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. Self-harm is the deliberate infliction of damage to your own body and includes cutting, burning, and other forms of injury. While cutting can look like attempted suicide, it’s often not; most people who mutilate themselves do it as a way to regulate mood. People who hurt themselves may be motivated by a need to distract themselves from inner turmoil or to quickly release anxiety that builds due to an inability to express intense emotions.
Self-harm or self-injury means hurting yourself on purpose. One common method is cutting yourself with a knife. But any time someone deliberately hurts herself is classified as self-harm. Some people feel an impulse to burn themselves, 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 work and relationships.
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?
Self-harm is not a mental illness, but a behavior that indicates a lack of coping skills. Several illnesses are associated with it, including borderline personality disorder, depression, eating disorders, anxiety or post-traumatic stress disorder.
Self-harm occurs most often during the teenage and young adult years, though it can also happen later in life. Those at the most 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 does drugs, he is also at greater risk of self-injury, because alcohol and drugs lower self-control.
The urge to hurt yourself 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 yourself stimulates the body’s endorphins or pain-killing hormones, thus raising their mood. Or if a person doesn’t feel many emotions, he might cause himself pain in order to feel something “real” to replace emotional numbness.
Once a person injures herself, she may experience shame and guilt. If the shame leads to intense negative feelings, that person may hurt herself 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 herself, she may be at an increased risk of feeling suicidal. It’s important to find treatment for the underlying emotions.
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 And Signs of Self-Injurers:
While cutting and self-harming occurs most frequently in adolescents and young adults, it can happen at any age. Because clothing can hide physical injuries, and inner turmoil can be covered up by a seemingly calm disposition, self-injury in a friend or family member can be hard to detect. In any situation, you don’t have to be sure that you know what’s going on in order to reach out to someone you’re worried about. 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, and red flags you can look for:
Blood stains on clothing, towels, or bedding; blood-soaked tissues
Childhood trauma or significant parenting deficits. Many adapt to the trauma by developing unhealthy fantasies about being being rescued from their grief.
Difficulties in impulse control, like eating disorders or drug abuse.
Covering up. A person who self-injures may insist on wearing long sleeves or long pants, even in hot weather.
Engaging in Magical Thinking: physical wounds make you immune to other, greater harm.
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.
Frequent “accidents.” Someone who self-harms may claim to be clumsy or have many mishaps, in order to explain away injuries.
Growing up in an environment where intense emotions weren’t allowed.
History of childhood illness or severe illness and/or disability in a close family member.
Isolation and irritability. Your loved one is experiencing a great deal of inner pain—as well as guilt at how they’re trying to cope with it. This can cause them to withdraw and isolate themselves.
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.
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.
Needing to be alone for long periods of time, especially in the bedroom or bathroom.
Sharp objects or cutting instruments, such as razors, knives, needles, glass shards, or bottle caps, in the person’s belongings.
Unexplained wounds or scars from cuts, bruises, or burns, usually on the wrists, arms, thighs, or chest
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 themselves
Self-harm is a way of expressing and dealing with deep distress and emotional pain. It includes anything you do to intentionally injure yourself. Some of the more common ways include:
- Cutting or severely scratching your skin
- Burning or scalding yourself
- Hitting yourself or banging your head
- Punching things or throwing your body against walls and hard objects
- Sticking objects into your skin
- Intentionally preventing wounds from healing
- Swallowing poisonous substances or inappropriate objects
- Carving words/symbols on skin
- Interfering with wound healing
- Head banging
- Pulling out hair
- Piercing skin with sharp object
Self-harm can also include less obvious ways of hurting yourself or putting yourself in danger, such as driving recklessly, binge drinking, taking too many drugs, and having unsafe sex.
Regardless of how you self-harm, injuring yourself is often the only way you know how to:
- Cope with feelings like sadness, self-loathing, emptiness, guilt, and rage
- Express feelings you can’t put into words or release the pain and tension you feel inside
- Feel in control, relieve guilt, or punish yourself
- Distract yourself from overwhelming emotions or difficult life circumstances
- Make you feel alive, or simply feel something, instead of feeling numb
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.
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?
The relief that comes from cutting or self-harming is only temporary and creates far more problems than it solves.
Relief from cutting or self-harm is short lived, and is quickly followed by other feelings like shame and guilt. Meanwhile, it keeps you from learning more effective strategies for feeling better.
Keeping the secret of self-harm is difficult and lonely. Maybe you feel ashamed or maybe you just think that no one would understand. But hiding who you are and what you feel is a heavy burden. Ultimately, the secrecy and guilt affects your relationships with friends and family members and how you feel about yourself.
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.
You can hurt yourself badly, even if you don’t mean to. It’s easy to end up with an infected wound or misjudge the depth of a cut, especially if you’re also using drugs or alcohol.
You’re at risk for bigger problems down the line. If you don’t learn other ways to deal with emotional pain, you increase your risk of major depression, drug and alcohol addiction, and suicide.
Self-harm can become addictive. It may start off as an impulse or something you do to feel more in control, but soon it feels like the cutting or self-harming is controlling you. It often turns into a compulsive behavior that seems impossible to stop.
The bottom line is that cutting and self-harm won’t help you with the issues that made you want to hurt yourself in the first place. No matter how lonely, worthless, or trapped you may be feeling right now, there are many other, more effective ways to overcome the underlying issues that drive your self-harm.
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.
The help and support of a trained professional can help you work to overcome the cutting or self-harming habit, so consider talking to a therapist. A therapist can help you develop new coping techniques and strategies to stop self-harming, while also helping you get to the root of why you hurt yourself.
Remember, self-harm doesn’t occur in a vacuum. It exists in real life. It’s an outward expression of inner pain-pain that often has its roots in early life. There is often a connection between self-harm and childhood trauma. Self-harm may be your way of coping with feelings related to past abuse, flashbacks, negative feelings about your body, or other traumatic memories-even if you’re not consciously aware of the connection.
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.
- Finding the right therapist may take some time. It’s very important that the therapist you choose has experience treating both trauma and self-injury. But the quality of the relationship with your therapist is equally important. Trust your instincts. Your therapist should be someone who accepts self-harm without condoning it, and who is willing to help you work toward stopping it at your own pace. You should feel at ease, even while talking through your most personal issues.
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.
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.
Page last audited 8/2018