Symptoms
Self-harm is not always easy to detect because people often try to hide it. Some signs that a person might be self-injuring include:
Scars that occur in a pattern, sometimes restricted to one area of the bodyKeeping sharp objects, such as knives, needles, or razor blades, on handFresh scars, scratches, bite marks, or bruisesRepeatedly rubbing one area of the bodyWearing long sleeves and pants even in very hot weatherLow self-esteemNegative self-talk, statements of hopelessnessFeelings of worthlessnessUnpredictable, impulsive behaviorMaking excuses to explain away visible injuries
Methods of self-injury can include:
CuttingBurningScratchingSelf-hittingPinchingHead-bangingPiercing skin with needles or sharp objectsHair pullingInserting objects under the skin
People sometimes only engage in one form of self-injury, but it is not uncommon for multiple methods to be used. The arms are one of the areas that people self-harm most frequently, but other areas of the body including the legs and torso are also common targets.
Causes
Self-harm is a complex condition that has no simple explanation. Although suicidal feelings may accompany self-injury, it does not necessarily indicate a suicide attempt. Most often self-harm is simply a mechanism for coping with emotional distress. People who select this emotional outlet may use it to express feelings, deal with feelings of unreality or numbness, stop flashbacks, punish themselves, or relieve tension. For more mental health resources, see our National Helpline Database. Self-harm is not recognized as a mental illness, but the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists non-suicidal self-injury as a proposed condition under the category of conditions in need of further study. Self-injury is also associated with certain conditions including:
Depression Bipolar disorder OCD Borderline personality disorder PTSD Eating disorders Anxiety disorders Alcohol and substance use
Risk Factors
Risk factors for self-injury include:
Sex: Females are thought to self-injure at a greater rate than males Age: Teens and young adults are more likely to self-harm Mental disorders: Having another mental health condition can increase the risk of self-injury Trauma: Past stress and trauma during childhood can increase the risk of self-injury behaviors Drug and alcohol misuse: Cutting, burning, and other forms of self-harm may occur when a person is under the influence of a substance
Self-injury indicates a lack of coping skills for dealing with severe emotional distress. People who self-harm may struggle to understand and manage their emotions. They also may not have the necessary skills to cope with stress and trauma in healthy ways. Although self-injury such as cutting is recognized as a common problem among the teenage population, it is not limited to adolescents. People of all sexes, nationalities, socio-economic groups, and ages can self-injure. While suicide is not the intent of self-injury, self-harm has a strong association with suicide attempts. In one study of adolescents, 46% who had engaged in non-suicidal self-injury went on to attempt suicide before the age of 21.
Diagnosis
Self-injury is not a recognized disorder, but it is a sign that a person needs help coping. A doctor will start by evaluating whether or not the individual is suicidal and treating any physical injuries that are present. A doctor or therapist will then evaluate the person’s health history including:
The emotions that are associated with the behaviorsHow long the self-injury has been taking placeThe severity and types of injuries that have taken place
The next step is to determine if the individual has a coexisting psychiatric condition and to evaluate if the person is at risk for suicide. Once these assessments have been made, the doctor can make recommendations for treatment.
Treatments
Medications such as antidepressants, mood stabilizers, and anxiolytics may alleviate the underlying feelings that the patient is attempting to cope with through self-injury. In addition to treating any coexisting psychiatric conditions, cognitive-behavior therapy (CBT) can be an effective treatment for non-suicidal self-injury. This type of therapy addresses underlying negative thought patterns as well as the harmful behaviors themselves. Another important aspect of treatment is learning better coping mechanisms to replace the self-harm behaviors. Once the person is stable, therapeutic work should be done to help cope with the underlying problems that are causing their distress. Some experts say that hospitalization or forced stopping of the self-injury is not a helpful treatment. It may make the doctor and involved friends and family feel more comfortable, but does nothing to help the underlying problems. Further, the person is generally neither psychotic nor actively suicidal and will benefit more from working with a doctor who is compassionate to the reasons that they are hurting themselves. A desire to cooperate and get well is a major factor in recovery.
Coping
If someone you know is engaging in cutting or some other form of self-injury, there are things that you can do to offer support and assistance.
Offer non-judgmental support. People who engage in self-harm tend to be self-critical and struggle with feelings of worthlessness. Show that you care and are concerned and encourage the individual to reach out to a parent, counselor, or doctor. You might not understand the behavior, but it is important not to dismiss their emotions.Don’t threaten. If it is a child or teen who is engaging in self-harm, avoid making accusations or threats. Talk to your child’s pediatrician or a mental health professional about what steps you should take next.Encourage them to seek help. Offer to help them find a doctor or mental health professional.
A Word From Verywell
In addition to the risk of accidental life-threatening injuries, self-harm behaviors such as cutting also present a risk of scarring and infection. If you are engaging in self-injury, no matter how minor or infrequent, you should talk to your doctor. Such actions are a sign of a larger problem that needs to be addressed, so the sooner you get help, the better the outcome.
