The Basics of Self-Injurious Behavior
Self-Injurious Behavior, also known as Self-Mutilation (or more commonly Cutting), describes behaviors in which an individual causes physical harm to their own body. While making small cuts on one’s arms or legs is the more common example of this behavior, self-injury can also include head-banging, punching walls, burning one’s self, scratching one’s self and even punching one’s self in the head and face.
Self-Injurious behavior is directly related to emotional disturbances and is often a symptom of a deeper mental health issue. This can be associated with mood disorders and certain personality disorders (according to the DSM.)
Self-Injury is often mistaken for suicidal behavior, as minor cuts to the arms and wrists can physically resemble a suicide attempt. While ‘cutting’ and ‘burning’ can and will lead to scarring and permanent skin damage, these behaviors are not normally designed to inflict mortal or fatal harm to the body.
However, Suicidal Ideation can often co-exist alongside Self-Injurious behaviors in a person, and Self-Injurious behaviors can accidentally lead to more immediate danger if one ‘goes too far.’ Still, it is important to recognize the difference between suicide and self-mutilation.
There are four primary reasons why individuals habitually harm themselves in a non-suicidal manner:
1. The physical pain caused by self-injury distracts from more volatile emotional distress and emotional pain. It is used as a distraction.
2. The physical pain allows somebody to feel something, anything – in other words, to reduce dissociation, disconnectedness and emotional numbness. It is used as the opposite of an anesthetic.
3. The physical pain releases “endorphins” into the body. This is a less common reason but can be verbalized as a rationalization by cutters.
4. Peer pressure associated with certain subcultures and fads (some ‘goth’ and ‘emo’ cliques.)
Females tend to be Self-Injurers more than males, and teenagers and young adults tend to Self-Injure the most.
Almost all Self-Injurers have a history of physical, sexual, or emotional abuse. It is often these traumatic events that generate the extreme emotional pressure that becomes too much for a person to face or confront. Continued drug use or depression can lead to a flat affect or ongoing feelings of dissociation. Low self-esteem is also prevalent in populations of Self-Injurers.
One client I worked with was ‘triggered’ into wanting to hurt herself when she encountered men that reminded her of an extremely abusive ex-husband, or even when she became very frustrated. This was coupled with a history of sexual abuse and very low self-esteem.
Self-Injurers often hide their injuries from loved ones. They may wear long pants and tops with long sleeves to conceal scratches and cut marks. Most Self-Injurers harm themselves when they are alone and away from the watchful eyes of others.
A ‘hoarder’ is somebody who actively scavenges for sharp objects in which to use to cut themselves at a later time. This includes knives, scissors, shards of glass, and other objects. I personally worked with a cutter who smashed a light bulb in order to cut, and she would try to keep her fingernails long for scratching purposes.
Treatment for Self-Injurers takes place on a variety of levels.
First, the deeper roots of emotional distress need to be confronted. This is often done through psychotherapy in a safe environment, or through the teaching of specific DBT (Dialectical Behavioral Therapy) skills. Many areas have rape crisis hotlines that can provide immediate counsel to persons with a history of sexual abuse or trauma.
If one is struggling with the urge to Self-Mutilate, it makes sense for a trusted friend or family member to remove sharp objects and other potentially dangerous materials from their living space.
Another level of treatment involves either Avoidance or Replacement behaviors. A person can be encouraged to engage in something else, such as calling a loved one, writing in a journal, or taking a walk when the urge to Self-Harm appears. Physical exercise certainly can lead to a release of endorphins that far exceeds that which is caused by making superficial cuts on one’s skin. A replacement behavior may include wearing a rubber band or elastic hair-tie around one’s wrist and snapping it to cause a brief jolt of physical pain that does not cause any physical damage to one’s body.
Finally, certain antidepressants such as Prozac can numb the emotional distress one may feel and create a feeling of euphoria.