Overview

Nonsuicidal self-injury, often simply called self-injury, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, this type of self-injury is a harmful way to cope with emotional pain, intense anger and frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it's usually followed by guilt and shame and the return of painful emotions. Although life-threatening injuries are usually not intended, with self-injury comes the possibility of more-serious and even fatal self-aggressive actions.

Getting appropriate treatment can help you learn healthier ways to cope.

Symptoms

Signs and 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 on hand
• Wearing long sleeves or long pants, even in hot weather
• Frequent reports of accidental injury
• Difficulties in interpersonal relationships
• Behavioral and emotional instability, impulsivity and unpredictability
• Statements of helplessness, hopelessness or worthlessness

Forms of self-injury

Self-injury usually occurs in private and is done in a controlled or ritualistic manner that often leaves a pattern on the skin. Examples of self-harm include:

• Cutting (cuts or severe scratches with a sharp object)
• Scratching
• Burning (with lit matches, cigarettes or heated, sharp objects such as knives)
• Carving words or symbols on the skin
• Self-hitting, punching or head banging
• Piercing the skin with sharp objects
• Inserting objects under the skin

Most frequently, the arms, legs and front of the torso are the targets of self-injury, but any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.

Becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. But for others, self-injury can become a long-term, repetitive 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 issues that need to be addressed.

Talk to someone you trust — such as a friend, loved one, doctor, spiritual leader, or a school counselor, nurse or teacher — who 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 and nonjudgmental help.

When a friend or loved one self-injures

If you have a friend or loved one 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 consulting your pediatrician or other health care provider who can provide an initial evaluation or 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 immediately.

Also consider these options if you're having suicidal thoughts:

• Call your mental health professional if you're seeing one.
• Call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use their webchat on suicidepreventionlifeline.org/chat.
• Seek help from your school nurse or counselor, teacher, doctor, or other health care provider.
• Reach out to a close friend or loved one.
• 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 psychological pain.
• Difficulty managing emotions. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality

Through self-injury, the person may be trying 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 his or her 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 depression or distressful feelings to the outside world
• Be punished for perceived faults

Risk factors

Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the preteen or early teen years, when emotions are more volatile and teens 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. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
• Life issues. Some people who injure themselves were neglected, were sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality. Some people who self-injure are socially isolated.
• Mental health issues. People who self-injure are more likely to be highly self-critical and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
• Alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or recreational drugs.

Complications

Self-injury can cause a variety of complications, including:

• Worsening feelings of shame, guilt and low self-esteem
• Infection, either from wounds or from sharing tools
• Permanent scars or disfigurement
• Severe, possibly fatal injury
• Worsening of underlying issues and disorders, if not adequately treated

Suicide risk

Although self-injury is not usually a suicide attempt, 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 your loved one'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 resilience and healthy coping skills that can be used during periods of distress.
• Encourage expansion of social networks. Many people who self-injure feel lonely and disconnected. Helping someone form 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 peers to seek help. Peers tend to be loyal to friends. Encourage children, teens and young adults to avoid secrecy and reach out for help if they have a concern about a friend or loved one.
• Talk about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults 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 self-injury is discovered by family members or friends. Or a doctor doing a routine medical exam may notice signs, such as scars or fresh injuries.

There's no diagnostic test for 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.

A mental health professional may also evaluate you for other mental health disorders that may be linked to self-injury, such as depression or personality disorders. If that's the case, evaluation may include additional tools, such as questionnaires or psychological tests.

Treatment

There's no one best way to treat self-injuring behavior, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health disorders 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 experienced in self-injury issues.

If the self-injury behavior is associated with a mental health disorder, such as depression or borderline personality disorder, the treatment plan focuses on that disorder, 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-injuring behavior
• Learn skills to better manage distress
• Learn how to regulate your 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 healthy, adaptive ones
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others
• Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

Medications

There are no medications to specifically treat self-injuring behavior. However, if you're diagnosed with a mental health disorder, such as depression or an anxiety disorder, your doctor may recommend antidepressants or other medications to treat the underlying disorder that's associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.

Psychiatric hospitalization

If you injure yourself severely or repeatedly, your doctor may recommend that you be admitted to a hospital for psychiatric care. Hospitalization, often short term, can provide a safe environment and more-intensive treatment until you get through a crisis. Mental health day treatment programs also may be an option.

Lifestyle and home remedies

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

• Stick to your treatment plan. Keep therapy appointments and take prescribed medications 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 doctor or mental health professional's phone number handy, and tell him or her about all incidents related to self-injury. Appoint a trusted family member or friend as the person you'll immediately contact if you have an urge to self-injure or if self-injuring behavior recurs.
• 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 doctor for advice if you have sleep problems, which can significantly affect your behavior.
• Avoid alcohol and recreational drugs. They affect your ability to make good decisions and can put you at risk of self-injury.
• Take appropriate care of your wounds if you injure yourself or seek medical treatment if needed. Call a family member or friend for help and support. Don't share instruments used for self-injury — that raises the risk of infectious disease.

Coping and support

If you or a loved one needs help in coping, consider the tips below. If there's a focus on thoughts of suicide, take action and get help immediately.

Coping tips if you self-injure include:

• Connect with others who can support you so you don't feel alone. For example, reach out to a family member or friend, contact a support group, or get in touch with your doctor or mental health professional.
• 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, practice relaxation techniques, or participate in dance, art or music.

Coping tips if your loved one self-injures include:

• Get information. Learn more about self-injury to help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior. Know the strategies and relapse prevention plan your 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 he or she is 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 medication and stress the importance of keeping therapy appointments. 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 can also serve as a role model by using appropriate 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 your loved one's doctor or mental health professional 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, too. Take some time to do the things you enjoy doing, and get adequate rest and physical activity.

Preparing for an appointment

Your first appointment may be with your family doctor, another health 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 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 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 any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins, herbs or other supplements that you're taking, including the dosages
• Questions to ask your doctor

Questions to ask your doctor may include:

• What treatments are available? Which do you recommend for me?
• What side effects are possible with that treatment?
• What are the alternatives to the primary approach that you're suggesting?
• Are there medications that might help? Is there a generic alternative to 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 doctor 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?
• 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 social networks 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 doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.