For people who can’t fathom deliberately hurting themselves, self-injury may seem shocking and frightening. But for people who do injure themselves by cutting or other means, self-injury offers a momentary sense of calm and a release of tension. Unfortunately, that’s usually quickly followed by guilt and shame and the return of other painful emotions. And with self-injury comes the very real possibility of inflicting serious and even fatal injuries.

Self-injury isn’t a specific disease or condition. Rather, it’s a type of abnormal behavior. It may accompany a variety of mental disorders, such as depression and borderline personality disorder. Because self-injury is often done on impulse, it’s sometimes considered an impulse-control behavior problem. Self-injury is also known as self-harm, self-injurious behavior and self-mutilation.

Although it’s hard to estimate how many people engage in self-injury because some never seek treatment, it’s thought that about 3 percent to 5 percent of Americans have deliberately hurt themselves at some point in their lives. Self-injury may be more common — and on the rise — in adolescents.

Signs and Symptoms

What self-injury is and isn’t:

Self-injury is behavior in which people deliberately harm their own bodies in some way to cope with overwhelming emotions. Self-injury frequently is an impulsive act. You may become upset and spontaneously seek a way to hurt yourself, recklessly doing damage to your body. Other times, self- injury may be inflicted in a controlled, methodical manner. You may even plan it in advance, taking steps to avoid detection and to prevent infections.

Self-injury isn’t the same as injury that arises from culturally sanctioned practices in some parts of the world, including scarring, piercing and tattooing, which historically have been considered forms of self-mutilation. Self-injury is distinguished from such practices by the emotional intent behind it — it’s an unhealthy coping method for overwhelming feelings.

Self-injury also isn’t the same as a suicide attempt. For instance, someone may try to harm himself or herself by taking an overdose of medication, but stop short of taking a lethal dose. In self-injury, the intent isn’t to die, but to inflict bodily harm. However, self-injury can accidentally result in suicide.

Types of self-injury:

Self-injury is most commonly associated with cutting, which involves making cuts or scratches on your body. Cutting can be done with any sharp object, including knives, needles, razor blades or even fingernails.

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be subjected to self-injury.

Some people don’t feel pain while they’re hurting themselves, even when creating deep cuts. Others do find self-injury painful but welcome the pain as a punishment or as a distraction from emotional turmoil.

There are many types of self-injury besides cutting, and someone may engage in one or more of them. Other types of self-injury include:

• Burning
• Poisoning or overdosing
• Scratching
• Carving words or symbols on the skin
• Breaking bones
• Hitting or punching
• Piercing the skin with sharp objects
• Head banging
• Pulling out hair
• Interfering with wound healing
• Pinching
• Biting

Some experts consider overexercising a form of self-injury, as well as stopping medication in an attempt to cause harm to yourself.

Signs of self-injury:

People who injure themselves often try to keep their behavior secret. It may be difficult to spot signs of self-injury.

Signs of self-injury may include:

• Scars, such as from burns or cuts
• Cuts, scratches or other wounds
• Bruises
• Broken bones
• Keeping sharp objects on hand
• Spending a great deal of time alone
• Wearing long sleeves or long pants even in hot weather
• Claiming to have frequent accidents or mishaps

Causes:

There’s no one single or simple cause of self-injury. The mix of emotions that drives some people to hurt themselves is complex. People who engage in self-injury, whether adolescents or adults, are often in the throes of deep psychological pain but lack healthy ways to cope. So they turn to self-injury to gain relief. Physical injury distracts them from painful emotions or helps them feel a sense of control over an otherwise uncontrollable situation. For those who have feelings of emptiness or little emotion, self-injury is a way to feel something, anything, even if it’s physical pain. It also offers an external way to express internal distress and despair. Self-injury is sometimes associated with certain medical conditions, such as personality disorders, depression, eating disorders, substance abuse and post-traumatic stress disorders. In addition, self-injury may occur in people who have developmental disabilities, such as autism and mental retardation.

Risk factors:

Although intentional self-injury can affect anyone, from pre-adolescents to older adults, certain factors may increase the risk that someone will engage in self-injury, including:

• Age. Self-injury often starts in the preteen or early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness and conflicts with parents or other authority figures.
• Sex. Self-injury is more common in females than in males. But that may be a false difference, because females are more likely than males to seek treatment.
• Family history. Some evidence suggests that self-injury is more common in people who have a family history of suicide or self-injury.
• Psychosocial factors. Many people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood. Social isolation and living alone may also increase the risk. Unstable living conditions, such as unemployment and divorce, may also be factors.
• Certain mental disorders. Some mental disorders are more commonly associated with self-injury, including borderline personality disorder and other personality disorders, depression, substance abuse disorders, post-traumatic stress disorder and eating disorders. Many of these disorders often occur together. People who self-injure are more likely to be impulsive and to have poor problem-solving skills.
• Alcohol or substance misuse. People who engage in self-harm often do so while under the influence of alcohol or illicit drugs.

When to seek medical advice:
People who deliberately injure themselves typically feel overwhelmed by a mix of emotions, ranging from anger and rage to depression and hopelessness. They may be embarrassed and shamed about their self-injury and try to hide it from others. Some who engage in self-injury may secretly enjoy it since it soothes emotional pain, albeit temporarily. Some may even flaunt it, especially if self-injury is used as a way to upset parents or other authority figures.

In any case, self-injury contributes to a life of distress and chaos. It also poses the risk of serious, debilitating injury, disfigurement or even death.

If you have injured yourself severely or believe it may be life-threatening, call 911 or your local emergency services provider. If a loved one has injured himself or herself severely, take them to the hospital or call for emergency help.

Family and Friends of People who Self Harm

Do you know someone who hurts themselves? Are you at a loss as to how to try and do the right thing by them. Is it ok to talk about it, or should you stay quiet? Is it ok to ask to see cuts, burns or scars?

How you react to someone’s self injury (SI) is important, and how they react to your concern may well distress you, but each individual deals with their self harm in their own way.

When you first find out that a loved one self injures you may well feel overwhelmed with conflicting emotions. Perhaps you are shocked that your loved one resorts to self harm, perhaps you are confused as to what it all means. You may experience guilt and anger, frustration and sadness. Depending on how you discovered your loved one relies on self harm as a coping mechanism, you may have little time to adapt to the news.

Self injury is a very personal act, and there are many methods by which a person hurts themselves. It can be best to ignore the method of self harm to begin with, and focus on the emotional experience that you’re loved one is going through. Self injury is a word which covers a lot of behaviours, all of which share one key element; they are done with the intention of harming oneself, but not as a way to commit suicide, rather, as a way to cope and survive.

It can be frustrating supporting a loved one through self injury as they may not feel comfortable to talk about what drives them to harm themselves, yet they may also feel very lonely and isolated, feeling trapped in their emotions. It’s important to look after your own emotional well being if you are supporting someone who uses self injury.

Ultimatums and No-Harm Contracts

It can be tempting to issue a demand or ultimatum, saying that they must stop hurting themselves this instance. It’s tempting to believe that everything will be alright now that you know, and now that you’re helping.

Such ultimatums can only serve to drive your loved one further away from you, as you demonstrate that you don’t understand and that you’re not listening. A person who self injures may well feel isolated and alone; ultimatums only increase the feelings of isolation.

At times, even professional caregivers such as Counselors will insist that a person agrees to a ‘No-Harm Contract’. This can only be counter-productive. As self injury is a coping mechanism it is not reasonable to take it away before providing a suitable replacement mechanism, or strategy for coping.

Your Relationship with the Person

The LifeSIGNS fact sheets for Family/Friends give general information which will be useful for anyone who knows someone who self-injures. The following information elaborates slightly, depending on your relationship with the person.

If You’re a Parent

Finding out that your child has been self-injuring might come as a total shock, and can be devastating. A person who self-injures often thinks that by taking out their emotional pain on themselves that they won’t be hurting other people. Of course their self-injury will hurt those who care about them, but you must remember that this was not their initial intention.

Depending on the age of your child it can be hard not to panic, but you must try not to. Be there if your child wants to talk, and do not belittle them when they do. Remember that self-injury is habit-forming, and once someone is in the cycle of self-injury the smallest things might trigger them. Telling your child that it is stupid to hurt themselves because they have had an argument with a friend or because they have failed a test is not going to achieve anything, and will only upset you both.

Although it is difficult you must try to give your child space and privacy. Encourage them to talk, and to accept professional help, but don’t force them. Obviously you want your child to stop hurting themselves, but this can be a long process. No one (especially young people) likes being told what to do and what not to do, so telling someone to stop is not helpful. Remember to let your child know that while you do not condone their behaviour, you love them unconditionally and will always support them.

If You’re a Friend

If you’re a friend of someone who is under 18 and self-injures, encourage them to speak to an adult about it. If you are at school there might be a nurse or counsellor, or a trusted teacher who you they could talk to. Or you might offer to be with them if they feel able to talk to their parents or another relative.

Your friend might tell you that you must not tell anyone. However, if you’re concerned that they are in danger or might be suicidal, then you have to tell someone. Remind your friend that while telling people isn’t easy, in the long-run it will enable them to get the help they need in order to start feeling better.

As a friend of someone who self-injures (of any age) be there to listen to them. Try to remain calm and patient even if you can’t understand why they would want to hurt themselves. Let your friend know that they are not alone, and encourage them to join the LifeSIGNS message board for peer support.

Above all, although you care about your friend you must remember to take care of yourself first. Unless you do this you will not be a help to anyone!

If You’re a Partner / Girlfriend / Boyfriend

Having a relationship with a person who self-injures can at times be frustrating and very upsetting. Your partner might have been self-injuring long before they met you and you might think that now they have you that they shouldn’t feel the need to hurt themselves anymore. However, self-injury is a complex behaviour, and no matter how much you would like your partner to stop hurting themselves, it is not that simple.

Encourage your partner to seek professional help (if they have not done so already) – counselling as a couple might be appropriate for you. Be there for them through the highs and the lows, but make sure that you look after yourself as well.

Care

A more psychological aspect of self-injury is the need to be cared for. A person feels unloved or unwanted; he or she self-injures in order to care for the wounds. Although the person hurting is the one caring for the hurt, they still feel cared about on some level. For some people this may feel like the only way they ever get cared about, be that actually true or not.

Control

There can also be a feeling of empowerment stemming from the harming of oneself. One is the perpetrator of the crime, the crime victim, and the person who cleans up after it and fixes it. For someone who feels powerless, that may give them a sense of control. If one feels one has no other control over his or her life that can be very powerful and difficult to give up. Who does NOT want some control over his or her life?

Release

Some people may feel it is the only form of release they have… like self-injury is the only thing that is always there for them. If friends and family are not available, or are just plain sick of hearing about someone’s issues, he or she may believe that self-injury is the only method available to express difficult feelings. In this case there is not much incentive to stop. Everyone needs some way of expressing emotions, and if one really feels that this is the only way, he or she will continue to do so until another, hopefully more appropriate way, is found.

Happy

Strange as it sounds, I have heard of people who self-injure because they are happy. The people I have spoken to about this all say that they have been chronically depressed for most of their lives, and then got treatment (usually anti-depressant medication) which made them feel better. However, they have only known pain, so it seems ‘normal’ to them. They have a tough time stopping because self-injury causes the pain and distress to which they have become so accustomed. (Most of these people were self-injurers before they received treatment for depression, and just carried on the behaviour after getting help. I have yet to find anyone who began self-injuring after receiving treatment, though it would not surprise me to find that such individuals do exist).

Punishment

There are those who find it difficult to stop self-injuring because they feel they deserve punishment. If no one else will punish them for what they perceive as their misdeeds (these my be real or imagined) they use self- injury to punish themselves.

Most people do feel a need to atone in some way for the wrongs they do. If they can find no other way to fill this desire, they may use self-injury. There are also those who just feel that they are “bad” people. Not that they have done wrong, but that they are wrong. Again, they may have a hard time stopping self-injury because they feel that they somehow deserve punishment for being such terrible human beings. Most of these people are actually quite caring individuals, but for they cannot see the good in themselves and therefore they punish themselves.

Trauma and Mental Health

There are other reasons, mostly dealing with psychosis, flashbacks from traumatic events, and / or issues with dissociation. I am not going into those in this essay because in those cases self-injury is secondary to other psychological issues. In order to explain the relationship between self-injury and the other issues, I would have to explain the other issues in some depth. I am not a medical professional and am not qualified to do this.

There are certainly other reasons why self-injury is difficult to stop. Part of the problem is that it can just become a habit, like any other maladaptive behaviour. If you have ever tried to break a bad habit you know how difficult it can be.