Self-Injury: Types, Causes and Treatment

by Arthur Buchanan

There is no simple portrait of a person who intentionally injures him/herself. This behavior is not limited by gender, race, education, age, sexual orientation, socio-economics, or religion. However, there are some commonly seen factors:

Self-injury more commonly occurs in adolescent females. Many self-injurers have a history of physical, emotional or sexual abuse. Many self-injurers have co-existing problems of substance abuse, obsessive-compulsive disorder (or compulsive alone), or eating disorders. Self-injuring individuals were often raised in families that discouraged expression of anger, and tend to lack skills to express their emotions. Self-injurers often lack a good social support network. What are the types of self-injury? The most common ways that people self-injure are:

• cutting burning (or "branding" with hot objects)
• picking at skin or re-opening wounds hair-pulling (trichotillomania)
• hitting (with hammer or other object)
• bone-breaking head-banging (more often seen in autistic, severely retarded or psychotic people)
• multiple piercing or multiple tattooing

Throughout history, various cultures have intentionally created marks on the body for cultural or religious purposes. Some adolescents, especially if they are with a group engaging in such practices, may see this as a ritual or rite of passage into the group. However, beyond a first experiment in such behavior, continued bodily harm is self-abusive. Most self-injuring adolescents act alone, not in groups, and hide their behavior. There are also some more extreme types of self-mutilation, such as castration or amputation, which are rare and are associated with psychosis.

How does self-injury become addictive?

A person who becomes a habitual self-injurer usually follows a common progression:

• the first incident may occur by accident, or after seeing or hearing of others who engage in self-injury the person has strong feelings such as anger, fear, anxiety, or dread before an injuring event
• these feelings build, and the person has no way to express or address them directly
• cutting or other self-injury provides a sense of relief, a release of the mounting tension
• a feeling of guilt and shame usually follows the event
• the person hides the tools used to injure, and covers up the evidence, often by wearing long sleeves
• the next time a similar strong feeling arises, the person has been "conditioned" to seek relief in the same way
• the feelings of shame paradoxically lead to continued self-injurious behavior
• the person feels compelled to repeat self-harm, which is likely to increase in frequency and degree

Why do people engage in self-injury?

Even though there is the possibility that a self-inflicted injury may result in life-threatening damage, self injury is not suicidal behavior. Although the person may not recognize the connection, SI usually occurs when facing what seems like overwhelming or distressing feelings. The reasons self-injurers give for this behavior vary:

• self-injury temporarily relieves intense feelings, pressure or anxiety
• self-injury provides a sense of being real, being alive - of feeling something
• injuring oneself is a way to externalize emotional internal pain - to feel pain on the outside instead of the inside
• self-injury is a way to control and manage pain - unlike the pain experienced through physical or sexual abuse
• self-injury is a way to break emotional numbness (the self-anesthesia that allows someone to cut without feeling pain)
• self-abuse is self-soothing behavior for someone who does not have other means to calm intense emotions
• self-loathing - some self-injurers are punishing themselves for having strong feelings (which they were usually not allowed to express as children), or for a sense that somehow they are bad and undeserving (an outgrowth of abuse and a belief that it was deserved)
• self-injury followed by tending to wounds is a way to express self-care, to be self-nurturing, for someone who never learned how to do that in a more direct way harming oneself can be a way to draw attention to the need for help, to ask for assistance in an indirect way
• sometimes self-injury is an attempt to affect others - to manipulate them, make them feel guilty or bad, make them care, or make them go away

What is the relationship between self-injury and suicide?

Self-injury is not suicidal behavior. In fact, it may be a way to reduce the tension that, left unattended, could result in an actual suicide attempt. Self-injury is the best way the individual knows to self-sooth. It may represent the best attempt the person has at creating the least damage. However, self-injury is highly linked to poor sense of self-worth, and over time, that depressed feeling can evolve into suicidal attempts. And sometimes self-harm may accidentally go farther than intended, and a life-threatening injury may result.