What is self-harm?

Also called self-injury, self-inflicted violence, or self-mutilation, self-harm is defined as the purposeful destruction of bodily tissue in an effort to alleviate emotional pain. Typically, self-harm shows up in the form of cutting on the body with blades, knives, scissors, or other sharp instruments. Self-harm can also be burning, scratching, hitting, banging, bone-breaking, or interfering with wound-healing. Generally speaking, tattooing and piercing are not considered self-harm.

One of the scariest things about self-harm is that a lot of people think it’s a suicide attempt, especially since cutting often happens on the arm, very near the wrist and important arteries. This is a common misconception. Self-harm is not suicidal behavior, even though it can sometimes look like it. On the contrary, self-injurers have found a way of coping with difficult emotions—which is a statement of survival, not despair. However, if self-harm goes untreated for long enough, eventually those intense feelings can lead to despair, and suicide is a possible outcome, albeit a rare one. Self-injurers should seek counseling from a professional therapist with whatever it is inside that feels so overwhelming.

There are several different kinds of self-harm. Very severe and dramatic injuries to the body, such as limb amputation and eyeball enucleation, are associated with severe mental illness such as schizophrenia. This kind of behavior is most often seen in psychiatric hospitals, and is treated with intensive therapy and psychiatric medication. Repetitive head banging and skin picking are another kind of self-harm, often associated with disorders such as mental retardation and autism. In these cases, specially trained occupational and behavioral therapists work with the individual and the family in controlled environments to reduce the frequency of injury from the behavior.

The more common type of self-harm, seen often in elementary and high schools and among many young adults, is called “superficial self-injury." This is the kind I work with. It is characterized by purposeful self-destructive behavior, such as cutting or burning, that is often hidden by the self-injurer due to shame and embarrassment. The key word here is “purposeful”--it serves the purpose of alleviating emotional pain.   On the outside, these individuals are known to be bright, creative, non-confrontational, helpful, and friendly. On the inside, they are suffering a great deal, and use self-harm as a way to soothe their internal pain.

Why on earth would they do that to themselves?

Ah, the most commonly asked question. The truth is there are dozens of reasons, but they are not all easy to understand. Sometimes hurting the body is a way of inflicting a kind of pain that can be controlled, especially when the pain inside--or the environment outside--feels completely out of control. Sometimes breaking the skin can feel like popping a balloon that has too much air inside. In this case, self-harm serves as a “release valve” that decreases built up emotional pressure inside. Other times a person might even inflict a wound to purposely feel pain. Someone like this might feel dead inside, and feeling pain helps them to feel more alive.

You might have heard people refer to self-harm as “attention-getting behavior.” This is where things get a little touchy. The problem with referring to it in this way is that it tends to end the conversation (and therefore the possibility of ever helping the self-injurer) in a dismissive manner. As a society, we are often guilty of being disgusted by attention-getting behavior, and we cast it off as an immature and irresponsible act of rebellion. I like to challenge those who carry such beliefs. First, self-inflicted wounds are more commonly found on body parts that are easily hidden by clothing. This would indicate that the self-injurer is neither proud of the wound, nor does he or she desire attention from it. But there’s a bigger point to be made here: If self-harm is indeed the behavior of an attention-starved individual, shouldn’t we take a closer look at the starvation itself, and not shame the behavior that has resulted? Someone who so desperately needs attention is suffering from the emotional equivalent of severe malnutrition, and is in need of an emotional IV tube. Harming the body on purpose is a cry for help, and it is important that these individuals get the help they need without being shamed, belittled, or interrogated.

Are you worried about someone you love? Answer these questions to find out if your loved one might be engaging in self-harm.

Are you worried about yourself? Answer these questions to find out if it’s time to call a therapist about self-harm.

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