Self harm is the act of injuring or harming your body on purpose. Cutting, burning, or other methods of injuring your body are common forms of self harm, and usually indicate an underlying mental health condition.1,2,3 Therapy in an inpatient or outpatient setting can help people who self harm learn more effective methods of coping, while also addressing underlying mental health issues.4
*This article will provide information about specific kinds of self harm, which may be triggering for some people.
What Is Self-Harm?
Self harm is any intentional act of self-injury that isn’t motivated by an intention to end your life. Most people who self harm engage in cutting, burning, or other acts that cause wounds, but there are a range of different behaviors that can be classified as self harm.1,3 Restricting food, exercising too much, pulling your hair, or even picking at scabs could all be considered self harm.1,3,4
The definition of self harm has been debated by researchers, and some people also include risky or impulsive behaviors like substance use, high risk sexual behaviors, or self-sabotaging behaviors as a type of self harm.3,4 These kinds of behaviors are certainly harmful, but self harm is most commonly used to describe more direct and immediate behaviors that cause harm to a person’s body.1,5
Self harm is also called by other names, including self injury (SI), self-inflicted violence (SIV), self injurious behaviors (SIB), and nonsuicidal self injury (NSSI). Difficult emotions that arise from frustrating or stressful external situations are often the trigger for self harm. Self harm is often used as a method of coping with negative emotions or getting rid of the strong urges these emotions bring up.1,4
Who Is Most Likely to Self Harm?
Most people who self-harm have another mental health condition. Personality disorders (especially borderline personality disorder), eating disorders, mood disorders, and impulse control disorders are most common in connection with self-harm.1,2,3
People who have trouble regulating their emotions or controlling their impulses are also more likely to engage in self-injuring behavior.1,2,3,4 External events are often a trigger, and involve a person feeling hurt, angry, or upset and not knowing how to cope.2,6 Cutting or injuring themselves is used as a method to feel a temporary sense of relief for their emotional pain, but does not address the root issues.
Over time, self harming behavior can escalate to more serious and dangerous injuries, and can even increase a person’s likelihood for suicide.4,7
Other risk factors shown to increase the likelihood of self harm are:1,2,4,6,7
- Being between the ages of 12-25 years old
- Being Caucasian (as many as 75% of people who self-harm are Caucasian )
- Being a female
- Having a history of childhood trauma or abuse
- Having a history of psychiatric hospitalizations
- Having friends who self-harm (for kids and teens)
- Having a history of self mutilation or self injury
- High stress and low support or poor coping skills
- A tendency to use more avoidance strategies to cope with difficult emotions
- Having attention-deficit/hyperactivity disorder (ADHD) symptoms
Self-Harm & Suicide Risk
Self-harm and suicidal behavior are not the same thing. People who engage in self-harm do not have a desire or intention to end their lives, but the act of injuring themselves does place them at higher risk for suicide.3,4,7 For that reason, self-harm should always be seen as a serious risk factor, even when it does not result in serious injuries.4,7
Part of the increased risk for suicide in people who self-harm may be related to the fact that self-harm is also closely associated to a number of risk factors for suicide.
The following risk factors are known to increase risk for suicide for people who self-harm:1,4,7,8
- History of trauma or abuse
- Another mental health condition
- Substance use problems
- Impulse control issues
- Problems regulating emotions
- Chronic health issues or disorders
Types of Self-Harm
There are many different kinds of self harming behaviors, and some have a higher risk for physical injury than others. Researchers who classify different kinds of self harm often do so by considering the motivation for the behavior, the degree of physical injury caused, and the social acceptability of the behavior.1,3
For example, getting a tattoo or piercing your ears would not be considered self harm because it involves other motivations besides coping or causing intentional self harm. Cutting, burning, or hitting oneself are common forms of self-harm, and all involve causing direct injury to the body.
Here are kinds of self harm, ranging from less serious to more serious:1,3,4
- Skin picking, scratching, nail biting, hair pulling, or not allowing wounds to heal
- Itching or rubbing skin excessively to the point of creating wounds
- Cutting, biting, or burning the skin to create superficial wounds
- Cutting, biting, or burning the skin to create deep wounds
- Hitting or punching areas of the body
- Restricting food, excessive exercise, or over-exerting oneself
- Ingesting, inserting, inhaling, or swallowing a dangerous object or substance
- Severing parts of the body or performing self-surgery
- Constricting an area of the body, strangling oneself, or restricting blood flow
Why Do People Self Harm?
Self harm is often used as a method of coping, and research indicates that a lack of emotional, behavioral, and impulse control is the main cause.1,2,5,6 Often, an outside frustrating situation or event is the initial trigger, and causes the person to experience intense distress. Strong emotions can create destructive impulses, and acting on these urges can provide a temporary sense of relief or release.1,2,4
People who self harm describe a number of different motivations for their behavior. While their reasons may not make sense to some people, it is clear that some people do report feeling a temporary sense of release or relief from injuring themselves.1,4 15-20% of people who self harm report not knowing why.
Here are some of the reasons that people self-harm:1,6
- To cope with distress or calm themselves down when upset
- To seek help or attention from another person
- Using self harm as a method of self-punishment
- To stop dissociation, feeling “numb” or “feeling nothing”
- To enhance an emotion or experience or make pain more “real”
- To express or cope with gender or sexual identity
- To maintain or explore boundaries
- To prevent or reduce urges to commit suicide
- To cleanse or purify the body
- To distract from emotional pain with physical pain
- To find release or expression for emotional pain
- To express anger towards others, themselves, or a situation
Signs of Self Harm
Cutting is the most common form of self harm, and it involves making intentional cuts on the skin.1 Some people who cut themselves do so on their wrists, while others cut themselves in places that are easier to hide, like their upper legs, stomach, or feet. Seeing several linear cuts or scars on a person is often one of the clearest signs of self harm.
Other indications that a person is engaging in self harm include:4
- Wearing long pants and sleeves even when it is hot outside
- Having unexplained bites, cuts, bruises, scabs, or scars
- Being secretive or evasive when asked about a scar or wound
- Having a lot of knives, razors, or other sharp objects around
- Having bald spots or missing patches of hair
- Frequent reports of accidents and injuries
Some forms of self harm have fewer physical signs and indicators. Often, the indicators for self harm in people who don’t cut or burn their skin are more psychological and behavioral in nature. For example, noticing a person is isolating themselves more, not doing the things they normally enjoy, or seeming down or sad may be the only indication someone close to them would have.4
Treatments for Self Harm
Self-harm is usually related to an underlying mental health condition. Most people who cut, burn, or injure themselves are suffering from a mood disorder, personality disorder, eating disorder, or an impulse control disorder.1 Seeking treatment for the underlying condition is important in order to address the root causes of self-harm. Most of these conditions can be treated effectively with therapy, sometimes in combination with medication. It’s important to remember, that medication, such as antidepressants, take time to work.
Therapy for Self Harm
Therapy is considered a frontline treatment for most mental health conditions. It involves meeting with a counselor for group, family, or individual counseling sessions. There are a number of different options for therapy, and some may work better for certain people, depending on their needs and preferences. Below are some of the more commonly used types of therapy for people who self-harm.4
Cognitive Behavioral Therapy (CBT)
CBT is one of the most well-researched types of therapy, and is considered an evidence-based treatment for many common mental health issues. In CBT therapy sessions, people learn about the way their thoughts, feelings, and behaviors are related, and are taught new coping skills that can create positive changes in their mood and behavior.
People who self harm are often taught thought stopping techniques, impulse control skills, or better ways of coping with difficult feelings or urges to self harm. CBT can be offered in group or individual therapy, and is sometimes even used by inpatient or intensive outpatient programs that involve multiple treatments per week.
Dialectical Behavioral Therapy (DBT)
DBT is another common type of therapy that is effective in treating many of the common conditions related to self harm, including borderline personality disorder and eating disorders. People who receive DBT learn a wide range of skills that can help them regulate their emotions, improve distress tolerance, and communicate their feelings and needs more effectively.
People who self harm often benefit from these skills, which are proven to directly reduce their risk for self harm. DBT also utilizes mindfulness skills, which can help people learn how to refocus their attention away from distressing thoughts, feelings, and urges. DBT is offered by clinicians in inpatient and outpatient settings in group and individual therapy sessions.
Family therapy involves a person and one or more family members or supports having joint sessions with a therapist. Since many people who self harm are younger, family involvement in treatment is often considered a best practice, and can help to address core issues in the family. Family therapy is generally offered by a trained family therapist who works with the client and their caregiver to improve communication and address issues at home.
Medication for Self-Harm
There isn’t a specific medication indicated for self harm, but many people who self harm struggle with another mental health condition that could be improved with medication.4 Medication may be prescribed to treat an underlying anxiety or mood disorder, with SSRI antidepressants being the most commonly used. Medication should always be taken as prescribed by a licensed medical provider and combined with therapy for best results.
How to Get Help for Self Harm
Self harm is a serious risk factor for suicide, and also is usally an indication of an underlying mental health condition. Seeking immediate mental health treatment is necessary, even when the injuries don’t require medical attention.4 Often, the cost of treatment is at least partially covered by insurance, helping to reduce the financial burden of getting help.
Many people begin their search for treatment online by using an online directory or doing a search for therapists or treatment centers near them. You could also consult with your primary care doctor to get a referral to treatment, or call your insurance company to request a list of in-network providers.
How to Get Help for a Child or Teen
If you have a child or teen who is self harming, it is important to seek treatment for them. Making an appointment with a licensed therapist for a clinical evaluation is often the first step to getting help for a child or teen. It will involve a detailed assessment of the child’s mental health symptoms, behaviors, and risk factors. Using this information, the clinician will make a treatment recommendation.4
You can find a therapist for your child or teen in the following ways:
- Contacting your child’s pediatrician to ask for a mental health referral
- Calling around to different therapists or mental health treatment centers
- Asking your insurer for a list of mental health providers who are in-network
- Using a therapist directory to find a therapist who specializes in certain issues
- Asking other parents in your community for recommendations for a therapist
- Calling your local department of health and human services to learn more about mental health treatment options in your community, as well as financial assistance (if needed)
Many kids and teens benefit from therapy, sometimes in addition to medication. Having their parent or caregiver actively involved in their treatment is proven to improve the success of treatment, so it’s important for parents to be willing to attend sessions and support the work their child is doing in therapy.
When & How to Get Emergency Treatment for Self Harm
Serious self-harm can result in injury and in some cases, even death. If a person has injured themselves to the point of becoming unconscious, has lost a lot of blood, or you’re concerned for their safety, the best course of action is to call 9-1-1 or take them to an emergency room. After their medical needs are attended to, the doctor will often recommend follow-up mental health treatment.4
Even when there isn’t a medical emergency related to self mutilation or injury, a person may be in need of emergency psychiatric care. If a person makes suicidal threats or you have reasons to believe they are at risk of suicide, it may be necessary to get them emergency help.
Calling 9-1-1 to ask for a CIT officer or for someone to do a “welfare check” may be the right course of action. Calling 2-1-1 is also a way to get direct contact with health and human services in many states, and is an option for people needing immediate mental health assistance.
Also, people who believe that someone is a danger to themselves or others have the ability to file an involuntary commitment order with their local magistrate. This order enables the police to transport the person (even against their will) to a local psychiatric facility for evaluation.
Once evaluated, if deemed a danger to themselves or others, they may be held for a certain period of time. This is an extreme course of action that should only be taken as a last resort when you have concrete reasons to believe that someone is unsafe. It is always best for a person to get treatment voluntarily when possible.
Final Thoughts on Self-Harm
People who self-harm aren’t attempting to take their own lives, but self-harm should still be treated like a serious risk factor.4,7 If you or someone you love is self-harming, remember that you’re not alone. Consider speaking with a therapist as soon as possible.