What is self-mutilation?

Self-mutilation or self-injury is the act of deliberate, repetitive, impulsive, non-lethal harming of one’s body. Many people who self-harm do not even know they are doing it. For example, some people pinch themselves until they create a scar or pick at their fingernails until they bleed. The adoption of self-injury practices usually indicates an unhealthy coping response.


Currently there is no clear diagnostic category for the disorder, with some debate still as to what would delineate symptoms of the disorder form the disorder itself, as well as where it should best be accommodated. Self-harm is most easily viewed as a form of pain (adrenaline) addiction / impulse-control disorder. Many mental health practitioners currently diagnose it under Impulse-control Disorder Not Otherwise Specified.


The actual act of self harm may include:
• cutting
• scratching
• picking scabs or interfering with wound healing
• burning
• punching self or objects
• infecting oneself
• inserting objects into body openings
• bruising or breaking bones
• some forms of hair pulling
• excessive body piercing


A self-harmer doesn’t usually start with a method to hurt themselves; they start off with horrible circumstances and psychologically painful thoughts. Some self-harmers suffer harsh early environments, such as:
Early environments of emotionally abuse. Children are sometimes told they are bad, sinful, selfish, hurtful, hateful, uncaring, crazy or weird. This often converts to feelings of guilt, shame, self-hatred and wanting to hurt or punish themselves.
Early environments of physical and/or sexual abuse (beatings, threats or torture). These kids are often also blamed for the abuse. Often the families have covered up the abuse. This kind of environment can lead to resentment, intense anger, and repressed rage, with defiance, for example, ‘You can’t make me change’, or alternatively with feelings of worthlessness.



Reasons people self-harm

Research shows that people hurt themselves for many and varied reasons. Often these reasons are overdetermined. Some of these reasons for self-harm or self-mutilation might include:
• getting back at an abusive person through self-mutilation and to show external signs of the internal hurt
• receiving a high like an ‘adrenaline rush’ from the self-harm
• becoming numb to pain through self-harm
• using the self-harm as a way of feeling alive, while struggling with depression, helplessness and hopelessness
• using self-harm as a way of escaping emotional feelings of harm from others
• being panicked and out of control and needing to do anything to cope with the moment
• attempts to get attention through guilt and fear, or even awe (in some teenage social circles)
• suicide attempts
• culturally and sub-culturally sanctioned self-harm (not always entirely within the control of the individual), which can cover a spectrum from earrings and tattoos, through male circumcision to other ritual maiming ceremonies in order to pass through manhood, and even to extremely barbaric activities such as female circumcision




Other causes of self-harm

Not all people who self-harm start with a terrible traumatic crisis. The problem with self-harm is that whatever the cause, it can often progress from humble beginnings
• Some may simply have had friends or relatives who injured themselves and learned the behaviour that way.
• Some have developed an unhealthy habit or coping skill that helps them calm down.
• For some people it appears to become like an addiction, in that it takes less and less provocation to self-harm, and the person has less and less ability to control the behaviour once it has begun. This developing powerlessness may well have a neurochemical derivative, and is accompanied by typical addiction problems of unmanageability (greater amounts of damage being caused, harder to cover it up, more risk of fatality etc etc), as well as denial (reasons given that permit the behaviour such as ‘it is okay to cut myself today as the pain is unbearable, but I will never do it again’).





People with self-mutilation problems are more likely to struggle with:
depressive disorder
• borderline personality disorder
bipolar disorder
post-traumatic stress disorder
obsessive-compulsive disorder
• attention deficit hyperactive disorder
• dissociative identity disorder
anxiety disorders
panic disorder
eating disorders
• schizotypal personality disorder
• dependent personality disorder
• intense emotions
• fear of interpersonal rejection




How do I get help for myself or my loved one?
The first step in getting help is finding out whether you have a problem. A psychologist with specific training in the treatment of addiction can effectively perform a professional assessment, which will identify whether you have an addiction problem, and will recommend the treatment most appropriate for you.
For info on how cognitive-behavioural therapy can help with addiction, click here.
To make an appointment or get advice, contact me here.