When people intentionally hurt themselves, it is a sign of intense emotional distress and a need for additional coping skills. There are a variety of self-harm methods that are common, and people may engage in one or more, to deal with intense emotions. At Highland Hospital Behavioral Health in Charleston, West Virginia, we treat mental health disorders that are often accompanied by self-injury and we help our patients to find other options for managing their distress.
Types of Self-Harm
If the behavior is accidental or has another purpose, such as spiritual practice or getting a tattoo or piercing to beautify the body, then it is not considered self-harm. It is important to remember that any behavior, when it is done to hurt oneself, can fall into this category, as long as it is intentional.
Some examples include:
- Puncturing or cutting with a sharp object
- Scratching
- Burning with a hot object like a match, candle wax, cigarette or lighter, or by rubbing the skin intensely
- Carving words or symbols into the skin
- Hitting, punching, or banging one’s head
- Pulling out hair
- Picking wounds
Diagnoses Commonly Associated with Self-Harm
Self-injurious behavior is not a mental health disorder but is a sign of severe emotional distress. It is often found in people who do have mental health conditions, the most common of which include:
- Borderline personality disorder
- Depression
- Eating disorders
- Anxiety
- Post-traumatic stress disorder (PTSD)
Understanding Why Would Someone Hurt Themselves on Purpose
People who intentionally inflict pain and injury on themselves may do so for a variety of reasons, such as:
- Feeling numb inside and wanting to replace that numbness with any available feeling
- Wanting to experience the endorphin rush that their body has in response to pain
- Trying to drown out emotional pain by causing physical pain
- Feeling like they “deserve” to be “punished” for some mistake they have made
- A response to guilt and/or shame they have about hurting themselves previously
- Giving themselves an increased sense of control over their lives
Risk Factors for Self-Harm
Having a mental illness is not the only thing that increases a person’s risk for engaging in self-injury. Other factors that make a person more likely to intentionally hurt themselves include:
- Being a teen or young adult (onset is often around 13-14 years of age)
- Having friends who engage in self-harm behaviors
- Struggles with sexual identity
- Impulsivity
- Having a history of trauma
- Growing up in an unstable family
- Engaging in substance misuse
Indications of Self-Harm
It can be embarrassing for people to admit that they have been engaging in self-injurious behaviors, so they may not reach out for help. Some signs that a person has been harming themselves include:
- Patterns of scars – especially on the arms, legs, and belly
- Frequent, fresh injuries
- Keeping items on hand to hurt themselves (knives, razor blades, lighters, etc.)
- Wearing long pants or shirts with long sleeves, even in hot weather
- Difficulty connecting with other people
- Impulsive or unpredictable behavior
Why Self-Harm is Cause for Concern
Self-injury is not always an indication of suicidal thoughts, but it is linked to an increased risk of suicide if left unaddressed. Over time, self-harm can diminish the fear of pain, making individuals more comfortable with the idea of ending their life.
Self-harm also carries these risks:
- Permanent scarring
- Blood loss
- Infection
- Guilt, shame, and other negative feelings from the act of self-harm
- Inability to stop the behavior
- Isolation or ostracization from friends and family who may not understand the behavior
- If a person engages in self-harm while under the influence of drugs or alcohol, they may be unaware of the degree to which they are harming themselves, resulting in more serious injuries than intended
Treatments to Address Self-Injury
Treatment options for self-harm behaviors often focus on the underlying causes of distress or developing a person’s range of coping skills, so that they can find different ways to manage their emotional needs. Therapy, particularly cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and psychodynamic therapy, is a common way to help a person increase their coping skills and their understanding of their own mental health and trauma history. Medication may be used to help a person regulate their emotions.
How You Can Help
If you are worried that someone you love might be engaging in self-harm, it is important to talk to them in a compassionate, judgment-free way:
- Wait until neither of you are feeling especially emotional. Ask them how they are doing and really listen to their response without making jokes or telling them that they are overreacting.
- Acknowledge the underlying pain that they are likely to be experiencing.
- State what you have observed and what concerns you have. This could sound like, “I am worried about you. I have noticed some cuts on your arms, and I am concerned that you might be hurting yourself.”
- Emphasize that even if you don’t understand, you care about them and you want to help. Do not threaten to remove your friendship as a way to make them stop.
- Remind them that there are a lot of people who engage in self-harm and that professional help is available.
- Focus on their distress, rather than on the harm they have done to themselves. Do not ask to see the injuries, which can feel more voyeuristic than helpful.
- Don’t demand that the person stop, as they may struggle to keep this promise and feel guilty for letting you down, making it even harder to avoid the behavior.
At Highland Hospital Behavioral Health, our team is trained to help people who are engaging in self-harm behaviors as part of a mental health disorder and to provide their loved ones with the tools to support them in their recovery.
