What is Self-Injury?
Self-Injury (SI) (also called self-harm, self-inflicted violence, or non-suicidal self-injury) is the act of deliberately harming one's own body, such as by cutting or burning, that is not meant as a suicidal act. Self-injury is an unhealthy way to cope with emotional pain, anger, and frustration.
The most common type of self-injury is skin-cutting, but self-harm refers to a wide range of behaviors, including burning, scratching, trichotillomania, poisoning, and other types of injurious behaviors.
There is a complex relationship between self-injury, which is not a suicidal act, and suicide. Self-harming behavior may be potentially life-threatening. There also exists a higher risk of suicide in those who self-injure.
The DSM-IV lists self-injury as a symptom of Borderline Personality Disorder; however, people who suffer depression, stress, anxiety, self-loathing, eating disorders, substance abuse, additional personality disorders, and perfectionism may also engage in self-injurious behavior.
Self-harm is most common in adolescence and teen years, usually beginning between the ages of 12 and 24; however, self-injury is not limited to the teen years. Self-injury can start at any age.
It's estimated that two million people from all races and backgrounds in the US injure themselves in some way. Young women are more likely than young men to engage in self-injurious behavior.
Why Do People Self-Injure?
There's no single cause that leads to self-injurious behavior. The mixture of emotions that trigger one to self-injure is complex. Generally, self-injury is the result of an inability to cope with deep psychological pain. Physical pain distracts the sufferer from painful emotions or helps the person who self-injures to feel a sense of control over an otherwise uncontrollable situation.
Emotional emptiness - feeling empty inside - may lead to self-harm, as it allows the sufferer to feel something - anything. It's an external way to express inner turmoil.
Self-injury can be a way to punish the self for perceived faults.
Risk Factors for Self-Injury:
There are certain factors that may increase the risk for self-injury. These include:
- Most people who self-injure begin as teenagers. Self-injury tends to escalate over the years.
- Having friends who self-injure increases the likelihood that someone will begin to self-injure.
- Having gone through sexual, emotional, physical child abuse or neglect.
- Drug or alcohol use - many of those who self-injure do so under the influence of drugs and/or alcohol.
- Being overly self-critical, lacking impulse control, having poor problem-solving skills.
- Mental illnesses such as depression, borderline personality disorder, anxiety problems, PTSD, eating disorders, and drug or alcohol abuse.
Common Traits of Self-Injurers:
Of course not everyone who self-injures will display all of the following characteristics. Some may identify with one or two; some may identify with none at all. Here are some common characteristics of those who self-injure:
- Difficulties in impulse control, like eating disorders or drug abuse.
- A history of childhood illness or severe illness and/or disability in a close family member.
- Limited social support network, due to shame of self-harm or because they have poor social skills. These social skills may include being hypersensitive and an inability to tune into the needs of others.
- Growing up in an environment where intense emotions weren't allowed.
- Fear of changes - everyday changes or any kind of new experience - people, places, and things. This may include the fear of getting well or stopping the self-injurious behavior.
- Feel undeserving of proper self-care. Many people who self-injure ignore their own needs, like a good diet, enough sleep, and exercise. They may be apathetic to their appearance or feel undeserving of such care.
- Childhood trauma or significant parenting deficits. Many adapt to the trauma by developing unhealthy fantasies about being being rescued from their grief.
- Low self-esteem coupled with a powerful need for love and acceptance by others. They may adopt an unhealthy care-taking role or take on too much responsibility for what happens in a relationship.
- They may engage in Magical Thinking: physical wounds make you immune to other, greater harm.
What Are Some Forms of Self-Injury?
While self-injury may take on many different forms, most people who self-injure stab or cut their skin with a sharp object. However, self-injury types are only limited to the individual's inventiveness and determination to harm themself.
- Carving words/symbols on skin
- Interfering with wound healing
- Head banging
- Pulling out hair
- Piercing skin with sharp objects
What Are Some Signs of Self-Injury?
It may be hard to ascertain whether someone you know or love is self-injuring. Clothing can easily hide most forms of self-injury, and the disposition of someone who self-injures may often be calm and serene.
As self-injury is not an attention-seeking behavior, it's likely that many people will go to great lengths to hide their self-injurious behaviors.
Here are some common signs that someone is self-injuring:
- Unexplained scars or wounds, often on the wrists, arms, legs, thighs, and chest
- Blood-stained clothing, towels, or bedding
- Fresh cuts, scratches, or bruises
- Frequent accidents - many injuries can be dismissed by the self-injurer by being "clumsy" or "accident prone"
- Sharp objects (razors, knives, needles) in the person's belongings
- Spending a lot of time alone - especially in the bedroom or bathroom
- Relationship troubles
- Wearing long sleeves and/or long pants even in hot weather
How Do I Know if I Self-Injure?
Cutting is not the only way that someone can self-injure. Picking scabs compulsively, pulling out hair, burning, punching, hitting your head against the wall, and many other methods are considered self-injury. Sometimes, people drink harmful substances like bleach or detergent if they are self-injuring.
If you use one of these methods or a similar method, especially when in emotional conflict, you likely self-injure.
You don't have to require stitches or a trip to the emergency room to self-injure. Even if you think it isn't “bad enough,” it is.
Help is out there, regardless of your situation.
What Does Self-Harm Help?
It's important to note that those who self-injure do so for many reasons - and self-injury often helps to soothe these issues. Understanding the reasons that one self-injures can help to ascertain ways to stop the self-harming.
Emotional Reasons for Self-Injuring:
- Self-soothing to calm intense emotions
- To punish yourself or express self-loathing
- Exerting control over your own body
- Express things that cannot be put into words
- Distraction from emotional pain
- Regulate strong emotions
Okay, So If Self-Harm Helps, Why Bother Stopping?
Self-harm may provide a temporary relief from the turbulence inside, but it comes at a steep price. In the long run, self-injury causes more problems than it stops. It makes it almost impossible to learn healthy coping mechanisms.
By not learning healthy coping mechanisms for dealing with emotional pain, a self-injurer can be at greater risk for major depressive disorder, substance abuse, and suicide. Self-injury does not help any of the issues that make the person who self-injures want to injure in the first place.
While the initial feeling following self-injury is relief, it is quickly replaced by shame and guilt - the same shame and guilt that keeping such a secret from loved ones causes. Living with the guilt and shame is a huge burden.
Self-harm is addictive. What may start off as an impulse - something done to "feel in control" - may begin to run the life of someone who self-injures. Self-injury can turn into a compulsive behavior that is nearly impossible to stop.
What Self-Injury Is Not:
There exist many myths surrounding self-injury. We're here to try and dispel some of these commonly held, but wrong, beliefs about self-injury.
- Self-Injury is not suicidal behavior. While people do occasionally die from self-injurious behavior, it is by accident. Generally, those who self-injure are not suicidal.
- Self-Harm is not a cry for attention. While many people - family, friends, even doctors - may believe that self-injury is attention-seeking behavior, those who self-harm generally try to hide what they are doing because they are ashamed.
- People who self-injure are not crazy. Those who self-injure are trying to deal with trauma, not mental illness. These people are simply trying to cope the only way they know how.
What Do I Do If I Am Self-Injuring?
Acknowledge the problem. You are probably hurting on the inside which is why you self-injure.
Talk to someone you trust. It could be anyone. A doctor, a counselor, a friend, a parent. Just confide in them.
Identify your self-injury triggers. If you know what your triggers are, you can learn to avoid or address these triggers.
Recognize that self-injury is an attempt to soothe yourself. Develop better, healthier ways to calm and self-soothe.
Figure out what function self-injury is serving. Replace self-injury by expressing your emotions in healthy ways.
Treatment for Self-Injury:
There is no golden standard of treatment for self-injury; rather, treatment is tailored to the specific reasons behind the self-injury and treating any underlying psychological conditions. Successful treatment for self-injury is possible but may take time and work to learn more appropriate coping mechanisms. Treatment options include:
Therapy (also known as "talk therapy") can help identify and manage underlying issues that trigger self-injury. Therapy can help build skills to tolerate stress, regulate emotions, boost self-image, better relationships, and improve problem solving skills.
Medications. While there are no medications that specifically treat self-injury, doctors often prescribe anti-depressants or other medications to treat any underlying mental illnesses. Treatment of those conditions may lessen the desire to self-injure.
Hospitalization. If injury is severe or repeated, an in-patient hospitalization may be necessary to provide a safe environment and intense treatment to get through a crisis.
What Do I Do if a Friend is Self-Injuring?
- Talk to this person privately about your suspicions about their self-injury.
- Be supportive of your friend, and don't tell them to just “get over it” or that they're “doing it for attention.” This is a very real and serious problem.
- If you believe that your friend is in danger, or that he or she has a plan for suicide, notify your parents, a teacher, a pastor, or any other trusted adult immediately. This is not your fault, and it is not on your shoulders to fix it.
- If you offer to listen to your friend, be prepared that their feelings might be overwhelming. You may not understand, and you might want to talk them out of it. You might want to make them stop, to threaten to withhold your friendship or caring if they don't. Please don't. This will only add to the shame they already feel.
- Respect the fact that a self-injurer can only stop when he or she is ready. Stopping for anyone but themselves will not work.
- Validate their feelings. “I understand how tough of a time this is for you.”
- Do not judge his or her experiences with self-injury or reasons for it.
- Offer specific forms of help, like finding a counselor.
- Make sure that your friend knows that you do not think he or she is a bad person for self-injuring. It is a coping mechanism like any other, and while it's hard to understand, your friend is doing his or her best to stay alive!
National Suicide Prevention Hotline:
National Self-Injury Helpline:
24-hour Crisis Hotline:
Additional Resources for Self-Injury:
S.A.F.E. Alternatives: a program that offers resources, referrals for therapists, and tips on how to end self-injury.
Self Injury Foundation: this foundation promotes awareness for those who self-injure and works to provide funding for research, advocacy, and support for those who self-injure and their families.
Adolescent Self Injury Foundation: an organization that works to raise awareness about adolescent self-injury and provides education, prevention tips, and resources for self-injurious adolescents and their families.
Self-Injury Support: a charity group that provides referrals and support for patients in the UK.