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Self-injury/cuttingBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/self-injury/DS00775
Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger 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. And with self-injury comes the possibility of more serious and even fatal self-aggressive actions.
Because self-injury is often done impulsively, it can be considered an impulse-control behavior problem. Self-injury may be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder.
Signs and symptoms may include:
- Scars, such as from burns or cuts
- Fresh cuts, scratches, bruises or other wounds
- Broken bones
- Keeping sharp objects on hand
- Wearing long sleeves or long pants, even in hot weather
- Claiming to have frequent accidents or mishaps
- Spending a great deal of time alone
- Pervasive difficulties in interpersonal relationships
- Persistent questions about personal identity, such as "Who am I?" "What am I doing here?"
- Behavioral and emotional instability, impulsivity and unpredictability
- Statements of helplessness, hopelessness or worthlessness
Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or severe scratches on different parts of your body with a sharp object. Other forms of self-harm include:
- Burning (with lit matches, cigarettes or hot sharp objects like knives)
- Carving words or symbols on the skin
- Breaking bones
- Hitting or punching
- Piercing the skin with sharp objects
- Head banging
- Pulling out hair
- Persistently picking at or interfering with wound healing
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 used for self-injury. People who self-injure may use more than one method to harm themselves.
Because self-injury is often an impulsive act, becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. However, for others, self-injury can become a long-term, repetitive behavior.
Although rare, some young people may self-injure in public or in groups to bond or to show others that they have experienced pain.
When to see a doctor
Getting appropriate treatment can help you learn healthier ways to cope.
- Reach out for help. If you're injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Talk to someone you trust — such as a friend, loved one, health care provider, religious leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help.
- Emergency help. If you've injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider.
When a friend or loved one self-injures
If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you'd be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some options for help.
- Your child. You can start by consulting your pediatrician or family doctor who can provide an initial evaluation or a referral to a mental health specialist. Don't yell at your child or make threats or accusations, but do express concern.
- Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
- Adult. Gently encourage the person to seek medical and psychological treatment.
There's no one single or simple cause that leads someone to self-injure. In general, self-injury is usually the result of an inability to cope in healthy ways with psychological pain related to issues of personal identity and having difficulty "finding one's place" in family and society. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.
Through self-injury, the person may be trying to:
- Manage or reduce severe distress or anxiety and provide a sense of relief
- Provide a distraction from painful emotions through physical pain
- Feel a sense of control over his or her body, feelings or life situations
- Feel something, anything, even if it's physical pain, when feeling emotionally empty
- Express internal feelings in an external way
- Communicate depression or distressful feelings to the outside world
- Be punished for perceived faults
Certain factors may increase the risk of self-injury, including:
- Being female. Females are at greater risk of self-injuring than males are.
- Age. Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
- Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
- Life issues. Some people who injure themselves were neglected, or sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality.
- Mental health issues. People who self-injure are more likely to be impulsive, explosive and highly self-critical, and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
- Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.
Self-injury can cause a variety of complications, including:
- Worsening feelings of shame, guilt and low self-esteem
- Infection, either from wounds or from sharing tools
- Life-threatening problems, such as blood loss if major blood vessels or arteries are cut
- Permanent scars or disfigurement
- Severe, possibly fatal injury, especially if you harm yourself while under the influence of alcohol or illegal drugs
- Worsening of underlying issues and disorders, if not adequately treated
Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-injuring. And the pattern of damaging the body in times of distress can make suicide more likely.
If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
- Seek help from your doctor, a mental health provider or other health care professional.
- Reach out to family members, friends, teachers or spiritual leaders for support.
If you think your friend or loved one is in immediate danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call for emergency help or take the person to the hospital, if you can safely do so. If possible, take away any tools used for self-injury.
Preparing for your appointment
Your first appointment may be with your family doctor, another primary care doctor, a school nurse or a counselor. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.
What you can do
To help prepare for your appointment:
- Make a list of symptoms you've had, including any that may seem unrelated to the reason for the appointment.
- Note your key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, herbs or supplements that you're taking.
- Take a family member or friend along, if possible, for support and to help you remember information.
- Be ready to provide accurate, thorough and honest information about your situation and your self-injuring behavior.
Prepare a list of questions to make the most of your time with your doctor. Some basic questions to ask your doctor include:
- What treatments are available? Which do you recommend for me?
- What side effects are possible with that treatment?
- What are the alternatives to the primary approach that you're suggesting?
- Are there medications that might help? Is there a generic alternative to the medicine you're prescribing?
- What should I do if I have an urge to self-injure between therapy sessions?
- What else can I do to help myself?
- How can I (or those around me) recognize that things may be getting worse?
- Can you suggest any resources that would help me learn more about my condition and its treatment?
Don't hesitate to ask questions any time you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions about your self-injuring and emotional state, such as:
- When did you first begin harming yourself?
- What methods do you use to harm yourself?
- How often do you cut or injure yourself in other ways?
- What feelings and thoughts do you have before, during and after self-injury?
- What seems to trigger your self-injury?
- What makes you feel better or worse?
- Do you have social networks or relationships?
- What emotional issues are you facing?
- How do you feel about your future?
- Have you had previous treatment for self-injury?
- Do you have suicidal thoughts when you're feeling down?
- Do you drink alcohol, smoke cigarettes or use street drugs?
Tests and diagnosis
Although some people may ask for help, sometimes self-injury is discovered by family members or friends. Or a doctor doing a routine medical exam may notice signs, such as scars or fresh injuries.
There's no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. A 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 be linked to self-injury, such as depression or personality disorders. If that's the case, evaluation may include additional tools, such as questionnaires or psychological tests.
Treatments and drugs
There's no one best way to treat self-injuring behavior, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression.
Treating self-injury behavior can take time, hard work and your own desire to recover. Because self-injury can become a major part of your life and it's often accompanied by mental disorders, you may need treatment from a mental health professional experienced in self-injury issues.
There are several treatment options for self-injuring behavior.
Known as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injuring behavior. Therapy can also help you learn skills to better manage distress, help regulate your impulsiveness and other emotions, boost your self-image, better your relationships, and improve your problem-solving skills.
Several types of individual psychotherapy may be helpful, such as:
- Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
- Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others.
- Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination guided by a therapist.
- Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being.
In addition to individual therapy sessions, family therapy or group therapy also may be recommended.
There are no medications that specifically treat self-injuring behavior. However, your doctor may recommend treatment with antidepressants or other psychiatric medications to help treat depression, anxiety or other mental disorders commonly associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.
If you injure yourself severely or repeatedly, your doctor may recommend that you be admitted to a hospital for psychiatric care. Hospitalization, often short term, can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.
Lifestyle and home remedies
You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips:
- Stick to your treatment plan, including keeping psychotherapy appointments and taking prescribed medications as directed.
- Keep your doctor or mental health care provider's phone number handy, and tell him or her about all incidents related to self-injury.
- Appoint a trusted family member or friend as the person you'll immediately contact if you have an urge to self-injure or if self-injuring behavior recurs.
- Take appropriate care of your wounds if you do injure yourself or seek medical treatment if needed — call your relative or friend for help and support.
- Don't share instruments used for self-injury, which raises the risk of infectious disease.
- Ask your doctor for advice if you have sleep problems, which can significantly affect your behavior.
- Learn how to include physical activity and relaxation exercises as a regular part of your daily routine.
Coping and support
If you or a loved one needs help in coping, consider the tips below. If there's a focus on thoughts of suicide, you or your loved one can call the National Suicide Prevention Lifeline 24-hour crisis line at 800-273-8255 (800-273-TALK).
Coping tips if you self-injure
- Recognize the situations or feelings that might trigger your desire to self-injure. Make a plan for other ways to soothe, distract or get support for yourself so you're ready the next time you feel that urge.
- Connect with others who can support you so that you don't feel alone. For example, reach out to a family member or friend, contact a support group or get in touch with your doctor.
- Learn to express your emotions in positive ways. For example, to help balance your emotions and improve your sense of well-being, become more physically active, practice relaxation techniques, or participate in dance, art or music.
- Avoid alcohol and illegal drugs. They affect your ability to make good decisions and can put you at risk of self-injuring.
- Avoid websites that support or glamorize self-injury. Instead, seek out sites that support your recovery efforts.
Coping tips if your loved one self-injures
- Get informed. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior.
- Try not to judge or criticize. Criticism, yelling, threats or accusations may increase the risk of self-injuring behavior.
- Let your loved one know you care no matter what. Remind the person that he or she is not alone and that you are available to talk. Recognize that you may not change the behavior, but you can help the person find resources, identify coping mechanisms and offer support during treatment.
- Share coping strategy ideas. Your loved one may benefit from hearing strategies you use when feeling distressed. You can also serve as a role model by using appropriate coping strategies.
- Find support. Consider talking to other people who've gone through the same thing you're going through. Share your own experiences with trusted family members or friends and keep in close touch with the professional taking care of your loved one. Ask your friend or loved one's doctor or therapist if there are any local support groups for parents, family members or friends of people who self-injure.
- Take care of yourself, too. Take some time to do the things you enjoy doing, and get adequate rest and physical activity.
There is no sure way to prevent your loved one's self-injuring behavior. But reducing the risk of self-injury may include strategies that involve both individuals and communities — for example, parents, schools, medical professionals, supervisors, co-workers and coaches:
- Identify people most at risk and offer help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
- Encourage expansion of social networks. Many people who self-injure feel lonely and disconnected. Forming connections to people who don't self-injure can improve relationship and communication skills.
- Raise awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury and what to do when they suspect it. Documentaries, multimedia-based educational programs and group discussions are helpful strategies.
- Promote programs that encourage peers to seek help. Peers tend to be loyal to friends even when they know a friend is in crisis. Programs that encourage youths to reach out to adults may chip away at social norms supporting secrecy.
- Offer education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.
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