by Laura E. Gibson, Ph.D., The University of Vermont
What is self-harm?
"Self-harm" refers to the deliberate, direct destruction of body
tissue that results in tissue damage. When someone engages in
self-harm, they may have a variety of intentions; these are
discussed below. However, the person's intention is NOT to kill
themselves. You may have heard self-harm referred to as
"parasuicide," ""self-mutilation," "self-injury," "self-abuse,"
"cutting," "self-inflicted violence," and so on.
How common is self-harm?
Self-harm is not well-understood and has not yet been
extensively studied. The rates of self-harm revealed through
research vary tremendously depending on how researchers pose their
questions about this behavior. One widely cited estimate of the
incidence of impulsive self-injury is that it occurs in at least 1
person per 1,000 annually
1. A recent study of psychiatric outpatients found that 33%
reported engaging in self-harm in the previous 3 months
2. A recent study of college undergraduates
3 asked study participants about specific self-harm behaviors
and found alarmingly high rates. Although the high rates may have
been due in part to the broad spectrum of self-harm behaviors that
were assessed (e.g., severe scratching and interfering with the
healing of wounds were included), the numbers are certainly cause
for concern:
18% reported having harmed themselves more than 10 times in
the past,
10% reported having harmed themselves more than 100 times in
the past, and
38% endorsed a history of deliberate self-harm.
The most frequently reported self-harm behaviors were needle
sticking, skin cutting, and scratching, endorsed by 16%, 15%, and
14% of the participants, respectively.
It is important to note that research on self-harm is still in
the early stages, and these rates may change as researchers begin
to utilize more consistent definitions of self-harm and more
studies are completed.
Who engages in self-harm?
Only a handful of empirical studies have examined self-harm in a
systematic, sound manner. Self-harm appears to be more common in
females than in males, and it tends to begin in adolescence or
early adulthood. While some people may engage in self-harm a few
times and then stop, others engage in it frequently and have great
difficulty stopping the behavior
4. Several studies
3,
5,
6 have found that
individuals who engage in self-harm report unusually high rates of
histories of:
Childhood sexual abuse
Childhood physical abuse
Emotional neglect
Insecure attachment
Prolonged separation from caregivers
At least two studies have attempted to determine whether
particular characteristics of childhood sexual abuse place
individuals at greater risk for engaging in self-harm as adults.
Both studies reported that more severe, more frequent, or a longer
duration of sexual abuse was associated with an increased risk of
engaging in self-harm in one's adult years
7,
8.
Also, individuals who self-harm appear to have higher rates of
the following psychological problems
2,
4,
6:
High levels of dissociation
Borderline personality disorder
Substance abuse disorders
Posttraumatic stress disorder
Intermittent explosive disorder
Antisocial personality
Eating disorders
Why do people engage in self-harm?
While there are many theories about why individuals harm
themselves, the answer to this question varies from individual to
individual
9,
10.
Some reasons why people engage in self-harm:
To distract themselves from emotional pain by causing
physical pain
To punish themselves
To relieve tension
To feel real by feeling pain or seeing evidence of
injury
To feel numb, zoned out, calm, or at peace
To experience euphoric feelings (associated with release of
endorphins)
To communicate their pain, anger, or other emotions to
others
To nurture themselves (through the process of healing the
wounds)
How is self-harm treated?
Self-harm is a problem that many people are embarrassed or
ashamed to discuss. Often, individuals try to hide their self-harm
behaviors and are very reluctant to seek needed psychological or
even medical treatment.
Psychological treatments
Because self-harm is often associated with other psychological
problems, it tends to be treated under the umbrella of a
co-occurring disorder like a substance abuse problem or an eating
disorder. Sometimes the underlying feelings that cause the
self-harm are the same as those that cause the co-occurring
disorder. For example, a person's underlying feelings of shame may
cause them to abuse drugs
and cut themselves. Often, the self-harm can be addressed in
the context of therapy for an associated problem. For example, if
people can learn healthy coping skills to help them deal with their
urges to abuse substances, they may be able to apply these same
skills to their urges to harm themselves.
There are also some treatments that specifically focus on
stopping the self-harm. A good example of this is Dialectical
Behavior Therapy
11, a treatment that involves individual therapy and group skills
training. DBT is a therapy approach that was originally developed
for individuals with borderline personality disorder who engage in
self-harm or "parasuicidal behaviors." Now the treatment is also
being used for self-harming individuals with a wide variety of
other psychological problems, including eating disorders and
substance dependence. The theory behind DBT is that individuals
tend to engage in self-harm in an attempt to regulate or control
their strong emotions. DBT teaches clients alternative ways of
managing their emotions and tolerating distress. Research has shown
that DBT is helpful in reducing self-harm.
Pharmacological treatments
It is possible that psychopharmacological treatments would be
helpful in reducing self-harm behaviors, but this has not yet been
rigorously studied. As yet, there is no consensus regarding whether
or not psychiatric medications should be used in relation to
self-harm behaviors. This is a complicated issue to study because
self-harm can occur in many different populations and co-occur with
many different kinds of psychological problems. If you are
wondering about the use of medications for the emotions related to
your self-harm behaviors, we recommend that you discuss this with
your doctor or psychiatrist.
How to find a qualified psychologist or psychiatrist
If you are trying to find a psychologist or psychiatrist, we
advise you to ask them whether they are familiar with self-harm.
Consider which issues are important to you and make sure you can
talk to the potential therapist about them. Remember that you are
the consumer-you have the right to interview therapists until you
find someone with whom you feel comfortable. You may want to ask
trusted friends or medical professionals for referrals to
psychologists or psychiatrists. Consider asking your potential
provider questions, such as:
How do you treat self-harm?
What do you think causes self-harm?
Do you have experience in treating self-harm?
For tips on communicating with medical providers in a medical
context see our fact sheet on "Discussing Trauma and PTSD with Your Doctor".
Self-help resources
There are a variety of self-help books on the market for people
who engage in self-harm. Most of these provide practical advice,
support, and coping skills that may be helpful to individuals who
engage in self-harm. These approaches have not been studied in
research trials, so it is not known how effective they are for
individuals who self-harm. Two books that may be useful to
individuals who self-harm are:
Alderman, T. (1997).
The Scarred Soul: Understanding and Ending Self-Inflicted
Violence. Oakland, CA: New Harbinger Publications.
Conterio, K., & Lader, W. (1998).
Bodily Harm: The Breakthrough Healing Program for
Self-Injurers. New York: Hyperion.
My friend or relative self-harms. What should I do to be
supportive?
If you have a friend or relative who engages in self-harm, it
can be very distressing and confusing for you. You may feel guilty,
angry, scared, powerless, or any number of things. Both of the
books mentioned above contain chapters for friends and family
members. Some general guidelines are:
Take the self-harm seriously by expressing concern and
encouraging the individual to seek professional help.
Don't get into a power struggle with the
individual-ultimately they need to make the choice to stop the
behavior. You cannot force them to stop.
Don't blame yourself. The individual who is self-harming
initiated this behavior and needs to take responsibility for
stopping it.
If the individual who is self-harming is a child or
adolescent, make sure the parent or a trusted adult has been
informed and is seeking professional help for them.
If the individual who is engaging in self-harm does not want
professional help because he or she doesn't think the behavior is
a problem, inform them that a professional is the best person to
make this determination. Suggest that a professional is a neutral
third party who will not be emotionally invested in the situation
and so will be able to make the soundest recommendations.
References
1.
Favazza, A. (1996).
Bodies under siege: Self-mutilation and body modification in
culture and psychiatry (2
nd ed.). Baltimore, MD: The Johns Hopkins University
Press.
2.
Zlotnick, C., Mattia, J.I., &
Zimmerman, M. (1999). Clinical correlates of self-mutilation in a
sample of general psychiatric patients.
The Journal of Nervous and Mental Disease, 187, 296 -
301.
3.
Gratz,
K.L., Conrad, S.D., & Roemer, L. (2002). Risk factors for
deliberate self-harm among college students.
American Journal of Orthopsychiatry, 72, 128 - 140.
4.
Simeon,
D., & Hollander, E. (Eds.). (2001).
Self injurious behaviors: Assessment and treatment.
Washington, DC: American Psychiatric Press.
5.
Van der Kolk,
B.A., Perry, J.C., & Herman, J.L. (1991). Childhood origins of
self-destructive behavior.
American Journal of Psychiatry, 148, 1665 - 1671.
6.
Zlotnick, C., Shea, M.T.,
Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996).
The relationship between dissociative symptoms, alexithymia,
impulsivity, sexual abuse, and self-mutilation.
Comprehensive Psychiatry, 37, 12 - 16.
7.
Boudewyn, A.C., & Liem, J.H.
(1995). Childhood sexual abuse as a precursor to depression and
self-destructive behavior in adulthood.
Journal of Traumatic Stress, 8, 445 - 459.