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Self-Injury/Cutting

Definition :
For people who can't fathom deliberately hurting themselves, self-injury may seem shocking and frightening. But for people who do injure themselves by cutting or other means, self-injury offers a momentary sense of calm and a release of tension. Unfortunately, that's usually quickly followed by guilt and shame and the return of other painful emotions. And with self-injury comes the very real possibility of inflicting serious and even fatal injuries.

Self-injury isn't a specific disease or condition. Rather, it's a type of abnormal behavior. It may accompany a variety of mental disorders, such as depression and borderline personality disorder. Because self-injury is often done on impulse, it's sometimes considered an impulse-control behavior problem. Self-injury is also known as self-harm, self-injurious behavior and self-mutilation.

Although it's hard to estimate how many people engage in self-injury because some never seek treatment, it's thought that about 3 percent to 5 percent of Americans have deliberately hurt themselves at some point in their lives. Self-injury may be more common — and on the rise — in adolescents.

Causes:
There's no one single or simple cause of self-injury. The mix of emotions that drives some people to hurt themselves is complex. People who engage in self-injury, whether adolescents or adults, are often in the throes of deep psychological pain but lack healthy ways to cope. So they turn to self-injury to gain relief. Physical injury distracts them from painful emotions or helps them feel a sense of control over an otherwise uncontrollable situation. For those who have feelings of emptiness or little emotion, self-injury is a way to feel something, anything, even if it's physical pain. It also offers an external way to express internal distress and despair.

Self-injury is sometimes associated with certain medical conditions, such as personality disorders, depression, eating disorders, substance abuse and post-traumatic stress disorders. In addition, self-injury may occur in people who have developmental disabilities, such as autism and mental retardation.

Risk Factor :
Although intentional self-injury can affect anyone, from pre-adolescents to older adults, certain factors may increase the risk that someone will engage in self-injury, including :

  • Age. Self-injury often starts in the preteen or early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness and conflicts with parents or other authority figures.
  • Sex. Self-injury is more common in females than in males. But that may be a false difference, because females are more likely than males to seek treatment.
  • Family history. Some evidence suggests that self-injury is more common in people who have a family history of suicide or self-injury.
  • Psychosocial factors. Many people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood. Social isolation and living alone may also increase the risk. Unstable living conditions, such as unemployment and divorce, may also be factors.
  • Certain mental disorders. Some mental disorders are more commonly associated with self-injury, including borderline personality disorder and other personality disorders, depression, substance abuse disorders, post-traumatic stress disorder and eating disorders. Many of these disorders often occur together. People who self-injure are more likely to be impulsive and to have poor problem-solving skills.
  • Alcohol or substance misuse. People who engage in self-harm often do so while under the influence of alcohol or illicit drugs.

When to seek medical advice :
People who deliberately injure themselves typically feel overwhelmed by a mix of emotions, ranging from anger and rage to depression and hopelessness. They may be embarrassed and shamed about their self-injury and try to hide it from others. Some who engage in self-injury may secretly enjoy it since it soothes emotional pain, albeit temporarily. Some may even flaunt it, especially if self-injury is used as a way to upset parents or other authority figures.

In any case, self-injury contributes to a life of distress and chaos. It also poses the risk of serious, debilitating injury, disfigurement or even death.

If you have injured yourself severely or believe it may be life-threatening, call 911 or your local emergency services provider. If a loved one has injured himself or herself severely, take them to the hospital or call for emergency help.

When you engage in self-injury
The relief found in self-injury is almost always short-lived. You may feel better for a little while, only to find that distressing emotions have quickly returned and you're once again reaching for a razor to cut your arm or a match to burn your stomach, even if you vowed to stop injuring yourself. Self-injury can become almost habitual — you may automatically turn to self-injury without stopping to consider other, safer alternatives to handling distress.

Self-injury may be more dangerous than you think. You risk hurting yourself more seriously than you intended — for instance, severing an artery that can lead to life-threatening blood loss. If you injure yourself while you're under the influence of illicit drugs or alcohol, you increase your risk of inflicting serious injury or even death.

It's very difficult to overcome self-injury on your own. Getting treatment from a mental health professional with experience in self-injury issues can help you learn healthier ways to cope — ways that won't leave your body permanently scarred. Try to work up the courage to confide in someone you trust, whether it's a friend or loved one, a health care professional or a school or university employee. They can help you take the first steps to successful treatment.

When a loved one engages in self-injury
If you have a loved one who engages in self-injury, you may not know what to do. You may be shocked, dismayed and scared. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach.

If your loved one is an adult, gently encourage him or her to seek medical treatment. If it's your child, you can start by consulting your pediatrician or family doctor, who can provide an initial evaluation or a referral to a mental health specialist.

Symptoms:
What self-injury is and isn't
Self-injury is behavior in which people deliberately harm their own bodies in some way to cope with overwhelming emotions. Self-injury frequently is an impulsive act. You may become upset and spontaneously seek a way to hurt yourself, recklessly doing damage to your body. Other times, self-injury may be inflicted in a controlled, methodical manner. You may even plan it in advance, taking steps to avoid detection and to prevent infections.

Self-injury isn't the same as injury that arises from culturally sanctioned practices in some parts of the world, including scarring, piercing and tattooing, which historically have been considered forms of self-mutilation. Self-injury is distinguished from such practices by the emotional intent behind it — it's an unhealthy coping method for overwhelming feelings.

Self-injury also isn't the same as a suicide attempt. For instance, someone may try to harm himself or herself by taking an overdose of medication, but stop short of taking a lethal dose. In self-injury, the intent isn't to die, but to inflict bodily harm. However, self-injury can accidentally result in suicide.

Types of self-injury
Self-injury is most commonly associated with cutting, which involves making cuts or scratches on your body. Cutting can be done with any sharp object, including knives, needles, razor blades or even fingernails.

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be subjected to self-injury.

Some people don't feel pain while they're hurting themselves, even when creating deep cuts. Others do find self-injury painful but welcome the pain as a punishment or as a distraction from emotional turmoil.

There are many types of self-injury besides cutting, and someone may engage in one or more of them. Other types of self-injury include :

  • Burning
  • Poisoning or overdosing
  • Scratching
  • Carving words or symbols on the skin
  • Breaking bones
  • Hitting or punching
  • Piercing the skin with sharp objects
  • Head banging
  • Pulling out hair
  • Interfering with wound healing
  • Pinching
  • Biting

Some experts consider overexercising a form of self-injury, as well as stopping medication in an attempt to cause harm to yourself.

Signs of self-injury
People who injure themselves often try to keep their behavior secret. It may be difficult to spot signs of self-injury.

Signs of self-injury may include :

  • Scars, such as from burns or cuts
  • Cuts, scratches or other wounds
  • Bruises
  • Broken bones
  • Keeping sharp objects on hand
  • Spending a great deal of time alone
  • Wearing long sleeves or long pants even in hot weather
  • Claiming to have frequent accidents or mishaps

Diagnosis:
Diagnosing self-injury can be difficult unless the person hurting himself or herself discloses the behavior. Sometimes self-injury is discovered accidentally. For instance, a doctor doing a routine medical examination may notice signs, such as scars or fresh burns.

During an initial evaluation for self-injury, a health care provider may ask you such questions as:

  • When your self-injury began
  • How often you engage in self-injury
  • What types of self-injury you use
  • What seems to trigger your self-injury
  • What emotional issues you face
  • What social networks or relationships you have
  • What previous treatment, if any, you've had
  • Your feelings about the future
  • Whether you have thoughts of suicide

A definitive diagnosis may require evaluation by a mental health professional with experience in treating self-injury. A mental health professional may also evaluate you for other mental illnesses that may accompany self-injury, such as depression or personality disorders.

Complication :
Self-injury causes a variety of complications.

  • Engaging in self-injury can contribute to or worsen feelings of shame, guilt and low self-esteem.
  • Even if you don't mean to hurt yourself seriously, self-injury can lead to life-threatening problems, such as blood loss if major blood vessels or arteries are cut.
  • Self-injury can lead to accidental or deliberate suicide. You may unintentionally injure yourself fatally, especially if you engage in self-injury while under the influence of alcohol or illicit drugs. People who engage in self-injury are also at higher risk of deliberately taking their own lives.
  • Self-injury can cause permanent scars. You may not worry about that while you're in the midst of hurting yourself or if you're a teen who thinks the future is bleak, but scarring may create shame or embarrassment years down the road.
Treatment:
Treating self-injury usually requires psychotherapy and medications, with emergency or psychiatric hospitalization sometimes necessary. Whether you engage in self-injury or have a loved one who does, know that there are ways to overcome it and healthier options to cope with emotional distress.

Treating self-injury can take time and hard work. Treatment focuses on addressing the underlying reasons for hurting yourself. Because self-injury can become so entrenched and it's often accompanied by serious mental disorders, treatment with a mental health professional well versed in self-injury issues may be necessary.

Treatment typically includes :

  • Psychotherapy. Also known as talk therapy or counseling, psychotherapy can help you identify underlying issues that trigger self-injury. In particular, a type of psychotherapy called dialectical behavior therapy (DBT) is frequently used for self-injury. Its main objective is to teach behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others. Your therapist may ask you to create a safety plan that includes steps to take to prevent an episode of self-injury. In addition to individual therapy, family therapy or group therapy may also be recommended.
  • Medications. There are no medications that specifically treat self-injury. However, your doctor may recommend treatment with antidepressants or other psychiatric medications that can help improve depression, anxiety or other mental disorders. An improvement in those symptoms may help you feel less compelled to hurt yourself.
  • Psychiatric hospitalization. If you injure yourself severely or repeatedly, your doctor may recommend psychiatric hospitalization. Hospitalization can provide a safe environment and more intensive treatment until you get through a crisis.

Prevention:
Preventing self-injury involves identifying people who are most at risk and then offering help. For instance, those at risk can be taught healthy coping skills that they can then draw upon during periods of intense distress. But identifying those at risk isn't always easy.

If you have a loved one who seems to have signs or symptoms of depression or who seems overwhelmed by events in his or her life, early intervention, such as psychotherapy, may prevent a worsening of problems that can lead to self-injury.

Some adolescents learn about cutting and other forms of self-injury from their peers or from media accounts. You may be able to help prevent your child from trying out self-injury if you openly talk about the issue and discuss what emotional challenges they face.

If you're contemplating self-injury for the first time, turn instead to a trusted friend or loved one, or a medical professional. They can help you find better options — options that won't leave you permanently scarred.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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