Self-Harming Behaviors

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KEY POINTS

• Self-harm means hurting your body on purpose.
• Self-harming behaviors may be treated with therapy or medicine. If you are a danger to yourself, you may need to be treated in the hospital.
• Journaling, art therapy, relaxation techniques, physical exercise, and other behaviors may be useful to replace self-harm behaviors.

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What does it mean to self-harm?

Self-harm means hurting your body on purpose. It often leaves marks or causes damage. It may also be called self-injury, self-mutilation, and self-abuse. Self-harm is a way to cope with or relieve painful or hard-to-express feelings, but the sense of relief you may get does not last long.

If you self-harm, you may be at a higher risk for suicide because of the danger of certain self-harm behaviors.

What is the cause?

The exact cause of this disorder is not known. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Problems in your family when you were growing up may increase your risk. For example, if you were abused as a child, you may have learned to blame yourself or to feel that you deserve to be hurt. Your risk is higher if someone in your family has the disorder, or if your parents abused drugs or alcohol.
• Having friends who self-harm can increase the risk.
• Abuse of alcohol and drugs may also lead to self-harm.
• Stress plays a part. If you deliberately harm yourself, you may be trying to:
  • Distract yourself from something that you feel you cannot deal with
  • Express feelings you can’t put into words
  • Help you feel in control
  • Make you feel something, instead of feeling numb
  • Release stress and tension and provide a sense of relief
  • Relieve guilt or punish yourself or others

Self-harming can happen at any age, but it is most common in teens and young adults.

What are the symptoms?

Symptoms may include:

• Cutting, biting, rubbing, or scratching yourself until your skin is broken and bleeds
• Head banging or hitting yourself hard enough to cause bruises
• Burning your skin using heat, chemicals, or cigarettes
• Pulling hair from your scalp or eyebrows
• Pulling off your fingernails or toenails
• Picking at scabs continually until you bleed and the sore does not heal
• Swallowing poisons or other non-food items

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you.

How is it treated?

Therapy may help.

• Behavior therapy helps you recognize that the way you act affects others. This can help you change problem behaviors.
• Cognitive behavior therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new thought and behavior patterns.
• Dialectical behavior therapy helps you be aware of your thoughts and behavior, learn how to express your needs, deal with stressful situations, and manage your emotions.

Medicine may be prescribed if you also have problems with anxiety, panic, depression, or obsessive thoughts.

Trying to stop self-harming may be very stressful. Journaling, art therapy, relaxation techniques, and physical exercise may be useful to replace self-harm behaviors.

If you are a danger to yourself, you may need to be treated in the hospital. You may also need to be in a day or evening treatment program for several months to learn how to manage your emotions in a safe way.

How can I take care of myself?

Your first task when you decide to stop is to break the cycle and find new ways to deal with your feelings. First, ask yourself these questions:

• What are the situations or feelings that trigger my desire to hurt myself?
• How will I feel when I am hurting myself?
• How will I feel after hurting myself?
• What else can I do that won't hurt me?

Make a conscious decision to do something else. Here are some ideas:

If you are angry, frustrated, or restless:

• Wrap yourself in a blanket and rock back and forth until you feel calmer.
• Flatten aluminum cans or hit a punching bag.
• Throw ice against a wall hard enough to shatter the ice.
• Clean your room or your whole house.

If you are sad, depressed, or unhappy:

• Do something soothing, such as taking a hot bath with bath oil or bubbles.
• Do something you enjoy, like going for a walk or watching a movie
• Do whatever makes you feel taken care of and comforted such as lighting incense, listening to soothing music, or calling a friend

If you are craving sensation or feeling unreal:

• Squeeze ice hard.
• Bite into a hot pepper.
• Rub peppermint or menthol ointment under your nose.
• Take a cold bath.

If you want to see blood or pick scabs:

• Draw on a picture of yourself with a red pen.
• Get a henna tattoo kit. After you put the henna on you can pick it off as you would a scab and it leaves an orange-red mark behind.

Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs. Exercise according to your healthcare provider's instructions.

Get support. Talk with family and friends. Join a support group in your area. Get emergency care if you or a loved one has serious thoughts of suicide or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  http://www.nimh.nih.gov/