Self-harm

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Self-harm
Synonyms	Self-injury, self-mutilation, self-inflicted violence
Pronounce	N/A
Specialty	N/A
Symptoms	Cutting, burning, scratching, hitting, interfering with wound healing
Complications	Infection, scarring, tissue damage, emotional distress
Onset	Typically adolescence
Duration	Can be episodic or chronic
Types	N/A
Causes	Psychological stress, trauma, mental disorders such as depression, anxiety, borderline personality disorder
Risks	Adolescence, mental health disorders, substance abuse, history of trauma
Diagnosis	Clinical assessment, psychological evaluation
Differential diagnosis	Suicide attempt, body modification, cultural practices
Prevention	Therapy, support groups, coping strategies
Treatment	Psychotherapy, cognitive behavioral therapy, medication
Medication	N/A
Prognosis	Varies; can improve with treatment
Frequency	Estimated 17-20% of adolescents, 5-10% of adults
Deaths	Rarely directly fatal, but associated with increased risk of suicide

Self-harm, also known as self-injury, is a behavioral health condition characterized by the intentional, direct damage to one's own body tissue, typically without suicidal intent. While often misunderstood as a suicide attempt, self-harm is more commonly used as a maladaptive coping mechanism to deal with overwhelming emotional distress, psychological trauma, or mental illness. It is a serious health concern that affects individuals across all ages, genders, and backgrounds.

Self-inflicted minor cuts on the forearm, a common method of self-harm

Definition and Terminology

Self-harm refers to a broad spectrum of deliberate behaviors that cause physical injury to the body. These behaviors are not intended to result in death, though they may increase the risk of eventual suicide. Other commonly used terms include:

• Self-injury
• Non-suicidal self-injury (NSSI)
• Self-mutilation
• Cutting

Common Forms of Self-Harm

Self-harming behaviors can vary widely and include:

• Cutting or carving the skin, often with razors or knives
• Burning the skin with cigarettes, lighters, or heated objects
• Scratching or picking at wounds to prevent healing
• Hitting or punching oneself
• Biting oneself
• Pulling out hair (see Trichotillomania)
• Ingesting harmful substances or foreign objects
• Head banging or deliberately fracturing bones

While cutting is one of the most visible and recognized forms of self-harm, many individuals engage in multiple forms.

Types and Motivations

The motivations behind self-harming behaviors are complex and multifaceted. Some common underlying factors include:

• Emotional regulation: Individuals often describe self-harm as a way to alleviate intense emotions such as sadness, anger, anxiety, or numbness.
• Trauma and abuse: A history of physical, emotional, or sexual abuse is frequently reported among those who self-injure.
• Expression of emotional pain: For some, self-harm is a way to externalize internal suffering that they cannot otherwise express.
• Dissociation: Self-harm may serve as a means to "feel something" during periods of emotional numbness or detachment.
• Self-punishment: Feelings of guilt or self-loathing may lead to harming oneself as a form of perceived atonement.

Self-harm is also more prevalent among individuals with certain psychiatric conditions, such as:

• Borderline personality disorder
• Depression
• Anxiety disorders
• PTSD
• Eating disorders
• Autism spectrum disorder

Diagnosis and Assessment

Diagnosis is typically made through clinical interviews and physical examinations. Healthcare providers will assess:

• The frequency, methods, and severity of self-injurious behavior
• Co-occurring mental health conditions
• Risk factors for suicide or suicidal ideation
• Triggers, thought patterns, and emotional responses leading to self-harm

While self-harm is not a diagnosis in itself, it may be classified under "Non-Suicidal Self-Injury" (NSSI) in the DSM-5 under the section for conditions requiring further study.

Treatment

Effective treatment for self-harm focuses on addressing both the behavior itself and the underlying emotional or psychological distress. Approaches may include:

Psychotherapy

• Cognitive behavioral therapy (CBT): Helps individuals identify and modify negative thought patterns that lead to self-harm.
• Dialectical behavior therapy (DBT): Particularly effective for individuals with borderline personality disorder. Teaches skills in distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness.
• Trauma-informed therapy: Addresses past trauma or abuse that may underlie self-harming behaviors.

Medication

While there is no medication specifically for self-harm, psychiatric medications such as antidepressants, mood stabilizers, or antipsychotics may be prescribed to treat co-occurring conditions like depression or anxiety.

Supportive Interventions

• Family therapy
• Group therapy
• Peer support programs
• School-based counseling

Prognosis

With early intervention and proper support, many individuals can overcome the urge to self-harm. However, because the behavior can become habitual, it often requires sustained therapy and relapse prevention strategies. The prognosis improves when individuals have access to compassionate care, coping skills, and a strong support network. Self-harm increases the risk of accidental injury and suicidal behavior, making ongoing monitoring essential. Healing typically involves learning to manage emotions more adaptively, developing self-compassion, and addressing past trauma.

Prevention

Prevention strategies involve identifying at-risk individuals and providing early access to mental health care. Preventive measures may include:

• Mental health education in schools
• Training teachers and parents to recognize warning signs
• Encouraging open conversations about emotional well-being
• Reducing stigma around mental health and self-harm

See Also

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Borderline personality disorder
• Depression
• Anxiety disorders
• Suicide prevention
• Mental health

References

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