What is it?
Self-injury is the act of deliberately harming your own body, such as cutting or burning yourself. It's not meant as a suicide attempt and isn't part of a socially acceptable cultural or artistic expression or ritual, such as tattooing. Rather, self-injury is an unhealthy effort to cope with overwhelming negative emotions, such as intense anger, tension and frustration.
While self-injury may bring a momentary sense of calm and a release of tension, it's usually followed by guilt and shame and the return of painful emotions. Self-injury is often done on impulse, so it's sometimes considered an impulse-control behavior problem. Self-injury may accompany a variety of mental illnesses, such as depression, eating disorders and borderline personality disorder. Self-injury is also known as self-harm, self-injurious behavior, self-mutilation and parasuicide.
Because self-injury is often kept secret, it may be difficult to spot signs and symptoms. Self-injury symptoms may include:
- Scars, such as from burns or cuts
- Fresh cuts, scratches or other wounds
- Broken bones
- Keeping sharp objects on hand
- Spending a great deal of time alone
- Wearing long sleeves or long pants even in hot weather
- Claiming to have frequent accidents or mishaps
Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or scratches on your body with a sharp object. But there are many other forms of self-harm, including:
- Carving words or symbols on the skin
- Breaking bones
- Hitting or punching
- Piercing the skin with sharp objects
- Head banging
- Pulling out hair
- Interfering with wound healing
Self-injury is usually repetitive behavior, occurring multiple times, rather than just once. Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be subjected to self-injury. Self-injury may be painful or not, largely depending on your state of mind at the time.
Self-injury frequently is an impulsive act. You may become upset, or triggered, and develop an urge to hurt yourself. Other times, though, self-injury is a planned event, inflicted in a controlled, methodical manner.
There's no one single or simple cause of self-injury. The mix of emotions that triggers self-injury is complex. In general, self-injury is usually the result of an inability to cope in healthy ways with deep psychological pain. For instance, you may have a hard time regulating, expressing or understanding your emotions. Physical injury distracts you from these painful emotions or helps you feel a sense of control over an otherwise uncontrollable situation.
When you feel emotionally empty, self-injury is a way to feel something, anything, even if it's physical pain. It also offers an external way to express internal distress and despair. You may also turn to self-injury as a way to punish yourself for perceived faults. Sometimes self-injury is an attempt to seek attention or to manipulate others.
Self-injury can affect anyone, from pre-adolescents to older adults. But certain factors may increase the risk of self-injury, including:
- Age. Most people who engage in self-injury are adolescents. Self-injury often starts in the early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness and conflicts with parents or other authority figures.
- Sex. Self-injury was thought to be more common in females than in males, but recent research shows that the rates are generally about the same.
- Family history. Some evidence suggests that self-injury is more common in people who have a family history of suicide, self-injury or self-destructive acts.
- Life issues. Some people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood. Social isolation and living alone may also increase the risk. Unstable living conditions, such as unemployment and divorce, also may be factors.
- Mental health issues. Among those at highest risk are people who experience many negative emotions and are highly self-critical. People who self-injure are more likely to be impulsive and to have poor problem-solving skills. Also, self-injury is commonly associated with certain mental illnesses, including borderline personality disorder, depression, anxiety disorders, substance abuse disorders, post-traumatic stress disorder and eating disorders.
- Alcohol or substance misuse. People who engage in self-harm often do so while under the influence of alcohol or illicit drugs.
Self-injury can cause a variety of complications, including:
- Worsening feelings of shame, guilt and low self-esteem.
- Infection, either from your wounds or from sharing implements.
- Life-threatening problems, such as blood loss if major blood vessels or arteries are cut.
- Accidental or deliberate suicide. You may unintentionally injure yourself fatally, especially if you engage in self-injury while under the influence of alcohol or illicit drugs. You're also at higher risk of deliberately taking your own life.
- Permanent scars or disfigurement.
Unless you want to recover from self-injury and disclose your behavior, it can be difficult for a doctor or therapist to diagnose self-injury. Sometimes self-injury is discovered accidentally. For instance, a doctor doing a routine medical examination may notice signs, such as scars or fresh injuries.
In any case, there's no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. During an initial evaluation for self-injury, a health care provider may ask you such questions as:
- When your self-injury began
- How often you engage in self-injury
- What types of self-injury you use
- What seems to trigger your self-injury
- What emotional issues you face
- What social networks or relationships you have
- What previous treatment, if any, you've had
- Your feelings about the future
Whether you have thoughts of suicideA definitive diagnosis may require evaluation by a mental health provider with experience in treating self-injury. A mental health provider may also evaluate you for other mental illnesses that may accompany self-injury, such as depression or personality disorders.