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Self Harm
What is it?
What Causes it?
Signs / Symptoms
Treatment / Therapies
Self-harm or self-injury means hurting yourself on purpose. One common method is cutting with a sharp object. Any time someone deliberately hurts themselves is classified as self-harm. Some people feel an impulse to cause burns, pull out hair or pick at wounds to prevent healing. Extreme injuries can result in broken bones.
Hurting yourself or thinking about hurting yourself is a sign of emotional distress. These uncomfortable emotions may grow more intense if a person continues to use self-harm as a coping mechanism. Learning other ways to tolerate the mental pain will make you stronger in the long term. Self-harm also causes feelings of shame. The scars caused by frequent cutting or burning can be permanent. Drinking alcohol or doing drugs while hurting yourself increases the risk of a more severe injury than intended and it takes time and energy away from other things you value. Skipping classes to change bandages or avoiding social occasions to prevent people from seeing your scars is a sign that your habit is negatively affecting school, work, and relationships.
Source: National Institute of Mental Health (NIMH)
Self-harm is not a mental illness, but a behavior that indicates a need for better coping skills. Several illnesses are associated with it, including Borderline Personality Disorder, Depression, Eating Disorders, Anxiety, or Post-Traumatic Stress Disorder (PTSD). Self-harm occurs most often during the teenage and young adult years, though it can also happen later in life. Those at greatest risk are people who have experienced trauma, neglect, or abuse. For instance, if a person grew up in an unstable family, it might have become a coping mechanism. If a person binge drinks or uses illicit drugs, they are at greater risk of self-injury because alcohol and drugs lower self-control.
The urge to hurt oneself may start with overwhelming anger, frustration or pain. When a person is not sure how to deal with emotions, or learned as a child to hide emotions, self-harm may feel like a release. Sometimes, injuring oneself stimulates the body’s endorphins or pain-killing hormones, thus raising their mood. If a person doesn’t feel many emotions, they might cause themselves pain in order to feel something “real” to replace emotional numbness.
Once a person injures themselves, they may experience shame and guilt. If the shame leads to intense negative feelings, that person may hurt themselves again. The behavior can thus become a dangerous cycle and a long-time habit. Some people even create rituals around it.
Self-harm isn’t the same as attempting suicide. However, it is a symptom of emotional pain that should be taken seriously. If someone is hurting themselves, they may be at an increased risk of feeling suicidal. It’s important to find treatment for the underlying emotions.
There's no one single or simple cause that leads someone to self-injure. In general, self-injury may result from:
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Poor coping skills. Non-suicidal self-injury is usually the result of an inability to cope in healthy ways with psychological pain.
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Difficulty managing emotions. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.
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Through self-injury, the person may be trying to:
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Manage or reduce severe distress or anxiety and provide a sense of relief
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Provide a distraction from painful emotions through physical pain
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Feel a sense of control over his or her body, feelings, or life situations
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Feel something - anything - even if it's physical pain, when feeling emotionally empty
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Express internal feelings in an external way
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Communicate depression or distressful feelings to the outside world
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Punish themselves for perceived faults
Source: National Institute of Mental Health (NIMH),
Signs and symptoms of self-injury may include:
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Scars, often in patterns
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Fresh cuts, scratches, bruises, bite marks, or other wounds
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Excessive rubbing of an area to create a burn
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Keeping sharp objects on hand
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Wearing long sleeves or long pants, even in hot weather
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Frequent reports of accidental injury
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Difficulties in interpersonal relationships
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Behavioral and emotional instability, impulsivity, and unpredictability
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Statements of helplessness, hopelessness, or worthlessness
Self-injury usually occurs in private and is done in a controlled or ritualistic manner that often leaves a pattern on the skin.
Examples of self-harm include:
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Cutting (cuts or severe scratches with a sharp object)
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Scratching
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Burning (with lit matches, cigarettes, or heated, sharp objects such as knives)
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Carving words or symbols on the skin
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Self-hitting, punching, or head banging
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Piercing the skin with sharp objects
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Inserting objects under the skin
Most frequently, the arms, legs, and front of the torso are the targets of self-injury, but any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.
Becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. But for others, self-injury can become a long-term, repetitive behavior.
Risk Factors: Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the preteen or early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
Certain factors may increase the risk of self-injury, including:
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Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
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Life issues. Some people who injure themselves were neglected, were sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality. Some people who self-injure are socially isolated.
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Mental health issues. People who self-injure are more likely to be highly self-critical and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as Borderline Personality Disorder, Depression, Anxiety disorders, Post-Traumatic Stress Disorder (PTSD), and Eating Disorders.
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Alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or recreational drugs.
Source: National Institute of Mental Health (NIMH)
There are effective treatments for self-harm that can allow a person to feel in control again. Psychotherapy is important to any treatment plan. Self-harm may feel necessary to manage emotions, so a person will need to learn new coping strategies. The first step in getting help is talking to a trusted adult, friend or medical professional who is familiar with the subject, ideally a psychiatrist. A psychiatrist will ask that person questions about their health, life history and any injurious behaviors in the past and present. This conversation, called a diagnostic interview, may last an hour or more. Doctors can’t use blood tests or physical exams to diagnose mental illness, so they rely on detailed information from the individual. The more information that person can give, the better the treatment plan will be.
Depending on any underlying illness, a doctor may prescribe medication to help with difficult emotions. For someone with depression, for instance, an antidepressant may lessen harmful urges.
A doctor will also recommend therapy to help a person learn new behaviors if self-injury has become a habit. Several different kinds of therapy can help, depending on the diagnosis:
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Psychodynamic Therapy focuses on exploring past experiences and emotions
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Cognitive Behavioral Therapy (CBT) focuses on recognizing negative thought patterns and increasing coping skills
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Dialectical Behavioral Therapy (DBT) can help a person learn positive coping methods
If your symptoms are overwhelming or severe, your doctor may recommend a short stay in a psychiatric hospital. A hospital offers a safe environment where you can focus your energy on treatment.
Prevention: There is no sure way to prevent your loved one's self-injuring behavior. Reducing the risk of self-injury includes strategies that involve both individuals and communities. Parents, family members, teachers, school nurses, coaches, or friends can help.
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Identify someone at risk and offer help. Someone at risk can be taught resilience and healthy coping skills that can be used during periods of distress.
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Expand social networks. Many people who self-injure feel lonely and disconnected. Helping someone form connections with people who don't self-injure can improve relationship and communication skills.
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Raise awareness. Learn about the warning signs of self-injury and what to do when you suspect it.
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Encourage peers to seek help. Peers tend to be loyal to friends. Encourage children, teens, and young adults to avoid secrecy and reach out for help if they have a concern about a friend or loved one.
Talk about media influence. News media, music, and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.
Source: National Institute of Mental Health (NIMH)
