Eating Disorders Center:
Self-Injury: Types, Causes and Treatment

 On this page: Who self-injures | Types | Addiction | Reasons for Self-Injury | Relation to Suicide | Helping a Friend or Family Member | Self-Help | Treatment | Online resources | Related Information

Self-injury (SI) – also known as self-harm or self-mutilation – is defined as any intentional injury to one's own body. It usually either leaves marks or causes tissue damage. It is hard for most people to understand why someone would want to cut or burn himself/herself). The mere idea of intentionally inflicting wounds to oneself makes people cringe. Yet there are growing numbers of young people who do intentionally hurt themselves. Understanding the phenomenon is the first step in changing it.

Who engages in self-injury?

There is no simple portrait of a person who intentionally injures him/herself. This behavior is not limited by gender, race, education, age, sexual orientation, socio-economics, or religion. However, there are some commonly seen factors:

• Self-injury more commonly occurs in adolescent females.

• Many self-injurers have a history of physical, emotional or sexual abuse.

• Many self-injurers have co-existing problems of substance abuse, obsessive-compulsive disorder (or compulsive alone), or eating disorders.

• Self-injuring individuals were often raised in families that discouraged expression of anger, and tend to lack skills to express their emotions.

• Self-injurers often lack a good social support network.

What are the types of self-injury?

The most common ways that people self-injure are:

• cutting

• burning (or “branding” with hot objects)

• picking at skin or re-opening wounds

• hair-pulling (trichotillomania)

• hitting (with hammer or other object)

• bone-breaking

• head-banging (more often seen in autistic, severely retarded or psychotic people)

• multiple piercing or multiple tattooing

Throughout history, various cultures have intentionally created marks on the body for cultural or religious purposes. Some adolescents, especially if they are with a group engaging in such practices, may see this as a ritual or rite of passage into the group. However, beyond a first experiment in such behavior, continued bodily harm is self-abusive. Most self-injuring adolescents act alone, not in groups, and hide their behavior. There are also some more extreme types of self-mutilation, such as castration or amputation, which are rare and are associated with psychosis.

How does self-injury become addictive?

A person who becomes a habitual self-injurer usually follows a common progression:

• the first incident may occur by accident, or after seeing or hearing of others who engage in self-injury

• the person has strong feelings such as anger, fear, anxiety, or dread before an injuring event

• these feelings build, and the person has no way to express or address them directly

• cutting or other self-injury provides a sense of relief, a release of the mounting tension

• a feeling of guilt and shame usually follows the event

• the person hides the tools used to injure, and covers up the evidence, often by wearing long sleeves

• the next time a similar strong feeling arises, the person has been “conditioned” to seek relief in the same way

• the feelings of shame paradoxically lead to continued self-injurious behavior

• the person feels compelled to repeat self-harm, which is likely to increase in frequency and degree

Why do people engage in self-injury?

Even though there is the possibility that a self-inflicted injury may result in life-threatening damage, self injury is not suicidal behavior. Although the person may not recognize the connection, SI usually occurs when facing what seems like overwhelming or distressing feelings. The reasons self-injurers give for this behavior vary:

• self-injury temporarily relieves intense feelings, pressure or anxiety

• self-injury provides a sense of being real, being alive – of feeling something

• injuring oneself is a way to externalize emotional internal pain – to feel pain on the outside instead of the inside

• self-injury is a way to control and manage pain – unlike the pain experienced through physical or sexual abuse

• self-injury is a way to break emotional numbness (the self-anesthesia that allows someone to cut without feeling pain)

• self-abuse is self-soothing behavior for someone who does not have other means to calm intense emotions

• self-loathing – some self-injurers are punishing themselves for having strong feelings (which they were usually not allowed to express as children), or for a sense that somehow they are bad and undeserving (an outgrowth of abuse and a belief that it was deserved)

• self-injury followed by tending to wounds is a way to express self-care, to be self-nurturing, for someone who never learned how to do that in a more direct way

• harming oneself can be a way to draw attention to the need for help, to ask for assistance in an indirect way

• sometimes self-injury is an attempt to affect others – to manipulate them, make them feel guilty or bad, make them care, or make them go away

What is the relationship between self-injury and suicide?

Self-injury is not suicidal behavior. In fact, it may be a way to reduce the tension that, left unattended, could result in an actual suicide attempt. Self-injury is the best way the individual knows to self-sooth. It may represent the best attempt the person has at creating the least damage. However, self-injury is highly linked to poor sense of self-worth, and over time, that depressed feeling can evolve into suicidal attempts. And sometimes self-harm may accidentally go farther than intended, and a life-threatening injury may result.

What can you do to help a friend or family member who is a self-injurer?

It is very hard to realize that someone you care about is physically harming herself or himself. Your concern may come out in frustration and even comments that can drive the person farther away. Some things that might be helpful are:

• understand that self-harming behavior is an attempt to maintain a certain amount of control, and that it is a way of self-soothing

• let her or him know that you care and that you will listen

• encourage expression of emotions, including anger

• spend time doing enjoyable activities together

• offer to help find a therapist or support group

• do not tell the person to stop the behavior or make judgmental comments – people who feel worthless and powerless are even more likely to self-injure

• if you are the parent of a self-injuring child, prepare yourself to address your family’s difficulties with expression of feelings, as this is a common factor in self-injury – this is not about blame, but about a learning process that will help the entire family

How can a self-injuring person stop this behavior?

Self-injury is a behavior that becomes compulsive and addictive. Like any other addiction, even though other people think the person should stop, most addicts have a hard time just saying no to their behavior – even while realizing it is unhealthy.

There are several things to do to help yourself:

• acknowledge that this IS a problem, that you are hurting on the inside, and that you need professional assistance to stop injuring yourself.

• realize that this is not about being bad or stupid – this is about recognizing that a behavior that somehow was helping you handle your feelings has become as big a problem as the one it was trying to solve in the first place.

• find one person you trust – maybe a friend, teacher, minister, counselor, or relative – and say that you need to talk about something serious that is bothering you.

• get help in identifying what “triggers” your self-harming behaviors and ask for help in developing ways to either avoid or address those triggers

• recognize that self-injury is an attempt to self-sooth, and that you need to develop other, better ways to calm and sooth yourself

• try some substitute activities when you feel like hurting yourself – there are some examples here, and many more that can be found online (links are provided below):

  • if cutting is a way to deal with anger that you cannot express openly, try taking those feelings out on something else – running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart

  • if cutting is a way to feel something when you feel numb inside, try holding ice or a package of frozen food, taking a very hot or very cold shower, chewing something with a very strong taste (like chili peppers, raw ginger root, or a grapefruit peel), or snapping a rubber band hard on your wrist

  • if cutting is a way to calm yourself, try taking a bubble bath, doing deep breathing, writing in a journal, drawing, or doing some yoga

  • if cutting involves your having to see blood, try drawing a red ink line where you would usually cut yourself, in combination with other suggestions above

Treatment

How is self-injury treated? One danger connected with self-injury is that it tends to become an addictive behavior, a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help us almost always necessary. It is important to find a therapist who understands this behavior and is not upset or repulsed by it. Some of the online resources below offer links for referrals to therapists experienced with self-injury.

• Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways.

• Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, post-traumatic stress therapies may be helpful.

• Interpersonal therapy is also the main treatment for the underlying issues of low self-worth that allowed this behavior to develop.

• Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents.

• Group therapy may be helpful in decreasing the shame associated with self-harm, and in supporting healthy expression of emotions.

• Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping family members learn to communicate more directly and non-judgmentally with each other.

• In some situations, an antidepressant or anti-anxiety medication may be used to reduce the initial impulsive response to stress, while other coping strategies are developed.

• A recent treatment involves an in-patient hospitalization program, with a multi-disciplinary team approach.

Visit HealthyPlace.com Self-Injury Community for much more information.

Online resources for self-injury

National Mental Health Association provides a good overview of the types, causes, and treatment of self-injurious behavior.

Self-Injury: A quick guide to the basics - From the American Self-Harm Information Clearinghouse, provides simple and clear definitions of what self injury is and is not, myths and purposes, and a variety of links to assistance. There are also several other sections on this site that provide useful information.

Self Injury Support - A site with good information, including resources and some referrals. This site states its purpose is to provide a positive approach and warns against websites on self-injury that may be “triggering” because of the content or pictures.

Self-Help for Self Injury - A wealth of resources and alternatives to self-injury, with many practical suggestions from those who struggle with this behavior. This site includes many pages and links, and also includes information for therapists treating self-injuring clients.

Self-Injury in Adolescents - Focus Adolescent Services is an Internet clearinghouse with excellent information that is easy to read, and many links to resources. It is supported by other organizations and webpages whose articles or ads run along the margin, but which do not detract from the central page.

Adolescent Self Harm from the American Association of Marriage and Family Therapists (AAMFT) provides a brief overview and also includes suggestions for parents on addressing the issue with their child. There is also a list of books available on the subject.

Visit HealthyPlace.com Self-Injury Community for more information.

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