Self-Injury, Self-Mutilation, Self-Harm

The number of people who participate in acts of self-mutilation is growing. Although self-harm is rarely a suicidal act, it must be taken seriously because accidental deaths do occur. It’s difficult to see the light at the end of the tunnel but breaking the cycle of self-abuse is possible if you reach out to someone you trust. Finding new ways of coping with your feelings can help to tone down the intense urges you feel which results in you hurting yourself. Recovery is a continuous process and learning how to stop this addictive behavior is within your reach if you work at it.

Types of self-injury

Definition of self-injury

Self-injury, self-inflicted violence, self-injurious behavior or self-mutilation is defined as a deliberate, intentional injury to one’s own body that causes tissue damage or leaves marks for more than a few minutes which is done to cope with an overwhelming or distressing situation. 

The most common self-injurious behaviors are:

• Cutting - involves making cuts or scratches on your body with any sharp object, including knives, needles, razor blades or even fingernails. The arms, legs and front of the torso are most commonly cut because they are easily reached and easily hidden under clothing

• Branding – burning self with a hot object, 
• Friction burn – rubbing a pencil eraser on your skin

• Picking at skin or re-opening wounds (dermatillomania) - is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused which relieves stress or is gratifying.

• Hair-pulling (trichotillomania) – is an impulse control disorder which at times seems to resemble a habit, an addiction, or an obsessive-compulsive disorder. The person has an irresistible urge to pull out hair from any part of their body. Hair pulling from the scalp often leaves patchy bald spots on their head which they hide by wearing hats, scarves and wigs. Abnormal levels of serotonin or dopamine may play a role in this disorder. The combined treatment of using an anti-depressant such as Anafranil and cognitive behavioral therapy (CBT) has been effective in treating this disorder. CBT teaches you to become more aware of when you’re pulling, helps you identify your pulling habits, and teaches you about what emotions and triggers are involved in hair pulling. When you gain awareness of pulling, you can learn to substitute healthier behaviors instead.
  

• Hitting (with hammer or other object),
  

• Bone breaking
  

• Punching
  

• Head-banging (more often seen with autism or severe mental retardation

• Multiple piercing or tattooing - may also be a type of self-injury, especially if pain or stress relief is a factor

• Drinking harmful chemicals

Reasons for self-injury

Why do they do it?

Even though it is possible that a self-inflicted injury may result in death, self-injury is usually not suicidal behavior.

The person who self-injures may not recognize the connection, but this act usually occurs after an overwhelming or distressing experience and is a result of not having learned how to identify or express difficult feelings in a healthy way.

Sometimes the person who deliberately harms themselves thinks that if they feel the pain on the outside instead of feeling it on the inside, the injuries will be seen, which then perhaps gives them a fighting chance to heal. They may also believe that the wounds, which are now physical evidence, proves their emotional pain is real. Although the physical pain they experience may be the catalyst that releases the emotional pain, the relief they feel is temporary. These coping mechanisms in essence are faulty because the pain eventually returns without any permanent healing taking place.

Self-harm serves a function for the person who does it. If you can figure out what function the self-injury is serving then you can learn other ways to get those needs met which will reduce your desire to hurt yourself. 

It is difficult to understand the motivations behind self-injurious behavior, but a clearer picture develops when you hear the common explanations self-injurers give for doing it:

• “It expresses emotional pain or feelings that I’m unable to put into words. It puts a punctuation mark on what I’m feeling on the inside!”
• “It’s a way to have control over my body because I can’t control anything else in my life”
• “I usually feel like I have a black hole in the pit of my stomach, at least if I feel pain it’s better than feeling nothing”
• I feel relieved and less anxious after I cut. The emotional pain slowly slips away into the physical pain”

Self-injury can regulate strong emotions. It can put a person who is at a high level of physiological arousal back to a baseline state.

Deliberate self-harm can distract from emotional pain and stop feelings of numbness.

Self-inflicted violence is a way to express things that cannot be put into words such as displaying anger, shocking others or seeking support and help.

Self-injurious behavior can exert a sense of control over your body if you feel powerless in other areas of your life.  Sometimes magical thinking is involved and you may imagine that hurting yourself will prevent something worse from happening.

Also, when you hurt yourself it influences the behavior of others and can manipulate people into feeling guilty, make them care, or make them go away.

Self punishment or self-hate may be involved.

Some people who self-injure have a childhood history of physical, sexual and emotional abuse. They may erroneously blame themselves for having been abused, they may feel that they deserved it and are now punishing themselves because of self-hatred and low self-esteem.  

Self-abuse can also be a self-soothing behavior for someone who does not have other means to calm intense emotions. Self-injury followed by tending to one’s own wounds is a way to express self-care and be self-nurturing for someone who never learned how to do that in a more direct way.

People who self-injure have some common traits:

• Expressions of anger were discouraged while growing up
• They have co-existing problems with obsessive-compulsive disorder, substance abuse or eating disorders
• They lack the necessary skills to express strong emotions in a healthy way 
• Often times there is a limited social support network

Self-injury as an addiction

How can a self-injuring person stop this behavior?

Self-injury is a behavior that over time 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 when they realize it is unhealthy.

Treatments for self-injury

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 is almost always necessary. It is important to find a counselor who understands this behavior and is not upset or repulsed by it.

• 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, therapies that address post-traumatic stress disorder may be helpful.
• 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 help to support healthy expressions of emotions
• Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping other family members learn how to communicate more directly and non-judgmentally with each other
• In cases of moderate to severe depression or anxiety an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.
• In severe cases an in-patient hospitalization program with a multi-disciplinary team approach may be required.