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by Alan R

Self-Harm

(Self-injury)

Definition

Self-harm or self-injury is causing pain or harm to yourself on purpose. The injury may be cuts, scratches, pulled hair, or others. It is not the same as a suicide attempt.

Causes

Self-harm is a sign of distress and problems with coping skills. People may self-harm when they feel intense anger or frustration. Some say if feels like tension release. Others may do it for a sense of control or to feel something other than numb.
Self-harm can cause shame. This shame can then create a new cycle of intense emotions and self-harm.
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Risk Factors

Self-harm is most common in teens and young adults. Other things that may increase the risk include:
Some mental health illnesses that may be present include:

Symptoms

The type of harm can vary. Some examples are:
  • Cutting of skin with a sharp object
  • Skin carving or burning
  • Self-punching or scratching
  • Needle sticking
  • Eye pressing
  • Finger, lips, or arm biting
  • Pulling out one's hair
  • Picking at one's skin
People who use self-harm may:
  • Have scars, often in a group
  • Wear long sleeves or pants, even in hot weather
  • Claim to have frequent accidents
  • Have relationship problems
  • Have behavioral problems
  • Talk about feeling hopeless
Some self-harm can cause severe injuries. It may include broken bones, eye damage, or amputation.

Diagnosis

Some may ask their doctor for help. A friend or relative may also bring it to the doctor's attention. However, people who self-harm often feel ashamed. This may prevent them from reaching out for help.
A doctor may notice scars during an exam. They may ask questions about stress, emotions, and wellness. This will help the doctor assess the problem. The questions may also help to see if other mental health issues may be present. A mental health counselor may also help to make the diagnosis.

Treatment

Treatment can help to find what is driving the self-harm. This will help to make a treatment plan. Counseling can help. There are different types that may help with self-harm such as:
  • Cognitive-behavioral therapy (CBT)—learn about harmful thought patterns. Develop new coping skills.
  • Dialectical behavior therapy—a type of CBT. Learn ways to manage stress, strong emotions, and relationships with others.
  • Psychodynamic therapy—type of talk therapy to address stress.
Some counselors specialize in self-harm behaviors. The type of treatment may change if other mental illnesses are uncovered in treatment. Proper treatment may stop worsening of symptoms.
Medicine may be used to ease severe symptoms if needed. A hospital stay may also be needed if there is risk of severe harm.

Prevention

Have honest and open conversations with your doctor about long term or intense stress, anxiety, or depression. Learning coping skills and stressors may help to prevent other problems like self-harm.

RESOURCES

American Psychological Association
https://www.apa.org
Mental Health America
http://www.mentalhealthamerica.net

CANADIAN RESOURCES

Canadian Psychiatric Association
https://www.cpa-apc.org
Canadian Psychological Association
https://cpa.ca

References

Self-harm. National Alliance on Mental Illness. Available at: https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm. Accessed August 1, 2020.
Self-harm in over 8s: Short-term management and prevention of recurrence. Clinical guideline (CG16). National Institute for Health and Clinical Excellence website. Available at: https://www.nice.org.uk/guidance/CG16. Accessed August 1, 2020.
Self-injury in adolescents. American Academy of Child & Adolescent Psychiatry website. Available at: https://www.aacap.org/AACAP/Families%5Fand%5FYouth/Facts%5Ffor%5FFamilies/FFF-Guide/Self-Injury-In-Adolescents-073.aspx. Accessed August 1, 2020.
Slee N, Garnefski N, van der Leeden R, Arensman E, Spinhoven P. Cognitive-behavioural intervention for self-harm: randomized controlled trial. Br J Psychiatry. 2008;192(3):202-211.
Suicidal ideation and behavior. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/suicidal-ideation-and-behavior. Accessed August 1, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrian Preda, MD
  • Review Date: 11/2018
  • Update Date: 08/01/2020
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