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A guide to realizing if your child is at-risk, displaying self-destructive behaviors, and needs your help and intervention.
Practical Help, Real Answers for Adoptive & Foster Parents
The Adoptive & Foster Parent Guide: Help Your Child Heal From Trauma & Loss
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What is SELF-INJURY? What is self-injurious behavior? Why does self-injury make some people feel better? What kinds of people self-injure? Aren't people who would deliberately cut or burn themselves psychotic? Is self-injury a failed suicide attempt? What problems may be encountered when getting professional help? What problems may be encountered in the emergency room? Can anything be done for people who hurt themselves? Help and Support - More Information on Self-Injury
It's called many things -- self-inflicted violence, self-injury, self-harm, parasuicide, delicate cutting, self-abuse, self-mutilation (this last particularly seems to annoy people who self-injure).
Broadly speaking, self-injury is the act of attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to one's body.
What is self-injurious behavior?
The forms and severity of self-injury can vary, although the most commonly-seen behavior is cutting, burning, and head-banging.
Other forms of self-injurious behavior include:
It's not self-injury if the primary purpose is:
Why does self-injury make some people feel better?
What kinds of people self-injure?
Self-injurers come from all walks of life and all economic brackets, although most come from a middle-class to upper-class background. People who harm themselves can be male or female; straight, gay, or bisexual; Ph.D.s or high-school dropouts or high-school students; rich or poor; from any country in the world.
Some people who self-injure manage to function effectively in demanding jobs; they are teachers, therapists, medical professionals, lawyers, professors, engineers. Some are on disability. Their ages range from early teens to early 60s.
Nearly 50% report physical abuse and/or sexual abuse during his or her childhood. Many self-injurers report that they were discouraged from expressing emotions, particularly anger or sadness.
The incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses ready when someone asks about the scars.
Aren't people who would deliberately cut or burn themselves psychotic?
No more than people who drown their sorrows in a bottle of vodka are. It's a coping mechanism, just not one that's as understandable to most people or as accepted by society as alcoholism, drug abuse, overeating, anorexia and bulimia, workaholism, smoking cigarettes, and other forms of problem avoidance.
Okay, then isn't it just another way to describe a failed suicide attempt?
NO. Self-injury is a maladaptive coping mechanism, a way to stay alive. People who inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity -- it's a way to keep from killing themselves. They release unbearable feelings and pressures through self-harm, and that eases their urge toward suicide. And, although some people who self-injure do later attempt suicide, they almost always use a method different from their preferred method of self-harm.
What problems may be encountered when getting professional help?
Self-injury brings out many uncomfortable feelings in people who don't do it: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.
People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers.
What problems may be encountered in the emergency room?
In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.
Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer already feels.
Although offering mental health follow-up services is appropriate, psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is clearly a danger to his/her own life or to others. In places where people know that self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.
Can anything be done for people who hurt themselves?
Yes. Several websites offer self-help ideas. Many new therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms and teach them how to start using those techniques instead of self-injury. These approaches reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury. Also, research into medications that stabilize mood, ease depression, and calm anxiety is being done; some of these drugs may help reduce the urge to self-harm.
This does not mean that individuals should be coerced into stopping self-injury. Any attempts to reduce or control the amount of self-harm a person does should be based on the person's willingness to undertake the difficult work of controlling and/or stopping self-injury. Treatment should not be based on a practitioner's personal feelings about the practice of self-harm.
© Deb Martinson
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Feelings of wanting to die or suicidal plans are reasons for parents to IMMEDIATELY seek professional care for their child.
Why Do Teens Self-Injure?
Teens who have difficulty talking about their feelings -- or who feel they are not allowed to do so -- may show their emotional tension, physical discomfort, pain, and low self-esteem with self-injurious behaviors. Although they may feel like the "steam" in the "pressure cooker" has been released following the act of hurting themselves, teenagers may also feel hurt, anger, fear and hate.
Most teens who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.
What Can Parents Do About Self-Injury?
Parents must listen to their child and acknowledge their child's feelings. (In other words, parents should validate feelings -- not the self-destructive behavior.)
Parents should also serve as role models in the way they deal with stressful situations and traumatic events, in how they respond to other people, by not allowing abuse or violence in the home, and by not engaging in acts of self-harm.
Evaluation by a mental health professional may assist in identifying and treating the underlying causes of self-injury. A mental health professional can also diagnose and treat any mental health disorders that may accompany self-injurious behavior.
Are you a teen or adult survivor of rape, sexual assault or sexual abuse? Are you a parent with a teen who has suffered a traumatic experience?
In-Person, Group, Phone, Skype Specializing in adolescents & adults who have been sexually abused
The Scarred Soul: Understanding and Ending Self-Inflicted Violence by Tracy Alderman
Scars That Wound, Scars That Heal: A Journey Out of Self-Injury by Jan Kern
Door of Hope for Teens ~ Free online and phone support for teenage girls and young women who struggle with self-injury. TEXT or CALL 615-746-7319 or 914-393-1904
Equilibrium ~ User-led self injury awareness organization designed to help educate and support people who self harm and their family and friends.
Lysamena Project on Self-Injury - Christian-based self-injury resources and information,
National Self Harm Network ~ UK-based organization that supports survivors, people who self-harm, and their family and friends.
RecoverYourLife ~ One of the biggest Self-Harm Support Communities on the Internet
Secret Shame ~ Self-injury information and support.
To Write Love On Her Arms ~ This is a story that began as a response to the story of Renee, a young woman who was suffering and struggling with self-destructive behaviors. It is now an amazing movement and outreach of love that offers hope and is committed to answering the needs of those who struggle with depression, addiction, suicide, and self-injury.
Trichotillomania Learning Center- Information, support, and resource referrals on trichotillomania (TTM) or compulsive hair-pulling.
More Information on Self-Injury
A Look at the Increase in Body Focused Behaviors (pdf) ~ Thought-provoking article on the connection between piercing, tattooing, body jobs, and self-injury.
Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults ~ Cornell University's research program aimed at establishing the prevalence of SIB in non-clinical samples of young adults and adolescents and applying developmental, public health, and social contagion frameworks to understand the behavior and its causes.
Diagnoses Associated with Self-Injury ~ People who engage in repetitive self-injury have reported being diagnosed with depression, bipolar disorder, anorexia and bulimia, obsessive-compulsive disorder, post-traumatic stress disorder, many of the dissociative disorders (including depersonalization disorder, dissociative disorder not otherwise specified, and MPD/DID), anxiety and panic disorders, and impulse-control disorders.
Double Whammy: Eating Disorders, Self-Injury Linked ~ A study suggests eating disorders and behaviors like cutting are linked, and also that people with eating disorders need to be more carefully screened for such behaviors
Long-term effects of self-harm ~ Self-harm doesn't just cause instant relief or instant damage; there can be long-term damaging effects, too.
Recovering from Self-Injury (pdf) ~ Excellent fact sheet on the recovery process from self-injurious behavior.
Self-Injury/Cutting ~ Fact sheet from the Mayo Clinic.
Self-Injury and People with Learning Disabilities (pdf) ~ This research project looked at the perspectives of people with learning disabilities who self-injure. This is the first time a study has actually asked people with learning disabilities throughout the UK about their own understandings of their self-injury and what would help them.
Self-Injury in Children ~ Though uncommon, children as young as preschool age have intentionally hurt themselves. Children who self-injure usually have experienced abuse, neglect, violence, or trauma such as the death of a loved one or involvement in a car accident.
Self-Injury: One Family's Story ~ A mother and daughter tell their story about self-harm and how they finally got the strength to get help.
Speaking the soul: Why kids cut and what we can do about it ~ An estimated one in five secondary school and college age youth have intentionally cut, burn, carve, bruise, or otherwise injured their bodies without the intention of committing suicide. Indeed, lifetime rates of self-injury in adolescents (estimates range from 13% to 25%) qualify as an epidemic. Here are some insights into self-injurious behavior and ways to understand, help, and support the self-injurer.
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