Self Injury

What is Self Injury?

Self-injury, also known as cutting or self-mutilation, occurs when someone intentionally and repeatedly harms herself/himself. The method most often used is cutting but other common behaviors include burning, punching, and drinking something harmful, like bleach or detergent.

Who Does It?

It’s estimated that about two million people in the U.S. injure themselves in some way.  The majority are teenagers or young adults with young women outnumbering young men. They are of all races and backgrounds.

Why?

Often, people say they hurt themselves to express emotional pain or feelings they can’t put into words.

It can be a way to have control over your body when you can’t control anything else in your life. A lot of people who cut themselves also have an eating disorder.

Although they usually aren’t trying to kill themselves, sometimes they’re unable to control the injury and die accidentally.

Warning Signs

Warning signs that someone is injuring themselves include: unexplained frequent injury including cuts and burns, wearing long pants and sleeves in warm weather, low self-esteem, difficulty handling feelings, relationship problems, and poor functioning at work, school or home.

Incidence & onset. Experts estimate the incidence of habitual self-injurers is nearly 1% of the population, with a higher proportion of females than males. The typical onset of self-harming acts is at puberty. The behaviors often last 5-10 years but can persist much longer without appropriate treatment.

Background of self-injurers. Though not exclusively, the person seeking treatment is usually from a middle to upper class background, of average to high intelligence, and has low self-esteem. Nearly 50% report physical and/or sexual abuse during his or her childhood. Many report (as high as 90%), that they were discouraged from expressing emotions, particularly anger and sadness.

Behavior patterns. Many who self-harm use multiple methods. Cutting arms or legs is the most common practice. Self-injurers may attempt to conceal the resultant scarring with clothing, and if discovered, often make excuses as to how an injury happened.

Reasons for behaviors. Self-injurers commonly report they feel empty inside, over or under stimulated, unable to express their feelings, lonely, not understood by others and fearful of intimate relationships and adult responsibilities. Self-injury is their way to cope with or relieve painful or hard-to-express feelings, and is generally not a suicide attempt. But relief is temporary, and a self-destructive cycle often develops without proper treatment.

Dangers. Self-injurers often become desperate about their lack of self-control and the addictive-like nature of their acts, which may lead them to true suicide attempts. The self-injury behaviors may also cause more harm than intended, which could result in medical complications or death. Eating disorders and alcohol or substance abuse intensify the threats to the individual’s overall health and quality of life.

Diagnoses. The diagnosis for someone who self-injures can only be determined by a licensed psychiatric professional. Self-harm behavior can be a symptom of several psychiatric illnesses: personality disorders (esp. borderline personality disorder); bipolar disorder (manic depression); major depression; anxiety disorders (esp. obsessive-compulsive disorder); as well as psychoses such as schizophrenia.

Evaluation. If someone displays the signs and symptoms of self-injury, a mental health professional with self-injury expertise should be consulted. An evaluation or assessment is the first step, followed by a recommended course of treatment to prevent the self-destructive cycle from continuing.

Treatment. Self-injury treatment options include outpatient therapy, partial (6-12 hours a day) and inpatient hospitalization. When the behaviors interfere with daily living, such as employment and relationships, and are health or life-threatening, a specialized self-injury hospital program with an experienced staff is recommended.

The effective treatment of self-injury is most often a combination of medication, cognitive/behavioral therapy, and interpersonal therapy, supplemented by other treatment services as needed. Medication is often useful in the management of depression, anxiety, obsessive-compulsive behaviors, and the racing thoughts that may accompany self-injury. Cognitive/behavioral therapy helps individuals understand and manage their destructive thoughts and behaviors. Contracts, journals, and behavior logs are useful tools for regaining self-control. Interpersonal therapy assists individuals in gaining insight and skills for the development and maintenance of relationships. Services for eating disorders, alcohol/substance abuse, trauma abuse, and family therapy should be readily available and integrated into treatment, depending on individual needs.

In addition to the above, successful courses of treatment are marked by 1) patients who are actively involved in and committed to their treatment, 2) aftercare plans with support for the patient’s new self-management skills and behaviors, and 3) collaboration with referring and other involved professionals.

 

Friends

If you are a boyfriend, girlfriend, a best friend, or just a friend of someone who self-injures it is important that you take care of yourself first.  People who self-injure often put friends (intentionally or not) in helpless situations.  A common request of a self-injurer is to ask a friend not to tell anyone else about their self-injury.  They may hold you 'hostage' with the threat, "if you tell..... I'll cut myself".  You may THINK you always have to be available so that they do not self-injure.  Friends tend to want to help the self-injurer in any way that they can, even if the self-injurer does not want the help.  Knowing how much, and how often to intervene can be overwhelming.  Setting boundaries within the relationship or deciding when to let go can also be stressful.

Intervention Tips

Tell your friend that you cannot keep their self-injury secret.  Explain to them that it puts you in an uncomfortable position.  Tell them you will confide in people that you think can help (teachers, school counselor, clergy, your parents, therapist, family doctor....)

Know your limits.  Are you spending more time worrying about your friend self-injuring, and less time about your needs?

If your friend self-injures and blames you, tell them that you are not taking responsibility for their self-injury.  This scenario is most common after a 'break up.' The self-injurer may tell you, "if you leave me I'll injure."  Do not stay in the relationship as a result of manipulative threats.  Tell them that you hope they will take responsibility for their BEHAVIOR, not self-injure and get the help they need.

Let them know that you are willing to help them look for information regarding TREATMENT OPTIONS.

Remember, a healthy relationship is one of honesty, compromise and communication.

 

If you are someone who is struggling with self-injury or know someone who is then you can contact the counseling center at 581-3413.