaviors. For example, you could snap a rubber band against your skin to simulate the cutting sensation. Other people prefer to rub an ice cube over the spot they wish to burn or cut. These actions may help you find emotional release without causing lasting injuries.
RECOVERING FROM SELF-HARM
Even after therapy has treated your emotional wounds, you may still have physical scars on your body. Your scars are nothing to be ashamed of – they are signs that you survived incredible pain. Some people wear their scars openly, while others prefer to hide or reduce them.
If you wear your scars openly, others may ask about them. You do not have to tell people any more than you feel comfortable with. If people try to pressure you, you can tell them, “It’s a long story,” or “I got hurt, but everything’s okay now.” You do not owe anyone an explanation – not your coworkers, not your dates, nobody.
If you would like to hide or reduce your scars, the following strategies may help:
- Long sleeves or pant legs can hide many scars. If you are in hot weather, you can buy sheer undershirts or leggings.
- Tattoos are an increasingly popular way to disguise one’s scars. Many people who have survived suicide or self-harm have marked their journey with a semicolon specifically. The semicolon tattoo often represents the choice to continue one’s life rather than end it.
- Scar cream can cover marks that aren’t hidden by your clothes. You may want to put the cream on after you get dressed so that you do not stain your outfit.
- Scar plasters are band-aids you can put on raised scars. They can reduce swelling and redness long-term.
- Laser therapy can help lighter scars fade, although you would need to discuss it with a medical professional beforehand.
There is no wrong way to manage your scars. You can do whatever makes you feel most comfortable.
HELPING A LOVED ONE WHO SELF-INJURES
It can be very distressing to learn that someone you love has been hurting themself. You may feel heartbroken, afraid, or even angry. You have a right to feel these emotions. However, it is important that you do not blame your loved one for these feelings. People who self-harm rarely do so to hurt or manipulate others. Most people self-harm to cope with their own pain.
It is common for well-meaning friends or family to say, “stop hurting yourself or else [insert punishment here].” Yet ultimatums like these typically backfire. Self-harm is a coping mechanism. If you demand a person stop self-harming but fail to address the underlying issues, then your loved one will likely resume harming themselves in secret. Plus, threats will likely erode the trust between you, making it less likely for your loved one to seek help.
Note that making threats is different from calling for help. If your loved one is suicidal or they need medical attention, calling 911 is appropriate. However, most people who self-harm are not at imminent risk of dying. Like alcohol addiction, their behavior is dangerous, but it is generally not lethal.
In other words, you can take the time you need to talk. Ask your loved one what they are going through. Even if their problem seems minor to you, it is likely excruciating for them. Try to focus on the person’s emotions rather than their injuries. If you only talk about how the person is damaging their body, your loved one may assume you care more about their looks than their feelings.
You can urge your loved one to seek therapy, but treatment will be less effective if you force them. Let them know you are here to support, not control them. As you prove you can communicate with them without “blowing up,” your loved one may grow more willing to follow your advice. Once your loved one is ready to get professional help, recovery can begin.
CASE EXAMPLES OF THERAPY FOR SELF-HARM
- Learning Coping Skills in Therapy: Alina, 23, comes to therapy because she was recently fired from a job for getting too angry. After a few sessions, the therapist notices cuts and burns on her arm. Alina admits to “occasionally” harming herself. She tearfully discloses that she hates herself for it because “the scars are so ugly,” but Alina says she can find no other release. Alina eventually reveals a history of depression. Her childhood was characterized by emotional abuse and social isolation. Alina’s anxiety is overwhelming after discussing her past, and her urge to cut increases. Yet her therapist helps her maintain emotional equilibrium and resist the urges. Through therapy, Alina develops new coping skills for managing anger, grief, and loneliness.
- Teenage Boy Self-Harms Due to Stress: Donovan, 17, goes to see his school counselor. His homeroom teacher has expressed concern about his vocal outbursts, irritability, and uncharacteristically poor classroom performance. The counselor asks Donovan about his knuckles, which are bruised and scabbed. Donovan brushes off the injuries 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 anxious because of his attraction to a male classmate. Due to his religious upbringing, Donovan is experiencing severe guilt and shame. He’s afraid to confess his attraction to anyone else. The counselor offers Donovan a referral to a therapist who specializes in supporting LGBTQ+ youth. The counselor then works with Donovan to identify healthier ways to relieve his stress until he can address it in therapy.
- Contario, K., & Lader, W. (n.d.). Self-injury. Retrieved from http://www.mentalhealthamerica.net/self-injury
- Lyness, D. (n.d.). How can I stop cutting? Retrieved from https://kidshealth.org/en/teens/resisting-cutting.html
- 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. Retrieved from https://www.jpedhc.org/article/S0891-5245(15)00227-8/fulltext
- Smith, M. & Segal, J. (2015, February 1). Cutting and self-harm. Retrieved from http://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm
- Self-harm and suicide. (n.d.) Centre for Suicide Prevention. Retrieved from https://www.suicideinfo.ca/resource/self-harm-and-suicide
- Self-harm—Scars. (2017). Rethink Mental Illness. Retrieved from https://www.rethink.org/diagnosis-treatment/symptoms/self-harm/scars
- Semicolon tattoos; (n.d.) Retrieved from http://www.semicolontattoo.com
- The truth about self-harm. (n.d.) Mental Health Foundation. Retrieved from https://www.mentalhealth.org.uk/publications/truth-about-self-harm