Self Harm and Mutilation

Self Harm is Not Suicide

Self-harm has been defined as “a preoccupation with deliberately hurting oneself without conscious suicidal intent, often resulting in damage to body tissue.” (Muelehkamp, 2005, p. 324).  It is also commonly known as self-injurious behavior (SIB), self-mutilation, self-abuse, and parasuicide. 

As you would expect, having multiple terms for self-harm creates misunderstanding and confusion in research and clinical settings. Self-harm and suicide attempts can seem very similar. Sometimes this results in an incorrect diagnosis and treatment assessments.

The Differences Between Self Harm and Suicidal Behavior 


Self-harm  Suicide attempts
Frequency Incidents are very frequent Attempts happen less frequently
Methods Cutting, burning, self-hittingSelf-poisoning
Severity Less severe Much more severe, sometimes lethal
Purpose Done to avoid suicidal impulsesDone with the intent to die

Self-harm can lead to suicide when it is no longer an effective method of coping with feelings of stress or trauma. In a crisis situation, self-harmers who have become desensitized to pain may view a suicide attempt as less frightening. Because self-harm can lead to suicide, it is important that every patient that self-harms be evaluated for suicide risk.

Self-harm, in general, is an act of bodily harm, but it is often demonstrated through acts of self-mutilation, like cutting oneself with razors or burning oneself with cigarette lighters. The severity of self-mutilation can be such that medical treatment and hospitalization may be necessary.

The most common methods of self-harm are:

  • Cutting—75%
  • Self-hitting—30%
  • Burning—28%

The psychology of self-harm can be complex. The permanent scars of self-harm may bring the sufferer feelings of both pride and shame, and they may choose to flaunt or hide the scars depending on their emotional state.

Someone who engages in self-harming behaviors is often secretive about it. Fear of being confronted causes them to hide their actions and cover up any evidence of self-mutilation. Many sufferers report their self-harm behavior as ‘ritualistic’, just as with drug abuse and alcoholism.

For example, a person who uses a lighter to burn his or her arms may follow a strict routine, which could include preparing a special and “safe” place to carry out that self-harm without disturbance. The method of harming and the aftermath may follow a very similar pattern each time. The location of these self-harming rituals may even be centralized in one place, such as the arms, thighs, stomach and sometimes even the face.

Why Do Individuals Engage in Self-Harm?

People self-harm as a way to release pent-up feelings such as anger and anxiety. Conversely, self-harm can be a way to “feel something’ for those who have become numb to their situation.  Those who self-harm sometimes use it as a way to communicate their emotional pain. They will show their wounds as a way to reach out for help.

A person who feels powerless and lacks self-esteem may use self-harming as a way to regain control. This is particularly common for those who have suffered abuse. They often have a feeling of powerlessness and self-loathing. People who self-harm may lack self-esteem and think they are to blame for the way they feel. In these cases, self-harm is a way for individuals to punish themselves.

The process of self-harming generally begins with experiencing a powerful emotion (such as rejection and a resulting self-hatred) followed by a desperate need to “cleanse” oneself of the unbearable feelings.

The Effects of Self-Harm

The sufferer will feel some pain when they first inflict physical harm on their body, but this pain is tempered by an immediate feeling of relief that floods the senses, when the first cut is drawn or first burn, is inflicted. The sufferer will carry on mutilating his or her body until these emotions have been completely extinguished.

Meanwhile, the body will suffer the natural reaction of the release of adrenaline that occurs along with physical harm. This can be found in that extinguishing of emotion and the “high” which self-harmers feel.

Sufferers report feeling this “high” at the first infliction of pain, which they desperately try to retrieve again and again, much like a drug addict pursues that same experience of a first high. Following an episode of self-harm, the addict will often revert to a state of distraction and distance and will usually be completely calm, showing little or no emotion whatsoever.

Who is Likely to Suffer From Self-mutilation?

  • Statistics show that most self-harming begins between the ages of 12 to 15.  
  • Five percent of the general adult population have self-harmed and 15% of youth.  
  • Females adopt cutting most often, while males are more likely to burn or hit themselves. Girls aged 14-17 are hospitalized for self-harm four times more often than boys.
  • Caucasian people have higher rates of self-harm than non-Caucasians.

People are more likely to be at risk for self-harm behaviors if certain factors are present. Some of these factors are:

  • Loss of a parent
  • Childhood illness or surgery
  • Childhood sexual abuse, physical abuse or other trauma
  • Family substance abuse
  • Negative body image perceptions
  • Lack of impulse control
  • Lack of strong family attachments, neglect

These risk factors may cause someone to use self-harm as a method of coping with unmet needs. They are attempts to compensate for the lack of healthy fulfillment.

Is It an Addiction?

The different types of self-harm aren’t often thought of like an addiction, even though they share many of the same components. Self-harm and addiction have a lot in common. Both are linked to abuse, trauma, and neglect and occur most often in young adults. Both have the potential to cause a lot of damage.

In both, some people are struggling to express emotion healthily. Instead of talking about what they are feeling and making changes, they use drugs, alcohol, and self-harming to get a sense of emotional release and still avoid the deeper issue.

In a way, self-harm and addiction are problems on top of problems. Just as addiction isn’t about the substances, self-harm isn’t about the cuts and bruises. It’s about the unsettled emotional pain behind the destructive behaviors.

As a coping mechanism, self-harm can become psychologically addictive because, to the self-harmer, it works. It enables them to cope with stress at the moment. The patterns created by it, such as having specific time intervals between acts of self-harm, can also create a pattern that can result in a craving to fulfill thoughts of self-harm.

Those who engage in self-harm face the reality of harming themselves while at the same time obtaining relief from the act. It may be hard for some to actually start the cutting, but they do because they know the relief that follows. 

Natural opioids

This feeling of relief comes from the beta-endorphins that are released in the brain. Endorphins are opioids that originate within the brain and are released in response to a physical injury.  They act as natural pain killers and induce pleasant feelings. In response to self-harm, these endorphins would act to reduce tension and emotional distress. Many self-harmers report very little to no pain while self-harming.

Signs of Self-Harming

The signs of self-harm are often clear, as the sufferer carries the scars that result from the act of cutting and burning oneself. Common signs of self-harm include secretive behavior, wearing long sleeves even when the weather is hot to hide the scarring, staring at or playing with scars, and obsessions with whatever method they choose to use in their self-harming ritual.

It is also helpful to watch for uncharacteristic behavior such as mood swings or engaging in other self-destructive behavior (such as drug use, alcohol abuse, starvation, purging, overeating, and promiscuity).

People who self-harm may:

  • Appear withdrawn, or quieter and more reserved than usual
  • Stop participating in their regular activities
  • Have rapid mood changes
  • Get angry or upset easily
  • Exhibit poor school performance when they usually do well
  • Have unexplained cuts or scratches

Self-Harm is Treatable

Diagnosing and treating self-harm requires the same level of clinical knowledge and caring as any other obsessive and compulsive behavior. Effective treatment requires a deep understanding of compulsive behaviors and addictions, as many people who end one compulsive behavior find themselves engaging in other types of self-destructive and addictive behavior in an effort to cope with the feelings that surface.

In treating self-harm, it is necessary to follow a similar approach as with other addictions. The first step is ending the behavior and allowing the feelings which the sufferer is avoiding to surface. It is only then that healing can begin in the form of therapy and counseling.

Each person treated not only understands the underlying causes of their behavior but becomes empowered to arrest the behavior and experience inner healing. Self-harm is distressing to those who witness its effects and is rightfully understood as a cry for help.

There is some uncertainty about which forms of psychosocial and physical treatments of people who harm themselves are most effective. Psychiatric and personality disorders are common in people who self-harm.  As a result, self-harm may indicate depression and/or other psychological problems. Many people who self-harm have moderate to severe depression, so treatment with anti-depressant medication may often be used.

Analysis of patients with self-harming behavior found that psychological therapy is effective in reducing self-harm. 

Therapy for Self-Harm Patients

Although pharmacotherapy (treatment through the use of medication) has not been tested as a treatment, the psychological therapies with the largest effect are:

Cognitive Behavioral Therapy (CBT) is a psychological therapy that addressed issues such as anxiety and depression as well as other mental health concerns.  It helps people become aware of inaccurate or negative thinking. It makes it easier to see challenging situations more clearly and responses to them that are more effective.

Dialectical Behavior Therapy (DBT) is a variation of CBT and is designed for individuals with self-harming behaviors such as cutting, suicidal thoughts, and attempts.  The focus of DBT is to help a person change self-destructive behaviors and work toward a more fulfilling life.  

Problem Solving Therapy is a brief psychological intervention that focuses on identifying the specific problems that an individual is facing and discovering alternative solutions.  Individuals learn to accurately define the problem they face, consider multiple solutions, and decide on the best course of action.

Inpatient vs. Outpatient Programs

Outpatient treatment programs can provide very real treatment for people with addictions and mental health issues. Without removing them from careers, schools, and families, programs like this work with local providers. They obtain care during daytime hours and return home at night or attend therapy groups in the evenings and continue their normal daytime activities. No hospitalization is involved. Outpatient programs can vary in terms of intensity and time commitment. Since all outpatient programs provide some level of free time, they are best for people who have a strong support system at home and a deep desire to get better.

Residential programs (inpatient treatment) provide round-the-clock supervision that’s just not possible in an outpatient program. For some, this makes all the difference. It could be vital for people who have very severe cases that can’t be mended through less-intensive techniques.

What Can You Do to Help Your Loved One?

The first thing you can do is educate yourself about self-harm. Ask how the person is feeling and don’t avoid the subject but don’t be judgmental. Be supportive of your friend and acknowledge their pain without reinforcing their behavior. Don’t focus on the behavior itself.  Encourage them to get professional help

At Northbound Treatment Services, self-mutilation treatment consists of one-on-one counseling, group therapy, and a daily program of recovery. A 12-Step program is extremely beneficial to a person who suffers from self-mutilation addiction. This daily program allows addicts to find cessation of their obsessive and compulsive behaviors and provides tools and support for continued recovery.

If you self-harm, you may feel embarrassed about it or worry that other people will judge you or try to make you stop if you tell them about it. Many people keep it a secret for this reason. If you’re harming yourself, it’s very important to talk to someone you trust and who understands what you are going through. 

If you have noticed scars, marks or behavior that concerns you, but you are not sure whether the person is self-harming, talk to them.  They might not want to open up right away, but letting them know you are there for them is a big help. Show that you care and that you are concerned.

In either case, you can contact us today. At Northbound, we offer a safe and effective treatment setting for individuals who practice self-harm.  

References

www.cihi.ca/web/resource/en/info_child_harm_en.pdf

www.wikipedia.org

www.mentalhealth.org.nz

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