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Self-Injury (SI)

Self-Injury (SI), sometimes known as Self Mutilation or Self-Harm, is a disorder that results in self-inflicted physical harm or cutting, severe enough to cause tissue damage or marks that may last for hours, or may leave scarring. This injury is accomplished without suicidal intent or intent to achieve sexual pleasure. It is deliberate, repetitive, impulsive, and non-lethal. Body piercing, tattoos or other markings that are created for cosmetic, tribal, ritualistic, or decorative purposes are not considered self-injury. Self-Injury (SI) is a way for patients to cope with feelings of physical and emotional anxiety. In some patients, it is used to reconnect them to reality and halt the feelings of numbness, to make traumatic flashbacks stop or to punish themselves and temporarily suspend feelings of self-loathing. Self-Injury is undertaken to relieve anxiety, tension or distress. Many patients who self-injure were the victims of neglect or abuse as children, and may never have learned to express appropriate emotion, or they may have learned that expressing emotion is bad. There is some evidence to indicate that patients have specific problems in the serotonergic system within the brain, and that these problems cause them to be more impulsive and aggressive. Because these patients do not wish to harm others, they may turn their aggression inward.

Self-Injury can include cutting, burning, head-banging, biting, skin picking, hair pulling, hitting the body with objects, inserting objects into wounds, self-suffocation, overdose and poisoning. In some patients, the escalating destructive nature of their self-injury no longer keeps the anxious feelings away and these patients are at risk for suicide. Most patients dislike the term ‘self-mutilation’, because they do not feel they are maiming their body, and that is not their intent. Some refer to the act as self-inflicted violence, self-abuse, cutting, or self-harm.

Whatever the name, this disorder can cause serious harm and disruption in the life of a patient and their family. Patients that suffer from self-harm disorders may have coincident conditions like eating disorders, alcohol and drug abuse, depression, or paranoia. The onset of self-injury is typically at puberty and behaviors can last five to ten years or longer, if untreated.

What are the symptoms?

• Unexplained injuries, bruising, scarring
• Wearing long pants or sleeves in the warm weather to cover injuries
• Low self-esteem
• Engages in self-blame
• Lying to cover up how injury occurred
• Finds it hard to handle emotions (especially anger and sadness)
• Relationship problems, is a loner
• Expresses hopelessness or numbness

How is it diagnosed and treated?

Doctors will perform a physical and mental evaluation to rule out other illness or disease. Self-injurious behavior can be a symptom of other disorders like Borderline Personality Disorder, Bipolar Disorder, Major Depression, Anxiety Disorders or Schizophrenia. Doctors must also distinguish between self-injury and attempted suicide.

Signs that the injury was, in fact, a suicide attempt would include:

• Feels hopeless about the future.
• Patient made concrete plans (left a note for other people, gave away possessions prior to injury)
• Planned the act for at least several hours
• Patient is disappointed to be alive
• Took precautions not to be found during or after the injurious event
• Patient expected the act to cause death

Diagnosis of self-injury would be based on these signs:

• Patient often has scars, bruises and cuts that cannot be explained
• Patient has a history of abuse or emotional neglect as a child
• Patient attempts to hide healing wounds
• Patient has low self-esteem and punishes self with blame

Treatment(s) can include:

• Medication as appropriate: anti-depressants, anti-anxiety, mood stabilizers.
• Stress management training
• Cognitive Behavioral Therapy
• Problem Solving Training
• Dialectical Behavioral Therapy, Psychodynamic Therapy as appropriate
• Appropriate treatment of coincident mental or physical disorders
• Psychotherapy
• Hospitalization in severe cases
• Treatment of wounds if appropriate
• Coping skills to stop behavior when patient experiences feelings that typically precede an episode

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