A buildup of emotions like frustration, anger, self-loathing, depression and anxiety can cause someone to seek an outlet through self-mutilation. A common misconception is to lump suicidal behavior with this deliberate self-harm, sometimes referred to as DSH and other times as NSSI, non-suicidal self-injury. They are, however, not the same and should be considered separately.
Self-harm is when individuals deliberately and intentionally hurt themselves. Unlike suicide where the intent is often to end the pain with death, self-harm is usually a release or an outlet for suffering. The British Medical Journal reports that the most common methods of DSH are cutting at 64.6 percent and poisoning at 30.7 percent.
Other methods include:
- Hair pulling
- Skin picking
- Intentional interference with wound healing
Self-harm, or self-mutilation, is defined as a self-inflicted and deliberate injury to the body tissue that causes pain, bruising or bleeding without any suicidal intent and not for purposes that are considered socially acceptable like tattooing or body piercing.
Those who harm themselves on purpose typically are seeking solace in the action; for some, it is a cry for help. Episodes of self-harm can be difficult to quantify as much of the time they go unreported and untreated. Many times self-harming behavior is wrongfully identified as a suicide attempt, when in reality the intent was not meant to be fatal.
Who Is at Risk
Self-harm is likely more common than most people realize as it often occurs behind closed doors and leaves marks hidden underneath clothing. It is most common in young adults with studies indicating that between 12 and 23 percent of adolescents engage in self-harming behavior during their lifetimes. Pressures of adolescence and high school may partially account for these high numbers.
Adolescents face enormous amounts of pressure and coupled with poor impulse control, peer influences, and developing brains and bodies can add to mounting emotional turmoil. Females also seem to be at a higher risk and professionals speculate that this could be due to different gender pressures that encourage females to internalize their pain, anger and frustration while men are more socially accepted to outwardly display it.
There are several other factors that seem to increase a person’s risks for developing self-harming behaviors including:
- Sexual abuse
- Childhood abuse
- Separation as a child from their caregiver
- Emotional neglect
- Psychiatric disorder
- Substance abuse
Overwhelming feelings of depression, anxiety, frustration and anger can lead to attempts to ease these strong emotions with self-injurious behavior that can leave long-lasting and permanent scars. Self-harming behavior can cause permanent skin and tissue damage and should not be taken lightly. Usually, the mutilating behavior is impulsive and private. It can cause further isolation as the person engaging in it may be overcome with feelings of shame afterwards.
Addiction Compounds the Issue
Self-harm can actually be a form of addiction as individuals crave the release that injuring themselves may bring about. Some feel it is an outlet to let the emotions escape, causing a feeling of relief, brief calm, and even sometimes a rush of endorphins afterwards. These feelings are generally short-lived and often followed up with feelings of shame and guilt, and a desire to punish themselves which can lead to further episodes of self-harm and other dangerous outlets. Those who engage in self-harm often are caught in a vicious cycle they may have trouble breaking on their own.
One such outlet that a person suffering from self-harm may explore is substance abuse. A study out of Oxford found that approximately 8.7 percent of people presenting with deliberate self-harm also abused drugs. Individuals suffering from DSH may seek relief in the form of drugs or alcohol for many of the same reasons they cut or burn themselves. They may actually use the substance as a poison in further attempts to self-harm.
Substance abuse may be an attempt to self-medicate or an attempt to further numb the pain. Unfortunately, it can actually make matters much worse. Some may initially have self-harming tendencies and then move to abusing substances, and some may start out as substance abusers and move on to self-mutilation. Both can have dangerous consequences.
Drugs and alcohol can slow reaction times and decrease nerve endings, making self-injuring behaviors very perilous while under the influence. For example, someone who cuts may cut too deep, causing serious or even fatal wounds before realizing the depth or severity. Alcohol and drugs can also exacerbate feelings of depression and anxiety, leading to more severe methods of injurious behavior even including suicide.
Those who regularly engage in non-suicidal self-injury (NSSI) say that it offers temporarily relief from overwhelming emotions and negative thoughts as much as 90 percent of the time, as reported by Current Psychiatry. It is important to understand that although this seems like it might be helpful, it is not a healthy outlet for relieving stress and should be treated. It can be a symptom of a greater issue and many who suffer from NSSI also may have substance abuse problems as well. Some of the warning signs of this condition are:
- Noticeable wounds that aren’t easily explained
- Wearing long-sleeved clothing at inappropriate times in an attempt to hide wounds
- Avoidance of social situations
- Isolation or a lot of time locked in a room or bathroom
- Feelings of worthlessness or hopelessness
- Personal identity issues
- Tools such as razors, bits of glass, lighters, knives or scissors in places they don’t belong and usually in easily accessible places
Typical locations for cuts and burns are on the arms, legs and stomach; all of which are places that are easily accessible and can be covered up. Social media sites are also flooded with cases of self-harm, and some even glorify it. Cases of celebrity self-mutilation continue to pop up, and self-harming behavior seems to be rising everywhere. Excessive visits to pro-self-harm websites could be a warning sign for a bigger problem. If you or someone you know is presenting these warning signs, it is time to get help.
Self-harming behavior can be difficult to notice, diagnose and treat. Only recently has the disorder really hit the public eye. Many times, episodes of self-harm are indicative of an underlying psychological disorder, but not always. When self-injurious behavior is coupled with addiction, treatment can be even more difficult. Those who struggle with addiction as well as self-harming behaviors need specialized treatment that simultaneously addresses both afflictions.
Dual diagnosis treatment understands the unique pressures that can lead individuals to want to harm themselves. Cognitive Behavioral Therapy may be an effective tool along with group, family and individual therapies. If someone suffering from self-harming behaviors has a traumatic event or trigger in their past or current life, dual diagnosis treatment can work to uncover the issues and help patients to cope in a healthier way.
Developing new life skills and ways to handle stress, anger and frustration as well as depression and anxiety are part of what makes dual diagnosis treatment so successful. At FRN, our trained professionals strive to remain on the forefront of new research and treatment options, and we can offer you the care you need to effectively address self-harming behaviors. Call us today to speak with one of our admissions coordinators about how we can help you or your loved one to begin a new healthy life in recovery.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.