Signs & Symptoms of Self-Harm

Learn about self-harm

Self-injury, also called “self-harm,” “non-suicidal self-injury,” or simply “cutting,” is the deliberate act of harming oneself through a variety of different methods, such as burning or cutting one’s skin, but is not intended as a suicide attempt. It’s worth noting that since self-injury is an impulsive act, many of the acts of self-harm can cause serious bodily harm – even death. While it can be impossible for some to understand, self-injury is an unhealthy coping mechanism that some people use to handle intense anger, frustration, or deep emotional pain. Unfortunately, the relief of tension and calm that many experience following the self-harm is usually followed by intense shame and guilt and the return of the deep emotional pain. As most people who engage in self-harm do so in a private, secretive manner, the shame and guilt surrounding these harmful acts can become a heavy burden. It’s very important to understand that self-harm and cutting do serve a number of purposes for the person engaging in the behavior, including:

• Making a person who feels “empty” inside actually feel something; anything
• Expressing emotions too hard to put into words
• Allowing a person to feel as though he or she is in control
• As a distraction from overwhelming emotions or challenging life events
• Externally express internal emotions
• Communicate distressing feelings in an external manner
• Relieving guilt by punishing oneself
• Releasing inner pain and tension

When a person who engages in self-harm enters a treatment program, he or she is able to learn the triggers for self-injury and begin to unearth the reasons for this self-destructive behavior. Once this is discovered, through a combination of therapies, many people learn the skills needed to overcome this unhealthy coping mechanism.

Self-harm statistics

Estimates suggest that between 2 million people of all ages, races, and backgrounds living in the United States injure themselves intentionally in some fashion. While most are teenagers or young adults, there are a growing number of men who are engaging in this behavior. It’s been estimated that about one in every 200 girls between the ages of 13 and 19 regularly engage in self-harming behaviors.

Causes and risk factors for self-harm

There’s no single or easily understood cause that leads to self-injury; generally self-harm is the result of unhealthy coping mechanisms and an inability to cope in healthy manners with overwhelming emotions or pain. The mixture of emotions that trigger self-injury is quite a complex array and can include a number of the following reasons for self-injury.

Genetic: There are a number of mental health disorders that include self-harm as a symptom. These may include borderline personality disorder (BPD), depression, anxiety, post-traumatic stress disorder (PTSD), and eating disorders. Many of these mental health disorders have been determined to have a genetic component.

Physical: People who engage in heavy alcohol or drug use – or some combination thereof – often self-harm while under the influence of drugs or alcohol.

Environmental: Many people who engage in self-injury did not learn proper coping techniques as children, some due to child abuse (physical, emotional, sexual, verbal), or neglect. Others may have been raised in families that did not allow for the expression of strong emotions.

Risk factors:

• History of trauma
• High degree of impulsivity, explosive, and self-critical personality features
• Being raised in an unstable home environment
• Having friends who self-harm
• Being female between ages 13 and 19
• Young individuals questioning their sexual identity

Signs and symptoms of self-harm

As there are a number of forms of self-injury, it can be very challenging to determine if a loved one is engaging in this dangerous behavior as often, people engage in more than one form of self-harm. Frequently, the arms, legs, and front of the torso are the targets of self-injury as these areas are easily accessible and easily covered by clothing. However, any area of the body can be the target of self-harm. Most common forms of self-injurious behavior include:

• Cutting skin
• Burning – with lit matches, cigarette lighters, or cigarettes
• Breaking bones
• Hitting or punching
• Carving words or symbols onto the skin
• Piercing the skin with sharp objects
• Head-banging
• Biting
• Pulling out hair
• Interfering with healing of wounds

Behavioral symptoms:

• Wearing long pants and sleeves even during the hot summer months
• Keeping sharp objects or implements of self-harm on one’s self at all times
• Spending an increasing amount of time alone
• Pervasive interpersonal relationship difficulties
• Irritability
• Claiming to be clumsy or have frequent accidents
• Impulsive, risky behaviors
• Unpredictable behaviors
• Statements about feeling worthless

Physical symptoms:

• Scars
• Fresh cuts, scratches, burns, or other types of wounds
• Broken bones
• Wounds that do not heal
• Missing patches of hair
• Blood stains on clothing, towels, tissues

Psychosocial symptoms:

• Feeling empty inside
• Withdrawing from friends and loved ones
• Questions of personal identity such as “why am I even here?”
• Emotional instability

Effects of self-harm

The long-term effects of self-harming behaviors can range from mild scarring to death, which is why treatment should be sought as soon as possible. With the proper combination of therapies, most people are able to learn more adaptive coping skills and eliminate their self-harming behaviors. Long-term consequences of self-harm include:

• Social isolation
• Social phobia
• Increased feelings of shame, disgust, guilt
• Poor self-esteem
• Worsening mental health conditions
• Broken bones
• Worsening physical health
• Permanent disfigurement
• Consequences of risky behaviors
• Loss of interpersonal relationships
• Infections
• Septicemia
• Suicide or suicidal behaviors
• Fatal injuries
• Accidental death

Self-harm and co-occurring disorders

Many people who self-injure suffer from co-occurring, co-morbid mental illnesses. The most common mental illnesses that occur with cutting include the following:

• Depressive disorders
• Anxiety disorders
• Bipolar disorder
• Substance abuse
• Schizophrenia
• Borderline personality disorder
• Personality disorders
• Eating disorders
• Trauma
• PTSD