Self-Injury: Types, Causes and Treatment
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 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.