Self-Harm
A National Center for PTSD Fact Sheet
by Laura E. Gibson, Ph.D., The University of Vermont
What is self-harm?
" Self-harm" refers to the deliberate, direct destruction
of body tissue that results in tissue damage. When someone engages
in self-harm, they may have a variety of intentions; these are discussed
below. However, the person's intention is NOT to kill themselves.
You may have heard self-harm referred to as " parasuicide,"
" self-mutilation," " self-injury," " self-abuse,"
" cutting," " self-inflicted violence," and
so on.
How common is self-harm?
Self-harm is not well-understood and has not yet been extensively
studied. The rates of self-harm revealed through research vary tremendously
depending on how researchers pose their questions about this behavior.
One widely cited estimate of the incidence of impulsive self-injury
is that it occurs in at least 1 person per 1,000 annually (Favazza,
1996). A recent study of psychiatric outpatients found that 33%
reported engaging in self-harm in the previous 3 months (Zlotnick,
Mattia, & Zimmerman, 1999). A recent study of college undergraduates
(Gratz, Conrad, & Roemer, 2002) asked study participants about
specific self-harm behaviors and found alarmingly high rates. Although
the high rates may have been due in part to the broad spectrum of
self-harm behaviors that were assessed (e.g., severe scratching
and interfering with the healing of wounds were included), the numbers
are certainly cause for concern:
- 18% reported having harmed themselves more than
10 times in the past,
- 10% reported having harmed themselves more than
100 times in the past, and
- 38% endorsed a history of deliberate self-harm.
The most frequently reported self-harm behaviors were needle sticking,
skin cutting, and scratching, endorsed by 16%, 15%, and 14% of the
participants, respectively.
It is important to note that research on self-harm is still in
the early stages, and these rates may change as researchers begin
to utilize more consistent definitions of self-harm and more studies
are completed.
Who engages in self-harm?
Only a handful of empirical studies have examined self-harm in
a systematic, sound manner. Self-harm appears to be more common
in females than in males, and it tends to begin in adolescence or
early adulthood. While some people may engage in self-harm a few
times and then stop, others engage in it frequently and have great
difficulty stopping the behavior (Simeon & Hollander, 2001).
Several studies (e.g., Gratz et al., 2002; Van der Kolk, Perry,
& Herman, 1991; Zlotnick et al., 1996) have found that individuals
who engage in self-harm report unusually high rates of histories
of:
- Childhood sexual abuse
- Childhood physical abuse
- Emotional neglect
- Insecure attachment
- Prolonged separation from caregivers
At least two studies have attempted to determine whether particular
characteristics of childhood sexual abuse place individuals at greater
risk for engaging in self-harm as adults. Both studies reported
that more severe, more frequent, or a longer duration of sexual
abuse was associated with an increased risk of engaging in self-harm
in one's adult years (Boudewyn & Liem, 1995; Turell & Armsworth,
2000).
Also, individuals who self-harm appear to have higher rates of
the following psychological problems (Simeon & Hollander, 2001;
Zlotnick et al., 1999; Zlotnick et al., 1996):
- High levels of dissociation
- Borderline personality disorder
- Substance abuse disorders
- Posttraumatic stress disorder
- Intermittent explosive disorder
- Antisocial personality
- Eating disorders
Why do people engage in self-harm?
While there are many theories about why individuals harm themselves,
the answer to this question varies from individual to individual
(Conterio & Lader, 1998; Favazza, 1998).
Some reasons why people engage in self-harm:
- To distract themselves from emotional pain by
causing physical pain
- To punish themselves
- To relieve tension
- To feel real by feeling pain or seeing evidence
of injury
- To feel numb, zoned out, calm, or at peace
- To experience euphoric feelings (associated
with release of endorphins)
- To communicate their pain, anger, or other emotions
to others
- To nurture themselves (through the process of
healing the wounds)
How is self-harm treated?
Self-harm is a problem that many people are embarrassed or ashamed
to discuss. Often, individuals try to hide their self-harm behaviors
and are very reluctant to seek needed psychological or even medical
treatment.
Psychological treatments
Because self-harm is often associated with other psychological
problems, it tends to be treated under the umbrella of a co-occurring
disorder like a substance abuse problem or an eating disorder. Sometimes
the underlying feelings that cause the self-harm are the same as
those that cause the co-occurring disorder. For example, a person's
underlying feelings of shame may cause them to abuse drugs and cut
themselves. Often, the self-harm can be addressed in the context
of therapy for an associated problem. For example, if people can
learn healthy coping skills to help them deal with their urges to
abuse substances, they may be able to apply these same skills to
their urges to harm themselves.
There are also some treatments that specifically focus on stopping
the self-harm. A good example of this is Dialectical Behavior Therapy
(DBT; Linehan, 1993), a treatment that involves individual therapy
and group skills training. DBT is a therapy approach that was originally
developed for individuals with borderline personality disorder who
engage in self-harm or " parasuicidal behaviors." Now
the treatment is also being used for self-harming individuals with
a wide variety of other psychological problems, including eating
disorders and substance dependence. The theory behind DBT is that
individuals tend to engage in self-harm in an attempt to regulate
or control their strong emotions. DBT teaches clients alternative
ways of managing their emotions and tolerating distress. Research
has shown that DBT is helpful in reducing self-harm. To learn more
about DBT, or to locate a DBT therapist in your area, go to: http://www.behavioraltech.com/basics.html.
Pharmacological treatments
It is possible that psychopharmacological treatments would be helpful
in reducing self-harm behaviors, but this has not yet been rigorously
studied. As yet, there is no consensus regarding whether or not
psychiatric medications should be used in relation to self-harm
behaviors. This is a complicated issue to study because self-harm
can occur in many different populations and co-occur with many different
kinds of psychological problems. If you are wondering about the
use of medications for the emotions related to your self-harm behaviors,
we recommend that you discuss this with your doctor or psychiatrist.
How to find a qualified psychologist or psychiatrist
If you are trying to find a psychologist or psychiatrist, we advise
you to ask them whether they are familiar with self-harm. Consider
which issues are important to you and make sure you can talk to
the potential therapist about them. Remember that you are the consumer-you
have the right to interview therapists until you find someone with
whom you feel comfortable. You may want to ask trusted friends or
medical professionals for referrals to psychologists or psychiatrists.
Consider asking your potential provider questions, such as:
-
How do you treat self-harm?
-
What do you think causes self-harm?
-
Do you have experience in treating self-harm?
-
For tips on communicating with medical providers in a medical
context (including communicating with professionals in an emergency
room), go to http://www.palace.net/~llama/psych/injury.html,
click the icon on the left side of the screen that reads "
first aid," and then click the icon " what to expect
in the emergency room." For more ideas on finding a therapist
who is familiar with the treatment of self-harm, go to http://www.palace.net/~llama/psych/injury.html
and then click on " offline resources" on the left
side of the screen.
Self-help resources
There are a variety of self-help books on the market for people
who engage in self-harm. Most of these provide practical advice,
support, and coping skills that may be helpful to individuals who
engage in self-harm. These approaches have not been studied in research
trials, so it is not known how effective they are for individuals
who self-harm. Two books that may be useful to individuals who self-harm
are:
Alderman, T. (1997). The Scarred Soul: Understanding and Ending
Self-Inflicted Violence. Oakland, CA: New Harbinger Publications.
Conterio, K., & Lader, W. (1998). Bodily Harm: The Breakthrough
Healing Program for Self-Injurers. New York: Hyperion.
http://www.palace.net/~llama/psych/injury.html
is a comprehensive website with links to research, self-help information,
referral information, and information for families and friends.
My friend or relative self-harms. What should
I do to be supportive?
If you have a friend or relative who engages in self-harm, it can
be very distressing and confusing for you. You may feel guilty,
angry, scared, powerless, or any number of things. Both of the books
mentioned above contain chapters for friends and family members.
Some general guidelines are:
-
Take the self-harm seriously by expressing concern and encouraging
the individual to seek professional help.
-
Don't get into a power struggle with the individual-ultimately
they need to make the choice to stop the behavior. You cannot
force them to stop.
-
Don't blame yourself. The individual who is self-harming initiated
this behavior and needs to take responsibility for stopping
it.
-
If the individual who is self-harming is a child or adolescent,
make sure the parent or a trusted adult has been informed and
is seeking professional help for them.
-
If the individual who is engaging in self-harm does not want
professional help because he or she doesn't think the behavior
is a problem, inform them that a professional is the best person
to make this determination. Suggest that a professional is a
neutral third party who will not be emotionally invested in
the situation and so will be able to make the soundest recommendations.
(This article is reproduced from the National Center for PTSD
Fact Sheet: Self-Harm,. Full text available at: http://www.ncptsd.va.gov/facts/problems/fs_self_harm.html)
Please also check out the National
Center for PTSD website for more articles on PTSD, trauma and
related topics.
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