Self-Injury
What is self-injury?
Self-injury (SI) is defined as any intentional injury to one's own body. This
disorder also is called self-harm or self-mutilation. Usually, self-injury
leaves marks or causes tissue damage. Self-injury can involve any of the
following behaviors:
- Cutting
- Burning (or "branding" with hot objects)
- Picking at skin or re-opening wounds
- Hair-pulling (trichotillomania)
- Head-banging
- Hitting (with hammer or other object)
- Bone-breaking
Most who engage in self-injury act alone rather than in groups. They also
attempt to hide their behavior.
What causes a person to engage in self-injury?
Self-injury can occur in either sex and in any race of people. The behavior
is not limited by education, age, sexual orientation, socioeconomic status, or
religion. However, there are some common factors among people who engage in
self-injury. Self-injury occurs more often among:
- Adolescent females
- People who have a history of physical, emotional, or sexual
abuse
- People who have co-existing problems of substance abuse,
obsessive-compulsive disorder, or eating disorders
- Individuals who were raised in families that discouraged
expression of anger
- Individuals who lack skills to express their emotions and lack
a good social support network
Even though there is the possibility that a self-inflicted injury might result
in life-threatening damage, self-injury is not considered to be
suicidal behavior. Self-injury usually occurs when people face what seems like
overwhelming or distressing feelings. Self-injurers might feel that self-injury is
a way of:
- Temporarily relieving intense feelings, pressure, or anxiety
- Being real, being alive, or feeling something
- Being able to feel pain on the outside instead of the inside
- Being a means to control and manage pain – unlike the pain
experienced through physical or sexual abuse
- Providing a way to break emotional numbness (the
self-anesthesia that allows someone to cut without feeling pain)
- Asking for help in an indirect way or drawing attention to the
need for help
- Attempting to affect others by manipulating them, trying to
make them care, trying to make them feel guilty, or trying to make them go
away
Self-injury also might be a reflection of a person’s self-hatred. Some
self-injurers are punishing themselves for having strong feelings that they were
usually not allowed to express as children. They also might be punishing
themselves for somehow being bad and undeserving. These feelings are an
outgrowth of abuse and a belief that the abuse was deserved.
What are the symptoms of self-injury?
The symptoms of self-injury include:
- Frequent cuts and burns that cannot be explained
- Self-punching or scratching
- Needle sticking
- Head banging
- Eye pressing
- Finger or arm biting
- Pulling out one's hair
- Picking at one's skin
Warning signs that an individual might be engaging in self-injury include:
- Wearing pants and long sleeves in warm weather
- The appearance of lighters, razors or sharp objects that one
would not expect among a person’s belongings
- Low self-esteem
- Difficulty handling feelings
- Relationship problems
- Poor functioning at work, school, or home
How is self-injury diagnosed?
If an individual shows signs of self-injury, a mental health professional
with self-injury expertise should be consulted. The mental health professional
will be able to make an evaluation and recommend a course of treatment.
Self-injury can be a symptom of psychiatric illness including:
- Personality disorders (particularly borderline personality
disorder)
- Bipolar disorder
- Major depression
- Anxiety disorders (particularly obsessive-compulsive disorder)
- Schizophrenia
How is self-injury treated?
Therapy can be used to help a person stop engaging in self-injury.
Cognitive-behavioral therapy might be used to help an individual learn to
recognize and address triggering feelings in healthier ways. Post-traumatic
stress therapies might be helpful for self-injurers who have a history of abuse or
incest. Group therapy might be helpful in decreasing the shame associated with
self-harm, and in supporting healthy expression of emotions. Family therapy can
help to address any history of family stress related to the behavior and can
help family members learn to communicate more directly and non-judgmentally with
each other. In addition, hypnosis or other self-relaxation techniques are
helpful in reducing the stress and tension that often precede incidents of
self-injury. Medicines such as antidepressants or anti-anxiety medicine might
be used to reduce the initial impulsive response to stress.
What is the prognosis (chance of recovery) for people who engage in self-injury?
The prognosis varies depending upon a person’s emotional or psychological
state. It is important to determine the factors that lead an individual’s
self-injuring behaviors. It also is important to identify any pre-existing
personality disorders that need to be treated.
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Copyright 1995-2006 The Cleveland Clinic Foundation. All rights reserved
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