What are cutting and self-mutilation?

Risk Factors and Related Conditions

Although self-injury can occur at any age, it usually begins in adolescence. It was originally thought that women were more likely than men to engage in self-injury, but later research indicates that the incidence is equal among women and men. Statistically, women are more likely to cut, while men are more likely to engage in other forms of self-harm, such as burning or hitting. According to the US National Library of Medicine, every one in one hundred people inflicts self-injury.

Persons who self-injure commonly have a history of abuse, including sexual, physical, or emotional abuse. Self-injury is often associated with other mental health problems, such as eating disorders, substance abuse, obsessive-compulsive disorders, schizophrenia, depression, bipolar disorder, borderline personality disorder, anxiety disorders, post-traumatic stress disorder, dissociative disorders, panic disorder, and phobias.

Persons who engage in self-injury often come from homes where expressing anger and other emotions is (or was) forbidden. They frequently have low self-esteem and exhibit perfectionism. Also, they are likely to be impulsive and to have poor problem-solving skills. However, self-injury does not indicate the severity of mental illness or the ability of the person to function and lead a relatively normal life.

Why Persons Self-Injure

There are many reasons for self-injury. One is using the behavior to provide a way to deal with overwhelming feelings, such as anger, extreme sadness, anxiety, depression, stress, sense of failure, self-hatred, or the helplessness of a trauma. Persons who self-injure have difficulty coping with severe emotional pain.

Self-injury can serve as a distraction from emotional pain, a way to express feelings that the person is unable to describe, or a way to feel a sense of control over something that is uncontrollable. Persons who self-injure often describe a feeling of calmness and relief of their intense feelings after they have injured themselves. Other self-injurers describe feeling emotionally numb and empty. For these persons, the self-injury allows them to feel something. Some are communicating their distress and expressing a need for help through self-injury. Others are punishing themselves for some imagined wrong.

Other persons use self-injury to prevent something worse from happening to them. A person may justify his or her behavior through the belief that if something bad is happening to him or her now, nothing else bad can happen. Others use self-injury to separate themselves from their feelings, which fade in the face of the physical pain. Though research has not conclusively proven it, a prevalent theory is that self-injury leads to the release of endorphins in the brain. Endorphins are chemicals found in the body that act as natural pain relievers and tranquilizers. Endorphin release produces a natural high that can temporarily mask emotional or physical pain.

It is thought that some persons self-injure to seek attention and to manipulate others. This is unlikely because most self-injurers are ashamed of the injuries that they cause, and they will hide their self-inflicted injuries. It is common for self-injurers to wear shirts with long sleeves and full-length pants in all types of weather to hide their injuries. The exceptions to this are persons who are developmentally or otherwise mentally disabled, such as those with autism. They are likely to engage in self-injury without also trying to hide the injury or the behavior. In this context, self-harm is called self-injurious behavior (SIB) and can have a number of causes. Someone with autism, for example, may exhibit SIB as a result of biochemical imbalances, sensory issues, to distract from other sources of physical pain, or in response to social or environmental triggers.

Symptoms and Treatment

No single therapy exists to treat persons who self-injure, and there is no consensus as to the most effective treatment. Typically, treatment must be developed based on the needs and other mental health conditions of the self-injurer. Possible helpful medications include antidepressants, antipsychotic drugs, and minor tranquilizers.

Often-used psychotherapeutic approaches include cognitive-behavioral therapy, dialectical-behavior therapy, and psychodynamic psychotherapy. The type of psychotherapy also depends on the other psychological illnesses of the client. In severe cases of self-injury, the person may be hospitalized to exert some control over the behavior.

Psychotherapy usually begins with an exploration of why the person self-injures. The therapist will teach alternative behaviors to use when the person feels like self-injuring. These alternatives include physical activities, journaling, and talking with friends or family members. Alternative actions also may be taught, such as snapping an elastic band that is wrapped around the self-injurer’s wrist. While this action does cause some pain, it does not cause injury. Biofeedback may be used to help the person identify the feelings that lead to the urge to self-injure.

It is important that the person understands that treatment, especially self-treatment, takes time, hard work, and motivation. If the self-injurer is an adolescent or child, family therapy may be necessary to identify what triggers the self-injuring behavior. Group therapy also may be used to provide the person with supportive relationships with others who are dealing with similar issues. Self-injurers who are developmentally disabled can be taught how to accomplish goals without using self-harming behaviors.

Bibliography

Hollander, Michael. Helping Teens Who Cut: Understanding and Ending Self-Injury. New York: Guilford, 2008.

Peterson, John, et. al. "Nonsuicidal Self Injury in Adolescents." Psychiatry 5.11 (2008): 20–26. Print.

Smith, Melinda, and Jeanne Segal. “Cutting and Self-Harm.” Jan. 2012. Web. 17 Apr. 2012. http://www.helpguide.org/mental/self_injury.htm.

Strong, Marilee. A Bright Red Scream: Self-Mutilation and the Language of Pain. New York: Virago, 2005.

Sutton, Jan. Healing the Hurt Within: Understanding Self-Injury and Self-Harm, and Heal the Emotional Wounds. 3rd ed. Oxford, England: How to Books, 2007.