Self-Injury
Self-Injury is also termed self-mutilation, self-harm or
self-abuse. The behavior is defined as the deliberate, repetitive,
impulsive, non-lethal harming of one’s self. Self-injury
includes:
These behaviors, which pose serious risks, may by symptoms of a
mental health problem that can be treated.
Warning Signs
Warning signs that someone is injuring themselves include:
unexplained frequent injury including cuts and burns, wearing long
pants and sleeves in warm weather, low self-esteem, difficulty
handling feelings, relationship problems, and poor functioning at
work, school or home.
Incidence & Onset
Experts estimate the incidence of habitual self-injurers is
nearly 1% of the population, with a higher proportion of females
than males. The typical onset of self-harming acts is at puberty.
The behaviors often last 5-10 years but can persist much longer
without appropriate treatment.
Background of Self-Injurers
Though not exclusively, the person seeking treatment is usually
from a middle to upper class background, of average to high
intelligence, and has low self-esteem. Nearly 50% report physical
and/or sexual abuse during his or her childhood. Many report (as
high as 90%), that they were discouraged from expressing emotions,
particularly anger and sadness.Behavior patterns. Many who
self-harm use multiple methods. Cutting arms or legs is the most
common practice. Self-injurers may attempt to conceal the resultant
scarring with clothing, and if discovered, often make excuses as to
how an injury happened.
Reasons for Behaviors
Self-injurers commonly report they feel empty inside, over or
under stimulated, unable to express their feelings, lonely, not
understood by others and fearful of intimate relationships and
adult responsibilities. Self-injury is their way to cope with or
relieve painful or hard-to-express feelings, and is generally not a
suicide attempt. But relief is temporary, and a self-destructive
cycle often develops without proper treatment.
Dangers
Self-injurers often become desperate about their lack of
self-control and the addictive-like nature of their acts, which may
lead them to true suicide attempts. The self-injury behaviors may
also cause more harm than intended, which could result in medical
complications or death. Eating disorders and alcohol or substance
abuse intensify the threats to the individual’s overall
health and quality of life.
Diagnoses
The diagnosis for someone who self-injures can only be
determined by a licensed psychiatric professional. Self-harm
behavior can be a symptom of several psychiatric illnesses:
Personality Disorders (esp. Borderline Personality Disorder);
Bipolar Disorder (Manic-Depression); Major Depression; Anxiety
Disorders (esp. Obsessive-Compulsive Disorder); as well as
psychoses such as Schizophrenia.
Evaluation
If someone displays the signs and symptoms of self-injury, a
mental health professional with self-injury expertise should be
consulted. An evaluation or assessment is the first step, followed
by a recommended course of treatment to prevent the
self-destructive cycle from continuing.
Treatment
Self-injury treatment options include outpatient therapy,
partial (6-12 hours a day) and inpatient hospitalization. When the
behaviors interfere with daily living, such as employment and
relationships, and are health or life-threatening, a specialized
self-injury hospital program with an experienced staff is
recommended.
The effective treatment of self-injury is most often a combination
of medication, cognitive/behavioral therapy, and interpersonal
therapy, supplemented by other treatment services as needed.
Medication is often useful in the management of depression,
anxiety, obsessive-compulsive behaviors, and the racing thoughts
that may accompany self-injury. Cognitive/behavioral therapy helps
individuals understand and manage their destructive thoughts and
behaviors. Contracts, journals, and behavior logs are useful tools
for regaining self-control. Interpersonal therapy assists
individuals in gaining insight and skills for the development and
maintenance of relationships. Services for eating disorders,
alcohol/substance abuse, trauma abuse, and family therapy should be
readily available and integrated into treatment, depending on
individual needs.
In addition to the above, successful courses of treatment are
marked by 1) patients who are actively involved in and committed to
their treatment, 2) aftercare plans with support for the
patient’s new self-management skills and behaviors, and 3)
collaboration with referring and other involved
professionals.
For more information contact your local Mental Health Association,
community mental health center, or for additional resources, please
call 1-800-969-NMHA.
National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959
S.A.F.E. Alternatives (Self-Abuse Finally Ends)
7115 W. North Avenue
Suite 319
Oak Park, IL 60302
Information line: 800-DON’T CUT (800-366-8288)
Written by Karen Conterio and Wendy Lader, Ph.D.
Reproduced with permission from S.A.F.E. Alternatives. 11/98
