Overview

Nonsuicidal self-injury, often simply called self-injury, is the act of deliberately harming the surface of your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. Rather, this type of self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it’s usually followed by guilt and shame and the return of painful emotions. Although life-threatening injuries are usually not intended, with self-injury comes the possibility of more serious and even fatal self-aggressive actions.

Getting appropriate treatment can help you learn healthier ways to cope.

Symptoms

Signs and symptoms of self-injury may include:

• Scars
• Fresh cuts, scratches, bruises or other wounds
• Excessive rubbing of an area to create a burn
• Keeping sharp objects on hand
• Wearing long sleeves or long pants, even in hot weather
• Difficulties in interpersonal relationships
• Persistent questions about personal identity, such as “Who am I?” “What am I doing here?”
• Behavioral and emotional instability, impulsivity and unpredictability
• Statements of helplessness, hopelessness or worthlessness

Forms of self-injury

Self-injury usually occurs in private and is done in a controlled or ritualistic manner that often leaves a pattern on the skin. Examples of self-harm include:

• Cutting (cuts or severe scratches with a sharp object)
• Scratching
• Burning (with lit matches, cigarettes or hot, sharp objects like knives)
• Carving words or symbols on the skin
• Hitting or punching
• Piercing the skin with sharp objects
• Pulling out hair
• Persistently picking at or interfering with wound healing

Most frequently, the arms, legs and front of the torso are the targets of self-injury, but any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.

Becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. But for others, self-injury can become a long-term, repetitive behavior.

Although rare, some young people may self-injure in public or in groups to bond or to show others that they have experienced pain.

When to see a doctor

If you’re injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed.

Talk to someone you trust — such as a friend, loved one, health care provider, spiritual leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help.

When a friend or loved one self-injures

If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you’d be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some ways to help.

• Your child. You can start by consulting your pediatrician or other health care professional who can provide an initial evaluation or a referral to a mental health specialist. Don’t yell at your child or make threats or accusations, but do express concern.
• Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
• Adult. Gently encourage the person to seek medical and mental health treatment.

Also consider these options if you’re having suicidal thoughts:

• Call your mental health specialist.
• Seek help from your primary doctor or other health care provider.
• Reach out to a close friend or loved one.
• Contact a spiritual leader or someone else in your faith community.

Causes

There’s no one single or simple cause that leads someone to self-injure. In general:

• Nonsuicidal self-injury is usually the result of an inability to cope in healthy ways with psychological pain.
• The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.

Through self-injury, the person may be trying to:

• Manage or reduce severe distress or anxiety and provide a sense of relief
• Provide a distraction from painful emotions through physical pain
• Feel a sense of control over his or her body, feelings or life situations
• Feel something — anything — even if it’s physical pain, when feeling emotionally empty
• Express internal feelings in an external way
• Communicate depression or distressful feelings to the outside world
• Be punished for perceived faults

Psychotherapy

Known as talk therapy or psychological counseling, psychotherapy can help you:

• Identify and manage underlying issues that trigger self-injuring behavior
• Learn skills to better manage distress
• Learn how to regulate your emotions
• Learn how to boost your self-image
• Develop skills to improve your relationships and social skills
• Develop healthy problem-solving skills

Several types of individual psychotherapy may be helpful, such as:

• Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others
• Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination, guided by a therapist
• Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.