What Is Self-Harm? Signs and Causes

Self-Harm, also called self-injury or cutting, is when a person purposely inflicts physical injury to themselves. Self-harm is not a mental disorder but can be a symptom of one. Self-harm is risky behavior that can be dangerous and should be taken seriously. 1

what-is-self-harm

What Is Self-Harm? Signs and Causes

Self-Harm, also called self-injury or cutting, is when a person purposely inflicts physical injury to themselves. Self-harm is not a mental disorder but can be a symptom of one. Self-harm is risky behavior that can be dangerous and should be taken seriously. 1

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The resulting injuries from self-harm can range from mild to major, but even “mild” cases of self-harm can result in infections or further damage to the person later on. Self-harm is not the same thing as a suicide attempt, but as a suicide attempt, it can be symptoms of a deeper issue, such as severe anxiety or depression.2 Self-Harm can present in people of all ages, but it tends to begin during the teenage years, or in young adulthood.2 If you or someone you care about are self-harming, there are resources to help, and relief can be had.

How Do People Self-Harm?

There are many methods people use to self-harm themselves. Some of those methods are:

  • Cutting themselves with knives or other sharp objects
  • Punching walls and other hard surfaces, or punching themselves
  • Burning themselves with matches, cigarettes, or a hot stovetop
  • Pulling out their hair
  • Poking objects into body openings 5
People who self-harm are feeling emotional pain that they don’t have the tools or experience to deal with. Self-harm is a way of soothing those feelings. The sensation of physical pain can actually be a relief or distraction from emotions that are too overwhelming or difficult to face. Some people who self-harm report feeling numb or empty inside, and inflicting physical pain on themselves is a way to at least feel something. 5

Signs and Symptoms of Self-Harm

People who self-harm often feel embarrassed or ashamed of their behavior, and will go through great lengths to hide it. If you worry that someone you care about is harming themselves, some of the signs you can look for include:

  • Unexplained cuts and bruises on their bodies
  • Secretiveness; hiding sharp objects for no apparent reason
  • Changes in mood
  • Changes in appetite or sleeping habits
  • Withdrawal from activities, such as sports or school clubs
  • Wearing long sleeves or jackets, even when the weather is warm
  • An unwillingness to socialize, or partake in activities that they used to enjoy 2

If you suspect that someone is self-harming, they are going to need support and understanding. You want to avoid expressing anger or judgment, but instead, show compassion and a willingness to listen. Professional intervention from a therapist or a physician may be necessary since self-harming is often a sign of something deeply troubling going on beneath the surface, so overwhelming that it creates the urge to hurt themselves.2

Who Is at Risk of Self-Harm?

Occasionally self-harming is a fluke thing – something a teenager tries once or twice because of peer pressure, or to mimic something they’ve seen on television. Some teens report their self-harming as an act of rebellion, or an experiment.5

However, there are often larger issues at play, sometimes in the form of personality disorders, substance abuse issues, or Post-Traumatic Stress Disorder (PTSD).

Kat describes herself as a cutter. She is in her mid-thirties now, and no longer self-harms. She reports cutting herself on and off from ages 13-19. She had this to say:

When my parents divorced I was completely overwhelmed with negative feelings. I didn’t know what those feelings were, and I certainly didn’t know how to express them. Sometimes I felt so much pain inside I thought I was going to explode. One day I just randomly picked up a knife and sliced my leg a little bit. It wasn’t a deep cut, but it somehow made me feel better. I felt much calmer, almost euphoric. It was like the physical pain let some of the emotional pain leak out. I never planned on cutting myself, it was always very compulsive, almost unexpected. And my intention was not to hurt myself – I was desperately trying to make myself feel better. When I drank alcohol or took drugs it was more likely that I would cut myself, and those cuts would usually be deeper.

Kat

Self-Harm and Substance Abuse

People who drink alcohol or take other drugs are more likely to self-harm than those who do not. Alcohol and other drugs can lower inhibitions, as well as contribute to compulsive and dangerous behaviors since it minimizes the fear of consequences.8

Poor decision-making and impulsive behaviors are risk factors for self-harm on their own.8 Intoxication can exacerbate those attributes, making self-harm even more likely to occur. When inhibitions are lowered and one is not thinking clearly, the desire to self-harm can become overwhelming, and in some cases the injuries will be more severe.

Is Self-Harm an Addiction?

Self-harm may become an addictive behavior in itself. Some people start craving the feelings of euphoria, and the release of endorphins that can occur during self-harm. Just like with addiction to alcohol and drugs, self-harm can be progressive – the sufferer may need to self-injure more often, and more severely in order to get those same feelings of relief and release.8

Also similar to abusing alcohol and other drugs, self-harming can lead to feelings of deep shame. That shame and regret can trigger even more urges to self-harm, and so the spiral continues.

People who self-harm refer to their activities very similarly to those who speak of substance addiction. The need to cut or injure themselves may become stronger the longer they abstain. They speak of “triggers”, or troubling events that create the urge to self-injure. They speak of being “self-injury free” for days or even weeks at a time, but without intervention it is difficult to stop.8

Self-Harm and Mental Disorders

Self-harm does not cause mental disorders, nor does everyone with a mental disorder self-injure themselves. The two often coexist however, and it’s important to take a look at some of the disorders that are most frequently linked to self-harm.

Depression

Borderline Personality Disorder (BPD)

Eating Disorders

Post-Traumatic Stress Disorder (PTSD)

Depression

Depression is characterized as a mental disorder and can leave the sufferer feeling empty, hopeless, and disassociated. Depressed people may overeat or abstain from eating; have trouble sleeping, or sleep too much. They may lose pleasure in activities they used to enjoy, and in extreme cases feel suicidal. Emptiness, sometimes described as a “void”, can lead to the desperation to feel something – anything at all and cutting or self-injury can make one feel “alive” again. The physical pain can tether someone back to the world, and the endorphins can temporarily ease the darkness of relentless depression.11 

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder occurs after experiencing a traumatic event. That event can be life-threatening – such as a serious car wreck, the loss of a loved one, or sexual assault. Countless different experiences can lead to PTSD, and sufferers can experience many different symptoms as a result; depression, avoidance, hypervigilance, and insomnia to name just a few. Self-harm can be a way to release some of that angst, or to feel in control again.

Borderline Personality Disorder (BPD)

Borderline Personality Disorder presents with extreme mood swings, distorted self-image, and erratic behavior. People with BPD may have trouble forming or maintaining meaningful relationships. They may experience severe anxiety and depression, and bursts of uncontrollable anger. BPD sufferers tend towards impulsivity and dangerous behaviors, including substance abuse and self-harming. Please note that BPD needs to be diagnosed by a professional; just because someone is moody or reckless does not mean they have a personality disorder.12 , 2 

Eating Disorders

Eating Disorders can include eating too much (binge-eating), not eating enough (anorexia nervosa), or purging (bulimia nervosa). All of these are symptoms of a mental disorder characterized by distorted thinking and behavior with regard to food. People of all ages and sexes can present with an eating disorder, and they can be caused by a combination of genetic, environmental and social factors. Feeling the need to control things can contribute to eating disorders, which is where self-harm may come in. There can also be a lot of shame involved, and self-injury may be a compulsive way to release some of those overwhelming feelings of shame and regret. 2 

Self-Harm and Suicide

The technical term for Self-Harm is Non-Suicidal Self-Injury (NSSI).12  Acts of self-harm are not characterized as suicide attempts. People who self-injure themselves are seeking relief from emotional distress that seems unmanageable, but ending their lives is not the intention behind the action. This can be confusing, especially for parents or other loved ones who witness self-harm. Suicide attempts and self-harm may look very similar to those on the outside looking in. The important distinction is that self-harmers are looking to feel better, while a suicide attempt is a sign that a person has given up hope of ever feeling better. Here are some ways to distinguish acts of self-harm from suicide attempts:

Inention

People who self-harm are trying to feel better. People who attempt suicide don’t think they will ever feel better – this is why suicide feels like the only option.

Methods

Injuries resulting from self-harm are generally superficial, involving the surface of the body. Rarely are the injuries life-threatening, or even require medical treatment (Life-threatening injuries can occur, but it is not typical).

Suicide attempts involve potentially lethal methods, such as swallowing pills, that have more adverse and lasting effects, even when the attempt fails.

Frequency & Lethality

Self-harm is a coping mechanism and can occur quite frequently, sometimes even daily. In severe cases, people may acquire scars from cutting or even break a bone, but generally, self-harm wounds are superficial.

Suicide attempts are rare, and typically much more damaging to the body than self-harm. Recovering from a suicide attempt is more intensive than recovering from an act of self-harm.

Level of Emotional Distress

Self-harm is a coping mechanism used to ease psychological pain and to make it easier to function. People who self-harm want to feel better about life – they haven’t completely given up on it.

People who attempt suicide feel completely hopeless, and no longer wish to keep going through the motions. They can’t see any possible way out of their pain, and it is seemingly endless.

The End Result

Self-injury can actually lead to a temporary improvement in mood and ability to function. It is fleeting relief, and exceedingly unhealthy, but does not usually lead to serious injury or death. A failed suicide attempt results in the exact opposite of mental improvement. Now, not only is the person in severe emotional and psychological pain, but they are physically damaged as well. Recovering from a suicide attempt requires incredible strength, and a willingness to get help so that it doesn’t happen again.12 

How to Stop Self-Harming

There are many different reasons that people self-harm, and there isn’t always a mental disorder behind those reasons. Some people who have poor impulse control think that self-harming is the only thing that helps, or they simply lack the tools for managing their emotions in a healthy way.

There are other ways to self-soothe, and to ease the burden of overwhelming emotions; ways that don’t cause physical injury. Emotions are temporary, they won’t last forever. Here are some suggestions for minimizing the occurrence of self-harm, and perhaps even ceasing it all together:

Physical Distraction

If you need a physical expression of inner anxiety or pain try finding other outlets that won’t hurt you. Rip up a bunch of paper, invest in a stress ball or two, dig your hands deep into clay, or build a sandcastle. You can try rubbing an ice cube on your skin to help ease the compulsion to cut.

Connect

Feeling alone and isolated is never a good thing for those in emotional distress. Try and find a connection with someone or something. Call a friend, play with your pet, perhaps even delve into a good book or a movie you know will make you laugh. It can help to get out of your head and focus on something outside of yourself until the impulse to self-injure subsides. 5 

Exercise

Get some exercise. Walk or run around the block, jump rope or kick a punching bag. Exercise produces endorphins, one of the things that contribute to the “feel good” aspect of self-harm.

Relax

If you’re in need of soothing or comfort, try some relaxation techniques. Take a shower or bath, cuddle with your dog, listen to some music that you love. Baking can be very calming, so can painting or knitting. It is important to discover self-soothing techniques that don’t cause injury or harm.

Remember, many people who self-harm do suffer from severe depression, PTSD, or other mental and emotional disorders. These tips aren’t going to help get to the root of the behavior in those cases. It is important to seek professional help when self-harming becomes unmanageable.

Treatment for Self-Harming

Depending on the root cause that compels someone to self-harm, treatment options can vary. For some, lifestyle changes will be enough. Learning to cope with troubling emotions with the help of exercise, healthy eating, sleeping enough and sustaining healthy and supportive relationships can do a lot towards ensuring that self-harming becomes a thing of the past.

For others, such as those who have experienced trauma, or suffer from chronic depression, therapy may be necessary for helping to alleviate the compulsion to self-harm.

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is based on the principle that psychological problems stem from faulty or unhelpful ways of thinking and behaving. In CBT people learn how to recognize those problematic thoughts and behaviors, and replace them with tools for coping with difficult situations and emotions. CBT helps individuals relearn to think about troubling situations or feelings that would normally overwhelm them. Healthier coping strategies will be attained, as well as a better perspective of oneself and the motivations of other people. Learning new techniques for reacting to the world around them can help those who have used self-harming as a means for dealing with emotional and situational difficulties.15 

Dialectical Behavioral Therapy (DBT)

Dialectical behavioral therapy is a form of therapy that was first developed to treat suicidal patients with Borderline Personality Disorder. It is now used to treat many different disorders, including addiction, PTSD, and eating disorders.

DBT focuses on teaching people specific life skills that will aid in better dealing with feelings and situations that used to be overwhelming and led to dangerous behaviors. Those skills are mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. 16  Incorporating these skills into ones daily life will help those who self-harm react to their specific triggers with healthier and less dangerous coping skills.

Whether you, your child, a friend, or a loved one is struggling with self-injury or self-harm, know that you are not alone, and there is help available. Self-harm can be treated; countless people have addressed their self-harming tendencies and gone on to live perfectly normal, functioning happy and fulfilling lives.

References

  1. Self-harm. (n.d.). Retrieved from https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm
  2. Self-Harm. (2021, March 15). Retrieved from https://medlineplus.gov/selfharm.html
  3. VA.gov: Veterans Affairs. (2018, August 03). Retrieved from https://www.ptsd.va.gov/understand/related/self_harm.asp
  4. Lyness, D. (Ed.). (2015, July). Cutting (for Teens) – Nemours KidsHealth. Retrieved from https://kidshealth.org/en/teens/cutting.html
  5. Lyness, D. (Ed.). (2015, July). How Can I Stop Cutting? (for Teens) – Nemours KidsHealth. Retrieved from https://kidshealth.org/en/teens/resisting-cutting.html
  6. Girls Health(n.d.). Retrieved from https://www.girlshealth.gov/feelings/sad/cutting.html
  7. Self-harm and self-injury. (n.d.). Retrieved from https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/self-harm
  8. Deliberate Self-Harm, Substance Use, and Negative Affect in Nonclinical Samples: A Systematic Review. (n.d.). Retrieved from https://www.tandfonline.com/doi/abs/10.1080/08897077.2012.693462
  9. Self-injury & Recovery Resources (SIRR). (n.d.). Retrieved from http://www.selfinjury.bctr.cornell.edu/about-self-injury.html
  10. Oumaya, M., Friedman, S., Pham, A., Abou Abdallah, T., Guelfi, J. D., & Rouillon, F. (2008). Personnalité borderline, automutilations et suicide : revue de la littérature [Borderline personality disorder, self-mutilation and suicide: literature review]. L’Encephale, 34(5), 452–458. https://doi.org/10.1016/j.encep.2007.10.007
  11. Depression. (2021, March 15). Retrieved from https://medlineplus.gov/depression.html
  12. Borderline Personality Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
  13. How Are Self-Injury and Suicide Related? (2020, September 08). Retrieved from https://childmind.org/article/how-are-self-injury-and-suicide-related/
  14. Rachel Ehmke is managing editor at the Child Mind Institute. (2019, May 21). Help for Cutting and Other Self-Injury. Retrieved from https://childmind.org/article/what-drives-self-injury-and-how-to-treat-it/
  15. What Is Cognitive Behavioral Therapy? (n.d.). Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
  16. About Us. (n.d.). Retrieved from https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

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