Self-harm, self-mutilation, self-abuse or self-injury refer to harming the body on purpose. It may also be referred to as “cutting” as this is a common means of self-injury, however, it is by no means the only way an individual may engage in self-harm. For the most part, someone engaging in self-abuse does not intend to kill themselves, and when this happens it is usually by accident, not intent.
The typical age of onset for self-injury is in the late teens or early adulthood; however, this depends on the purpose of the self-injury. This behavior may serve as an attention getting measure, to stop other negative behaviors that are occurring in the environment, as a means of self-soothing or decreasing anxiety, or when the individual suffers from the symptoms of dissociation, as a means of remaining grounded.
The most recent research suggests the non-suicidal self-injury occurs in approximately 1% to 4% of the adult population. The prevalence of severe and chronic self-harm has been estimated at about 1% of the adult population. There is a particularly high rate among adolescents as 15% have reported engaging in a form of self- harm. The highest prevalence rates are found in college students with estimates ranging from 17% – 35%. Research suggests no gender differences in the prevalence rates of self-injury, however, women are more likely to cut themselves while men are more likely to hit themselves. Both genders report high rates of burning themselves. The highest rates of hospitalization for self-injurious behaviors occurs at 20-29 years of age. These prevalence rates are considered significant underestimates of the problem as the behavior serves a function for those who engage in it and therefore, many may not disclose the behavior to others unless they are also engaging in self-harm. In fact, it has been hypothesized that the vast majority of those engaging in self-injurious behaviors never seek treatment.
Self-injurious behavior is a serious problem that frequently occurs with other disorder. While there are a number of disorders and conditions that co-occur with self-harm, certain disorders are associated with more severe and higher rates of these behaviors. These include:
- Dissociation and dissociative disorders
- Eating disorders (anorexia nervosa, bulimia nervosa)
- Major depression
- Substance use disorders
- PTSD and other stress-related disorders
- Borderline personality disorder
- Autism spectrum disorders
- Mental retardation
Causes of Self-Injury
There is no single cause that leads to self-harm. Some of the leading hypotheses regarding causes are:
- Learning – This theory states that positive or negative reinforcement establishes and maintains the behavior. Reinforcement is something that always increases a behavior. Positive reinforcement, or receiving something rewarding following a behavior, is believed to result when self-harm results in a sense of relaxation or elevated mood due to the release of endorphins. Additionally, if the behavior is performed where others can observe it, self-harm can result in desired attention and care. Negative reinforcement, or having something negative removed following the behavior, occurs when individuals experience a reduction in distress, negative emotions or the ability to avoid troubling thoughts.
- Coping Strategy – Often self-injurious behaviors are a coping strategy for individuals who have not learned more adaptive ones. They may be attempting to cope with problems regarding self-identity or feeling as if they can’t find a place in society they feel they belong. Other times they may be coping with the pain of a loss through death or divorce or possibly a history of abuse and/or neglect. Essentially, when this is the only coping strategy someone has, they will use it whenever they are faced with a stressful situation.
- Emotional Regulation – Some individuals have difficulty dealing with severe distress, and anxiety. Self- injury appears to provide these individuals with a sense of tension release and relief from distressing emotions.
- Distraction/Avoidance – Other individuals who are in severe emotional pain and distress may use the pain produced from self-harm to distract themselves from negative emotions or even to avoid the negative emotions by using self-harm behavior as soon as they sense a negative mood is about to begin.
- Control – Some individuals feel their life is out of their control through the actions of others who are overbearing or due to the sense their life is unpredictable and there is nothing they can do to restore a sense of control over the major things in their lives. For these individuals, self-harm is the one thing they feel they can control completely. They can hide their actions so no one can prevent them from engaging in the behavior, and they can make the decisions about where and how to injure themselves.
- Create Sensation – When individuals feel emotionally numb often they become desperate to feel anything, even pain. Sometimes pain can trigger emotions related to memories, albeit the emotions are likely negative or the pain may cause endorphins to be reduced, decreasing the pain and causing a sense of muted euphoria.
- Express Emotions– Sometimes men and women never learned to identify, label or properly express emotions in childhood. This could have been due to a family that taught them that expressing emotions was not acceptable. Yet we all need a way to express what we are feeling. Thus, not knowing the words or even the emotional labels that correspond to what they are feeling, they may use self-harm as a manner of indicating all negative emotions or general distress.
- Compensation for the Inability to Fight Back – In some families, children are forced to take verbal abuse while not being allowed to respond or fight back. As they grow up this cycle continues until they discover that harming themselves in front of the abuser stops the argument immediately and often rids them of the abuser’s presence.
- Punishment – Individuals who have grown up with the message there is something wrong with them or who are severely depressed and have similar thoughts often feel guilty, inadequate, worthless, guilty may come to internalize these beliefs, ultimately developing the perception that they are filled with flaws and sins. These individuals may use self-harm as a means of punishment for these faulty perceptions of a life filled with perceived transgressions.
Regardless of what the cause or reason is behind the self-injurious behavior, it’s important to remember that it is serving an important function for the individual and it’s critical to provide them with numerous coping strategies, emotional regulation skills and relaxation exercises prior to working towards removing the self- injurious behavior you might be doing more harm than good.
Signs and Symptoms of Self-Harm
While there are numerous signs and symptoms of self- harm, the most prominent ones include:
- Engaging in self- harm behaviors multiple times that cause bleeding, bruising or pain
- An expectation that the behavior will only result in minor to moderate physical harm
- The individual expects one of three outcomes to result from the behavior:
- Gaining relief from a negative mood or emotion, of a distressing cognitive state
- To end a problematic interpersonal situation
- To cause a positive mood state such as a sense of peacefulness or feelings of euphoria
- Interpersonal conflicts, negative emotions, distressing cognitions, tension or a sense of guilt or the belief that the individual is a bad person immediately precedes the self-harm for a period of time
- Becoming preoccupied with the self-harm behavior prior to engaging in it and the pre-occupation is difficult or impossible for the individual to control
- Frequent thoughts of self-harm even when the individual does not intend to act on them at that time
- The individual chooses areas where they can inflict shallow yet painful injuries
- The behavior causes significant distress
- The behavior interferes with the individual’s ability to function normally in social, school, work or other important areas
There are a number of negative consequence to self- injurious behavior that may be short lived or cause permanent damage. These include:
- Broken bones
- Permanent scarring
- Frequent wounds that can become infected
- The need to create multiple excuses and methods of hiding the behavior resulting in fear of discovery leading to social isolation. For example, the individual may claim they are clumsy and have a lot of accidents or dress in a concealing manner even in hot weather.
- Persistent interpersonal problems leading to avoidance of friends and families
- Intense anxiety and fear that someone will find out
- Depression related to their inability to stop engaging in the behavior despite knowing it isn’t adaptive
- Feelings of helplessness, hopelessness, and worthlessness due to either the inability to stop engaging in the behavior which reinforces their belief that they are flawed or related to the reasons they feel the need to punish themselves through the behavior
- Drug or alcohol abuse to self- medicate, which may become a substance abuse disorder; Use of drugs or alcohol can sometimes lead to a severe injury or even death when the individual still feels compelled to engage in self- harm while using the drug
- Underlying problems becoming worse or thoughts related to the problems becoming frequent until intrusive leading to worsening self-harm
At Riverwoods, we understand how difficult it can be to trust someone enough so that you are willing to disclose behaviors you have relied on or kept secret for some time. We will never attempt to make you stop the behavior before making sure you have a multitude of options to successfully replace the behavior. You can live a happy life without the need to harm yourself, and at Riverwoods, we can begin to teach you how to do so.