Self-harm, also called, self-mutilation, self-injury or cutting, is the intentional destruction of tissue or alteration of the body done without the conscious wish to commit suicide. Usually self-harm is an attempt to relieve tension. The wounds from self-injurious behavior are, by definition, not life-threatening and are not intended to be manifestations of suicidal ideation or suicidal gesturing.
The severity of self-harm is usually measured by three factors:
- the extent of the damage,
- the level of medical intervention required,
- the location of the wounds.
Contrary to popular belief, tattoos and body piercings are not considered forms of self-injurious behavior when they are performed by someone else in a social context and are primarily designed to “beautify” the body. Self-harm directly affects an estimated 2 to 3 million people in the United States – and that number includes only those who sought help.
Since the 1990′s self-harm has been a growing problem among adolescents. The majority of people who intentionally and repeatedly bruise, cut, burn, mark, bite, hit, scratch, pick, pull, mutilate and possibly amputate different parts of their own bodies are women between the ages of 13 and 30. Girls are four times more likely to engage in self-harm than boys, with girls between the ages of 16 and 25 at highest risk, although many girls begin cutting in middle school (ages 12 or 13).
The main reasons people give for engaging in self-harm are to:
- regulate strong emotions,
- distract from emotional pain,
- express feelings that can’t be put into words,
- exert a sense of control over their own body,
- to self-soothe.
The act of self-harm usually occurs after an overwhelming or distressing experience and is a result of not having learned how to identify or express difficult feelings in a healthy way. Self-punishment or self-hate may be involved. One of the risks connected with self-injury is that it tends to become an addictive behavior. Self-harm can become a habit that is difficult to break, even when the person wants to stop. The brain starts to connect the false sense of relief from bad feelings to the act of cutting, and it craves this relief the next time tension builds.
The urge to cut might be triggered by strong feelings the person can’t express — such as anger, hurt, shame, frustration, or alienation. People who cut sometimes say they feel they don’t fit in or that no one understands them. A person might cut after the loss of someone close or to escape a sense of emptiness. Cutting might seem like the only way to find relief or express personal pain over relationships or rejection. The most common form of self-mutilation, and the one usually seen in adolescents, is impulsive self-mutilation consisting of superficial skin cutting and burning.
Professionals generally believe that this is a maladaptive form of self-help or self-preservation and is done to achieve release from almost unbearable psychic tension and can give the adolescent a great sense of control. An adolescent who cuts can turn a state of overwhelm into a state of relative calm almost immediately. Cutting reduces panic to simply feeling bad.
Most people who engage in self-harm are treated as outpatients, although some specialized inpatient programs for self-harmers do exist. A number of different treatment approaches are used with self-mutilators, including individual therapy, family therapy, and group therapy. These therapies should focus on teaching self-awareness, alternate coping skills, behavior modification, and improved communication skills.
Parents and caregivers should consult a psychiatrist or psychotherapist with professional expertise in self-mutilation as soon as the behavior is discovered. Adolescents rarely outgrow this behavior. If left untreated, it can continue into adulthood. Safety and understanding are essential.
Helpful tips when dealing with a child that self-injures:
- Let your child know that you care about them and are available to listen at any time
- Understand that self-harming behavior is an attempt to maintain a certain amount of control which is a way of self-soothing
- Encourage verbal expressions of emotions including anger, sadness, frustration, etc
- Spend time doing enjoyable activities together
- Offer to help your child find a therapist or support group
- Don’t make judgmental/shaming comments
- teens who feel worthless and powerless are even more likely to self-injure
- Do not issue ultimatums or punish the self-injurious behavior. This can make feelings of lack of control and overwhelm even worse
- Parents should make sure they’re not the ones doing all the talking and be careful not to try to solve all their child’s problems
- Do not blame!!