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.

Diagnosis

Although some people may ask for help, sometimes family or friends discover the self-injury. Or a health care provider doing a routine medical exam may notice signs, such as scars or fresh injuries.

There's no specific test to diagnose self-injury. Diagnosis is based on a physical and psychological evaluation. You may be referred to a mental health professional with experience in treating self-injury for evaluation. This professional talks to you about your life, thoughts, feelings and behaviors.

A mental health professional also may evaluate you for other mental health conditions that could be linked to self-injury, such as depression or personality disorders.

Treatment

The first step is to tell someone about your self-injuring behavior so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression. Because self-injury can become a major part of your life, it's best to get treatment from a mental health professional who is experienced in treating self-injury.

If the self-injury behavior is linked with a mental health condition, such as depression or borderline personality disorder, the treatment plan focuses on that condition, as well as the self-injury behavior.

Treating self-injury behavior can take time, hard work and your own desire to recover.

Here's more information about treatment options.

Psychotherapy

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

• Identify and manage underlying issues that trigger self-injury.
• Learn skills to better manage distress.
• Learn better ways to manage intense 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 more effective ones. You can also gain skills that help you cope in different situations when needed.
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle distress, manage or regulate your emotions, and improve your relationships with others.
• Mindfulness-based therapies, which help you live in the present and cope with difficult emotions and negative thoughts. These can help reduce anxiety and depression and improve your general well-being.

In addition to individual therapy sessions, your provider may recommend family therapy or group therapy.

Medicines

There are no medicines to specifically treat self-injuring behavior. However, if you're diagnosed with a mental health condition, such as depression or an anxiety disorder, your health care provider may recommend antidepressants or other medicines to treat the underlying condition that's linked with self-injury. Treatment for these conditions may help reduce the urge to hurt yourself.

Inpatient care

If you injure yourself severely or repeatedly, your health care provider may recommend that you be admitted to a hospital for psychiatric care. Being cared for in a hospital, often short term, can provide a safe environment and more-intensive treatment until you get through a crisis. Mental health day-treatment programs that focus on learning behavioral coping skills to manage distress also may be an option.

Lifestyle and home remedies

In addition to professional treatment, here are some important self-care tips:

• Follow your treatment plan. Keep therapy appointments. Practice and use coping skills learned in therapy. Take any prescribed medicine as directed.
• Recognize the situations or feelings that might trigger your desire to self-injure. Make a plan for other ways to soothe or distract yourself or to get support, so you're ready the next time you feel the urge to self-injure.
• Ask for help. Keep your mental health provider's phone number handy. Tell your provider about all incidents related to self-injury. Choose a trusted family member or friend as the person you'll immediately contact if you have an urge to self-injure or if self-injury happens.
• Take care of yourself. Learn how to include physical activity and relaxation exercises as a regular part of your daily routine. Eat healthy. Ask your health care provider for advice if you have sleep problems, which can have a big impact on behavior.
• Avoid alcohol and recreational drugs. They affect your ability to make good decisions and can put you at risk of self-injury.
• Take care of your wounds if you injure yourself or seek medical treatment if needed. Call a trusted family member or friend for help and support. Don't share items used for self-injury. That raises the risk of infectious diseases.

Coping and support

If you or a friend or family member needs help in coping, consider the tips below. If there's a focus on thoughts of suicide, take action and get help right away.

Coping tips if you self-injure include:

• Connect with others who can support you so that you don't feel alone. For example, reach out to a trusted family member or friend, contact a support group, or contact your health care provider or mental health provider.
• Avoid websites that support or glamorize self-injury. Instead, seek out sites that support your recovery efforts.
• Learn to express your emotions in positive ways. For example, to help balance your emotions and improve your sense of well-being, become more physically active or practice relaxation techniques. Or participate in activities that you find personally meaningful, such as dance, art or music.

Coping tips if a friend or loved one self-injures include:

• Get information. Learn more about self-injury to help you understand why it occurs and how you might help stop this harmful behavior. Know the strategies and relapse prevention plan your friend or loved one has developed with the therapist so you can encourage it.
• Try not to judge or criticize. Criticism, yelling, threats or accusations may increase the risk of self-injuring behavior. Offer support, praise efforts to express emotions in healthy ways and try to spend positive time together.
• Let your loved one know you care no matter what. Remind the person that they're not alone and that you're available to talk. Recognize that you may not change the behavior, but you can help the person find resources, identify coping strategies and offer support during treatment.
• Support the treatment plan. Encourage your loved one to take prescribed medicine, if that's part of the plan. Stress the importance of keeping therapy appointments and practicing the skills learned.
• Make a safe home environment. Remove or limit access to matches, knives, razor blades or other items that may be used for self-injury.
• Share coping strategy ideas. Your loved one may benefit from hearing strategies you use when feeling distressed. You also can serve as a role model by using healthy coping strategies.
• Find support. Consider talking to people who've gone through what you're going through. Share your own experiences with trusted family members or friends. Ask the health care provider or mental health provider if there are local support groups for parents, family members or friends of people who self-injure. Or talk to a counselor or therapist.
• Take care of yourself. Take some time to do things that you enjoy. And get enough rest and physical activity.

Preparing for an appointment

Your first appointment may be with your primary care provider, a school nurse or a counselor. But because self-injury often requires specialized mental health care, you may be referred to a mental health professional for more evaluation and treatment.

Be ready to provide accurate, thorough and honest information about your situation and your self-injuring behavior. You may want to take a trusted family member or friend along, if possible, for support and to help you remember information.

What you can do

To help prepare for your appointment, make a list of:

• Symptoms you've had, including triggers for self-injury, how long you've been self-injuring, if you use any objects, and where on your body you usually self-injure.
• Key personal information, including any major stresses or recent life changes.
• All medicines, vitamins, herbs or other supplements that you're taking, including the doses.
• Questions to ask your mental health provider.

Questions to ask may include:

• What treatments are available? Which do you recommend for me?
• What side effects are possible with that treatment?
• What are other options to the approach that you're suggesting?
• Are there medicines that might help? Is there a generic version of the medicine you're prescribing?
• What should I do if I have an urge to self-injure between therapy sessions?
• What else can I do to help myself?
• How can I — or those around me — recognize that things may be getting worse?
• Can you suggest resources that would help me learn more about my condition and its treatment?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your mental health provider is likely to ask you a number of questions, such as:

• When did you first begin harming yourself?
• What methods do you use to harm yourself?
• How often do you cut or injure yourself?
• Where on your body do you self-injure?
• What feelings and thoughts do you have before, during and after self-injury?
• What seems to trigger your self-injury?
• What makes you feel better? What makes you feel worse?
• Do you have a supportive social circle or relationships?
• What emotional issues are you facing?
• How do you feel about your future?
• Have you had previous treatment for self-injury?
• Do you have suicidal thoughts when you're feeling down?
• Do you drink alcohol or use tobacco or recreational drugs?

Your mental health provider may ask more questions based on your responses, symptoms and needs. Preparing for questions will help you make the most of your time with the provider.