Self-Injury
Self-injury is the deliberate, impulsive, non-lethal and repetitive hurting of oneself. A maladaptive coping mechanism, it is associated with a number of mental illnesses, including anxiety and posttraumatic distress disorder, and especially linked with depression and borderline personality, eating and substance use disorders. Warning signs include frequent, unexplained bruises, cuts, other injuries, scars and/or healed wounds; collecting sharp tools like nail scissors, safety pins or shards of glass; excessively rubbing areas of the body to create a burn; increased isolation; refusing to enter a locker room and/or change clothes at school; relationship problems; and wearing a lot of Band-Aids or long sleeves and pants in warm weather.
Approximately one percent of the population habitually self-harms and about 17 percent of adolescents have engaged in nonsuicidal self-injury (NSSI) at least once. While it happens most often during the teenage and young adult years, it also can take place later in life. The onset of NSSI typically occurs at puberty with the behavior often persisting for 5 to 10 years. It can last far longer when appropriate treatment is not received; and youth who visit websites or view social media about self-injury are 11 times more likely to have thoughts about hurting themselves.
Self-harm is a method of relieving stress or discomfort rather than a means of being dramatic or drawing attention to oneself. The goal often is not the harm itself, rather a distraction from or release of emotional pain. Those most at risk are individuals who have experienced abuse, neglect or trauma. Self-injurers often feel empty inside and over or understimulated. Typically lonely and misunderstood by others, self-harm is a way to express their feelings. Relief is temporary, however, and a self-destructive cycle can develop due to the addictive nature of NSSI and practitioners soon feeling desperate about their lack of self-control.
Individuals who engage in self-injury are attempting to exert a control over their bodies that they believe they lack in other parts of their lives, punish themselves for something of which they are ashamed or simply feel something. As many as 55 percent of those who self-harm also have an eating disorder(s); and studies show that between 35 and 50 percent of self-injurers are male. While hands, stomachs, thighs and wrists are the most frequent sites of NSSI, self-harm can occur anywhere on the body. Skin cutting is the most common form of self-injury, yet it is not the only one. Burning, disordered eating, frequent or heavy substance use, head banging and hitting are other examples and most individuals use multiple methods.
In order to hide self-harm, youth may tell stories that explain one, but not all of their injuries (like “The cat scratched me.”); constantly wear large bracelets, watchbands or wristbands, and/or use bandages. Research has shown that asking about NSSI does not increase risk. Saying something like “I am concerned about you and want to make sure you are okay” actually is an indication that you truly care and are a person from whom the individual can seek support. If he or she does admit to self-harming, thank him/her for trusting you with the truth and having the courage to tell you. Seek to understand what caused the self-injury (bullying or a painful life transition, etc.), the needs it serves (such as releasing negative emotions) and the support he or she requires (including compassion) and help him/her quickly find a trained mental health professional.
Psychotherapy is an essential part of any treatment plan for self-injury. While Dialectical Behavior Therapy can teach youth how to tolerate uncomfortable feelings like anger, anxiety or rejection without resorting to self-harm; Cognitive Behavioral Therapy can show them how to recognize and then challenge negative or distressing thoughts. It is possible to develop positive coping mechanisms, identify triggers, learn healthy communication skills, reduce underlying stress, and regulate one’s emotions to prevent further NSSI. For example, drawing on oneself with a red pen, eating a hot chili, squeezing an ice cube or taking a cold shower are each alternatives to self-harm.