A National Center for PTSD Fact Sheet on Self Harm
by Laura E. Gibson, Ph.D., The University of Vermont
" 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.
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:
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.
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:
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):
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:
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.
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.
It is possible that psychopharmacological treatments would be helpful in reducing self harming 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:
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.
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.
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:
(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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