Counseling Resources Online: A Complete Guide to Self Injury
Self-injury refers to the practice of deliberately doing physical harm to one’s own body tissue. Also known as non-suicidal self-injury, self-mutilation, self-harm, or self-abuse, the behavior is often characterized by non-lethal cutting, scratching, interference with wound healing, hair pulling, burning the skin, banging the head into walls, and other means of doing bodily harm. Although statistical data can vary, reports claim that as many as two million individuals in the United States engage in self-mutilation. Worldwide estimates claim that as much as four percent practice the habit of self-injury. While all forms of self-harm can cause serious health risks, those who attempt such behaviors do not normally do so with conscious suicidal intent. Instead, the practice is often done by those who have trouble expressing their feelings or dealing with intense emotions, inflicting physical pain gives them a measure of control. When an individual practices cutting or behaviors associated as a means of body decoration, sexual gratification, or for spiritual ritual, the behavior is generally not associated with self-injury.
Reasons for Self-Injury
The reasons behind self-harm can be complex to understand. Some of the reasons for these injuries include a desire to feel something, a way to communicate, or as an attempt to turn intense uncontrollable emotional pain into physical pain that can be released and coped with. Others who have practiced self-harm have stated that they felt empty inside, lonely, angry, or numb. Many self-injurers are dealing with other untreated issues such as depression, obsessive-compulsive disorder, childhood abuse, substance abuse problems, and eating disorders. Self-injury is a repetitive, unhealthy disorder and although it may provide a measure of relief when done, this reprieve is only temporary. The self-destructive cycle is impulsive and repetitive in nature and becomes an addiction just like alcoholism or substance abuse.
A Self-Injurer Profile
Those who practice self-mutilation are from all backgrounds and do not fit a single profile. Some reports have indicated that self-injurers are more likely to be from middle to upper class backgrounds and of average or above average intelligence. Other reports, however, do not support this assumption. What does appear to be true; however is that those who self-injure are often dealing with low self-esteem. For nearly half of these self-injurers, the feelings are compounded by histories of sexual, mental or physical abuse and neglect. Demographics appear to suggest that there are no significant differences in the rates of self-harm based on race or gender.
Incidence and Onset
Usually, self-injurious behaviors start in adolescence. The typical age of onset is about 14 years of age; however, children who are much younger may also harm themselves. For some, the practice may not start until adulthood and may first begin occurring during their college years. Rates of self-injury differ based on the population being studied and how self-injury is assessed. For instance, some studies estimate that as much as one-quarter of young adults tried self-abuse at some point. In the United Kingdom, for instance, it has been estimated that 1 in 12 young people will practice self-harm at some point. Most of these young adults, however, stop the practice after one or two times. Studies show that about one-percent of the population can be described as chronic self-injurers.
Behavior Patterns and Types of Self-Injury
One of the most well-known types of self-injury is cutting. With cutting, the individual does harm to themselves, by cutting or scratching some part of the body. All types of sharp objects may be used including knifes, scissors, razors blades, or even fingernails. Deliberately inflicting burns on the body with a hot object or applying friction burns by rubbing an object over the skin also occurs with self-injury. Hair pulling and reopening old wounds are both types of self-injury related to impulse control disorders. For some, self-injury is done through hitting, breaking bones, or drinking harmful substances. Some even embed objects into the skin. Additionally, most self-injurers also tend to do bodily harm using multiple methods. Those who self-injure can do so over any part of their body but the arms and legs are usually the area most commonly targeted, since the resultant scars are easy to hide under clothing. If discovered, the self-injurer tends to make excuses about how the injuries occurred.
Although most who self-injure will attempt to keep their injuries secret, there are warning signs that may be visible. Some will wear long sleeves and pants to cover up their scars even in hot weather. They may also be regularly spotted with fresh bruises, scars, cuts, burns, or wounds for which they have no reasonable explanation for their cause or have very flimsy excuses. Some may actually carve words into their body that show low self-esteem and body image issues such as “ugly.” The self-injurer may also display problems in other areas of their life including difficulty maintaining friendships and relationships, mood changes, changes in eating habits, problems keeping up in school, and unsatisfactory performance at work.
Self-harm is a coping mechanism, not a means of attempting suicide but instead, allows the self-injurer to deal with what they are feeling. Suicide, on the other hand, is a deliberate attempt to take one’s life. Although, death is not the aim of self-mutilation the practice can be just as dangerous. For instance, teenagers who cut can end up with staph infections, those who share cutting instruments could end up with hepatitis. Those who self-embed objects underneath the skin can end up with a bone infection. A very deep cut that is not treated soon enough or a head injury causing a concussion can even lead to death. Besides accidental death associated with self-injury, the intensity of the underlying psychological condition such as depression, the lack of impulse control, and feelings of alienation can cause those who self-injure to progress to suicide attempts.
Help for self-injury starts with getting the condition diagnosed. Sometimes, self-injurious behaviors are accidentally discovered when individuals make a visit to the emergency room after unintentionally injuring themselves more than they intended too. For instance, a cutter may inadvertently slip when cutting their arm with a knife and cause a large, deep cut that needs stitching. In other situations, however, the self-injurer, a family member, friend, teacher or co-worker may take action. If self-injury is suspected, a visit to a mental health professional, preferably one that specializes in self-injury, is the only way to get an accurate diagnosis. These professionals can determine if self-harm is a symptom of mental illness such as Bipolar Disorder. After evaluating the self-injurer, the health care professional can determine a course of treatment best suited to breaking the addictive nature of the condition.
There are various means of treating self-injury. After speaking with a self-harmer to determine why they injure themselves, the self-injury expert, may recommend inpatient treatment, or outpatient therapy. If the self-mutilation has progressed to the point that an individual’s life is being threatened, a residential treatment program may be considered. Such programs often use a multidisciplinary approach to healing and may involve individual, group, and family therapy to help self-injurers overcome their self-destructive behaviors and understand how to better deal with their emotions. These programs also attempt to help the self-injurer avoid doing any self-harm for the course of their treatment. Some individuals may also use self-help strategies to help resist the urge to self-harm such as hitting pillows or snapping elastic bands on the wrist instead of cutting. Other alternative treatments that have been used include interacting with friends, developing new hobbies, listening to music, joining support groups and starting a diary.