Self injury/cutting

DEFINITION

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.

CAUSES

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

SYMPTOMS

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
• Biting
• 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 112 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.