Self-injury/cutting

Overview

Nonsuicidal self-injury, often simply called self-injury, is the act of harming your own body on purpose, such as by cutting or burning yourself. It's usually not meant as a suicide attempt. This type of self-injury is a harmful way to cope with emotional pain, sadness, anger and stress.

While self-injury may bring a brief sense of calm and a release of physical and emotional tension, it's usually followed by guilt and shame and the return of painful emotions. Life-threatening injuries are usually not intended, but it's possible that more-serious and even fatal self-harm could happen.

Getting the proper treatment can help you learn healthier ways to cope.

Symptoms

Symptoms of self-injury may include:

• Scars, often in patterns.
• Fresh cuts, scratches, bruises, bite marks or other wounds.
• Excessive rubbing of an area to create a burn.
• Keeping sharp objects or other items used for self-injury on hand.
• Wearing long sleeves or long pants to hide self-injury, even in hot weather.
• Frequent reports of accidental injury.
• Difficulties in relationships with others.
• Behaviors and emotions that change quickly and are impulsive, intense and unexpected.
• Talk of helplessness, hopelessness or worthlessness.

Forms of self-injury

Self-injury mostly happens in private. Usually, it's done in a controlled manner or the same way each time, which often leaves a pattern on the skin. Examples of self-harm include:

• Cutting, scratching or stabbing with a sharp object, one of the most common methods.
• Burning with lit matches, cigarettes or heated, sharp objects such as knives.
• Carving words or symbols on the skin.
• Self-hitting, punching, biting or head banging.
• Piercing the skin with sharp objects.
• Inserting objects under the skin.

Most frequently, the arms, legs, chest and belly are the targets of self-injury. But any area of the body may be a target, sometimes using more than one method.

Becoming upset can trigger urges to self-injure. Many people self-injure only a few times and then stop. But for others, self-injury can become a longer term, repeated behavior.

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 stressors that need attention.

Talk to someone you trust — such as a friend, family member, health care provider, spiritual leader, or a school counselor, nurse or teacher. They 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 help from people who aren't going to judge you.

When a friend or family member self-injures

If you have a friend or family member 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 talking with your pediatrician or other health care provider who can do an initial evaluation or make a referral to a mental health professional. Express your concern, but don't yell at your child or make threats or accusations.
• Preteen or teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
• Adult. Gently express your concern and encourage the person to seek medical and mental health treatment

When to get emergency help

If you've injured yourself severely or believe your injury may be life-threatening, or if you think you may hurt yourself or attempt suicide, call 911 or your local emergency number right away.

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

• Call your mental health provider if you're seeing one.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
• Seek help from your school nurse or counselor, teacher, or health care provider.
• Reach out to a close friend or family member.
• 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, self-injury may result from:

• Poor coping skills. Nonsuicidal self-injury is usually the result of an inability to cope in healthy ways with stress and emotional pain.
• Difficulty managing emotions. Having a hard time controlling, expressing or understanding emotions may lead to self-injury. The mix of emotions that triggers self-injury is complex. For example, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection and self-hatred. Being bullied or having questions about sexual identity may be part of the mix of emotions.

Self-injury may be an attempt 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 the 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 feelings of stress or depression to the outside world.
• Punish oneself.

Risk factors

Teenagers and young adults are most likely to self-injure, but those in other age groups do it, too. Self-injury often starts in the preteen or early teen years, when emotional changes happen fast, often and unexpectedly. During this time, teens also face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.

Certain factors may increase the risk of self-injury, including:

• Having friends who self-injure. Having friends who intentionally harm themselves makes it more likely for someone to begin self-injuring.
• Life issues. Past experiences of neglect, sexual, physical or emotional abuse, or other traumatic events may increase the risk of self-injury. So can growing up and remaining in an unstable family environment. Other risk factors include questioning personal or sexual identity and social isolation.
• Mental health issues. Being highly self-critical and struggling with problem solving increases the risk of self-injury. Also, self-injury is commonly linked with certain mental health conditions, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
• Alcohol or drug use. Being under the influence of alcohol or recreational drugs may increase the risk of self-injury.

Complications

Self-injury can cause complications, such as:

• Worsening feelings of shame, guilt and low self-esteem.
• Infection, either from wounds or from sharing tools.
• Permanent scars or other permanent harm to the body.
• Worsening of underlying issues and conditions, if not properly treated.
• Severe injury that could possibly lead to death.

Suicide risk

Self-injury is not usually a suicide attempt, but it can increase the risk of suicide because of the emotional problems that trigger self-injury. And the pattern of damaging the body in times of distress can make suicide more likely.

Prevention

There is no sure way to prevent someone's self-injuring behavior. But reducing the risk of self-injury includes strategies that involve both individuals and communities. Parents, family members, teachers, school nurses, coaches or friends can help.

• Identify someone at risk and offer help. Someone at risk can be taught how to better manage stress and deal with life's problems. The person can learn healthy coping skills to use during periods of distress.
• Encourage supportive social networks. Feeling lonely and disconnected may be a part of self-injury. Helping someone form healthy connections to people who don't self-injure can improve relationship and communication skills.
• Raise awareness. Learn about the warning signs of self-injury and what to do when you suspect it.
• Encourage friends to seek help. Peers tend to be loyal to their friends. Encourage children, teens and young adults to avoid secrecy and reach out for help if they have a concern about a friend or family member.
• Talk about media influence. News media, music and other highly visible outlets that feature self-injury may nudge children and young adults with mental or emotional issues to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.