Chronic Illness and Depression
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:
- Burning (or "branding" with hot objects)
- Picking at skin or re-opening wounds
- Hair-pulling (trichotillomania)
- Hitting (with hammer or other object)
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)
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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- Mental Health America. Self-injury. Accessed 2/5/2013.
- Brausch AM, Gutierrez PM. Differences in non-suicidal self-injury and suicide attempts in adolescents. J Youth Adolesc. 2010;39(3):233-42.
- Adolescent Self-Injury Foundation. Accessed 2/5/2013.
- Larkin GL, Beautrais AL. Chapter 283. Behavioral Disorders: Emergency Assessment. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. www.accessmedicine.com. Accessed 2/6/2013.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/4/2013...#12201