Self-Injury and Self-Harm

What Is Self-Harm?

Self-harm, also known as non-suicidal self-injury (NSSI), is deliberate, self-inflicted harm on the body that causes tissue damage or leaves marks such as bruises, wounds, scabs, or scrapes for some time. It means hurting yourself on purpose.

People who engage in self-harm usually do not have the intent to commit suicide. However, suicidal feelings may accompany self-harm even though self-harming behaviors do not specifically indicate suicide attempts.

A typical example of self-harm behavior is cutting, where people use a sharp object such as a razor or knife to cut into the skin and/or tissue. People often cut because they are deeply struggling to cope with intense emotions, past traumas, or underlying mental health disorders, and self-harm as a way to control or release these emotions.

People who self-harm often see it as:

• A way to express emotions that cannot be put into words
• An escape from traumatic memories
• A form of punishment for feelings or past experiences
• A way to cope with overwhelming emotions
• A way to transform emotional pain into physical pain

Self-harm is not itself a mental health disorder, but it is a sign of mental distress. There is a lot of stigma and falsehood associated with self-injury behaviors, and it is important to raise awareness about self-harm so we can break down the stigma and barriers to treatment.

Common Methods of Self-Injury

Although cutting is the most common and documented form of self-harm, there are many different methods of self-injury.

Self-harm can be inflicted on any area of the body, but people most often inflict self-harm on their stomachs, thighs, wrists, and hands. The severity of self-harm can range from superficial scratches to severe scars resulting in permanent disfigurement. Studies have shown that up to one-third of college students who engaged in self-harm said their wounds were severe enough that a medical professional should have seen them. Still, only 6.5% of college students seek medical attention for their self-inflicted wounds.

Common methods of self-injury include:

• Cutting
• Burning yourself
• Scratching yourself
• Biting yourself
• Swallowing pills
• Pulling your hair out
• Punching or hitting yourself
• Sticking objects inside your body
• Swallowing objects or chemicals that should not be swallowed
• Scalding yourself with hot water

It is important to note that what defines self-harm has less to do with the method of self-injury than with the actual act and intention of doing it.

Signs Someone is Self-Harming

There are a lot of falsehoods around self-harm behaviors, one being that people engage in self-harm because they are seeking attention. People who engage in self-harm behaviors often do so in private and will go to great lengths to cover up their wounds or scars.

Self-harm is often a sign that someone is hurting deeply inside and is unable to communicate their feelings of hurt, whether they are embarrassed, ashamed, unable to speak, or feel as though their feelings are not essential or others will not understand them.

The following are signs that someone may be engaging in self-harming behavior:

• Scars on the body (often in a specific pattern or only in one area)
• Wounds in multiple healing stages
• Wearing long sleeves or pants even in hot weather
• Wearing bandages or tape to cover the wounds
• Unpredictable/impulsive behavior
• Making excuses to explain scars and wounds
• Social isolation (making excuses to stay home, distancing oneself from friends, etc.)
• Hiding sharp objects such as knives, razors, etc.
• Talking about feeling worthless or helpless
• Signs of underlying mental health disorders, such as depression or anxiety

Why Do People Self-Harm?

Self-harm is often viewed as a way to express emotions and feelings; people want to feel pain as some form of escape. People self-harm for the following reasons:

To escape their reality

Many people who engage in self-harm feel the weight of the world on their shoulders and use cutting or other self-harm practices to escape from their reality. Self-harm is often used as a temporary outlet for heavy feelings that someone cannot cope with daily.

Inflicting physical pain can help escape these painful feelings, transferring emotional pain to physical pain. Self-harm practices release a temporary surge of dopamine (similar to drug use), which creates a very short sense of euphoria, but this temporary state is replaced by further feelings of guilt and shame, resulting in more emotional pain, creating an unhealthy cycle of escaping reality to numb emotions.

To deal with stress

Any life stressor can cause someone to self-harm, especially if they have unhealthy coping skills. Stressors such as work stress, any form of abuse, financial trouble, loss of a job, living with a neurodivergence such as autism, living with a mental health condition such as depression, or a medical illness or injury are all common stressors that bring someone to self-harm when they feel as though they have no other way to cope or manage their feelings.

To express their emotions

Individuals who are overwhelmed by feelings and do not have the proper coping skills to manage these feelings may self-harm because they find it difficult to put these feelings into words. These individuals may even recognize that these feelings are unhealthy, even shameful, and may be too embarrassed to express them because they are deemed unacceptable by society’s norms. Physical pain can be a distraction from emotional pain.

To be in control

Self-injury is a purposeful act of injuring oneself to feel physical pain; in other words, the person is in control. Many people who feel out of control in their daily lives, whether they are living with an unmanaged mental health disorder, have lost a job, or have suffered a traumatic loss, may often feel they cannot control anything in their life that matters. Self-harm is a way to take back that control.

To punish themselves for things they have done

People who engage in self-harm often feel unworthy or guilty about things in the past that they feel they may have done. Past experiences such as bullying, trauma, and abandonment, even when they are the victim, can induce feelings of guilt, especially when these experiences are not dealt with appropriately. Even if they did nothing wrong, they may feel they deserve to be punished.

They may also want to punish themselves due to displaced anger. Maybe they are angry at their abuser but cannot express to the person how they are feeling, and instead choose to take this anger out as self-punishment.

To distract themselves from past trauma or emotions

Trauma can come in all forms and often brings a lot of negative emotion, mainly when the trauma is not dealt with in a healthy manner. People may inflict self-harm to induce physical pain as a way to temporarily forget and block out the emotions and memories associated with the trauma. Instead of sitting in the present with uncomfortable feelings, self-harm can be an easy distraction to temporarily avoid feelings associated with the trauma, almost an escape. When these emotions begin to bubble to the surface, self-harm can be a way to forget them, but they will come back as soon as the physical pain and euphoric feelings wear off.

Self-Harm and Borderline Personality Disorder

Research suggests that people with borderline personality disorder (BPD) are more at risk for self-harming behavior. BPD is characterized by emotional instability, a distorted sense of self, unstable relationships, fear of abandonment, and self-harm. People with BPD often experience dissociative symptoms and an altered sense of body awareness. They may feel very unattached from their reality and struggle with body distortion.

Experts believe that people with BPD engage in self-harm because it is a way to feel a sense of control and provide intense physical sensation in the form of a way to experience reality and to be connected to oneself.

The Relationship Between Self-harm and Suicide

Sometimes, self-harm attempts are a method to avoid suicidal impulses. Still, more than half of the individuals who engage in deliberate self-harm present with suicidal risks, and although self-harm is not suicide, it can lead to suicidal ideation and action.

Self-harm is an unhealthy coping mechanism to deal with past trauma, feelings of depression, poor self-image, guilt, etc. When self-harm is no longer an effective coping method to deal with these negative feelings, an individual may turn to suicidal ideation. The link between self-harm and suicide is a grey area since, initially, most people who engage in self-harm behaviors do not intend to take their own life, but these feelings can change over time, mainly when self-harming behaviors no longer satisfy the initial reasons why the person self-harms.

If you or a loved one are having thoughts of suicide, you must seek help immediately. The National Suicide Prevention Lifeline is available 24/7 at 800-273-8255.

Who is at Risk?

Many risk factors are linked to self-harm, including:

• Female gender
• Younger in age (teenagers and young adults)
• History of trauma
• Borderline personality disorder
• Substance abuse
• Veteran
• In prison
• Asylum seeker
• Lost a loved one to suicide
• Impulsive behavior
• Poor coping skills
• Depression or other mental health disorders

What are the Risks?

Self-harm can come with many risks and consequences, such as the following:

• Injury to the body needing medical attention, such as infected wounds, severe bleeding, or tissue damage.
• Permanent scarring or disfigurement, which can result in feelings of guilt, shame, and poor self-esteem
• Nerve damage
• Unhealed broken bones
• Anemia
• Social isolation
• Family conflict
• Alcohol and drug use
• Accidental death
• Suicidal ideations

How to Help Someone Who Self-harms

If someone you know is engaging in self-harming behaviors, there are many ways you can offer help and support.

Treatment for self-harm lies in therapy and medication, including antidepressants, mood stabilizers, and anti-anxiety medications that may help to alleviate the underlying feelings and emotions driving the self-harm behaviors.

Therapy approaches include cognitive behavioral therapy, dialectical behavior therapy, and trauma-focused therapy, all of which are practiced and guided by a licensed therapist. As a non-therapist layperson, such as a friend or loved one, there is a lot you can do to support someone who is showing signs of self-harm.

• Educate yourself on self-harm: Learn from credible sources about self-harm to have a better understanding of what your loved one is experiencing.
• Do not judge: It is important not to judge, criticize, or make assumptions.
• Ask open-ended questions: Ask your loved one how they are feeling, what is bothering them, how they are coping, and if they would like to discuss their experiences. Allow them to speak as you listen.
• Let them know you care, no matter what: Although only they can change their behavior, you can offer support by letting your loved one know that you have love and respect for them, you want them to get better, and you are always here to listen and are always available to talk.
• Help them find support: You can assist them in searching for treatment, developing health coping skills, and joining support groups.
• Create a safe space: Remove sharp objects from the home environment.
• Support their treatment plan: Hold them accountable for taking their medication and attending therapy appointments. You can offer to drive them to appointments, wait in the waiting room, or attend support groups with them if allowed.
• Provide healthy coping mechanisms: Whether it’s breathing exercises, going for a walk, exercising, or creating art, you can join them on these little adventures as they learn to adopt these coping mechanisms.
• Practice self-care techniques: It is essential to take care of yourself and communicate with others so you can not only be a sounding board for your loved one but also ensure you can manage and cope with your own emotions.

When To Get Emergency Help

People should seek mental health support if they begin to have feelings of self-harm, and should seek emergency medical help immediately if they are engaging in self-harming behaviors.

If someone is having suicidal ideations or thoughts of harming themselves beyond self-injury behavior, call the National Suicide Prevention Lifeline at 800-273-8255 for help.