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Cutting the skin is probably the most common form of self-injury. The cuts are not usually deep, but in some cases medical attention is needed to clean, dress or stitch the wounds. The most common places on the body to cut are the wrists, upper arms, inner thighs and upper chest. Less common are the face, breasts, abdomen and genitals. Often people who cut themselves will use one or two methods, for example, knives, glass or razor blades. The person tends to have a certain area of the body that they prefer to cut, such as the arms.
Burning the skin (usually with cigarettes) is also common. People may also self-harm by scratching, hitting or punching, sometimes using an object. Other forms of self-injury include picking at the skin, pulling out hair, swallowing poisonous substances, taking an overdose of tablets or drugs or deliberately breaking bones.
Several other forms of behaviour can also be seen as types of self-injury. For example:
- Misusing drugs.
- Drinking too much alcohol.
- Smoking too much.
- Starving yourself or binge-eating.
- Making yourself vomit.
Although there is a connection between self-harm and suicide, the majority do not risk their lives. For many people who self-injure, their actions are only an attempt to cope with the stress and difficulties they face; their purpose is not to end their life. However, there is a possibility that those who self-injure may commit suicide either deliberately or accidentally as a result of their actions.
Self-harm is much more common among girls than boys, often starting in adolescence (between 13 and 18 years of age), although it can affect children from as young as 11 years old. Embarrassment, shame and fear of discovery often means that people keep self-injury a secret. Because of this, it is difficult to know how many people self-harm.
Some people self-harm only once or a few times, while others do it on a regular basis, sometimes throughout their lives.
Symptoms of self-injury
Self-harm is often a symptom of other health problems like depression, low-self esteem, self-hatred, grief or other deep emotional distress. Signs that somebody may be self-injuring are unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest.
People who self-injure are very careful to hide the damage and scars. They will often injure themselves in places that can be easily hidden by clothing so friends and family members may be unaware of the person self-injuring in private.
Another sign that someone could be self-harming is that the person will insist on keeping covered up at all times, even in hot weather.
Family and friends should look also for signs of depression and low self-esteem. The person who is self-injuring may feel deep shame and guilt or they may feel confused and worried by their own behaviour.
Causes of self-injury
People self-injure for a variety of reasons and sometimes the person does not actually know why they are doing it. However, it is commonly thought to provide a release for pent-up emotions and feelings. For some people it is their way of coping with a specific problem.
It is understood that in most cases of those who self-harm it is because they have gone through a very difficult time as a child or young adult.
Although this is not always the case, self-injury can often be linked to:
- sexual, physical and emotional abuse,
- low self-esteem or self-hatred,
- fear of rejection,
- being neglected,
- being isolated or separated from someone they love,
- being bullied or harassed,
- feelings of guilt, anxiety, loneliness, grief or anger, and
- feelings of numbness or emptiness or of not feeling connected to the world.
Self-injury is a sign of emotional distress and is not an attempt to seek attention.
People who self-harm often describe feelings of numbness or deadness or they may feel detached from reality, as if they are not part of the world. Some may injure themselves to stay separated from reality but others do it to make themselves feel more real, connected and alive.
As self-injury is often done in secret, it is up to the individual to visit their GP to receive help.
It is important that self-harm is taken seriously and that appropriate help and support is offered. The GP will discuss the history of self-harm with the person and try to find out if there is an underlying cause that can be treated. With the person's agreement the GP may refer the patient to the mental health services.
It is likely that the person will have:
- an obsession or addiction with self-injury,
- increasing tension before self-injuring and a sense of relief afterwards,
- no true intention of committing suicide, and
- not experienced psychotic symptoms, such as delusions or hallucinations.
Someone who self-injures is usually deeply distressed and needs understanding and support and should seek professional help.
A GP will usually refer them to a psychiatrist or a psychotherapist for an assessment. There are few clinical therapists specialising in self-injury, so referral is often to therapists who deal with abuse or whose expertise is in eating disorders.
Cognitive behavioural therapy (CBT) is ideally used to explore feelings before the individual self-injures, with the aim of finding other ways to express the build-up of feelings, emotions and tensions. The causes of low self-esteem are explored.
Psychotherapy may be offered to explore any history of sexual, physical or mental abuse. Also, advice is given on other outlets for the build up of tension and tips for how to keep safe if the person is continuing to self-harm.
Successful treatment depends on teaching the individual new ways of coping with emotions and feelings. People self-injure for all sorts of reasons, so a large part of recovery involves helping to recognise the individual triggers. Self-help groups can also be helpful.
Hospitalisation is only used as a last resort if the individual is at a risk of severe self-injury or suicide.
Complications of self-injury
People who injure themselves risk infections if their wounds are not treated properly. Cuts can become infected if a person uses non-sterile or dirty cutting instruments.
It is also important not to share cutting implements with other people as many diseases, including HIV and AIDS, can be caught this way.
They are also at risk of permanent scarring from the cuts and wounds.
NHS Choices links
- Live Well: find a therapist
- Health A-Z: CBT
- Health A-Z: depression
- Health A-Z: psychotherapy
- Health A-Z: eating disorders
- Video: depression