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

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