Self-Injury/Cutting

Self-injury is the act of harming or burning own body knowingly.

Typically, it is not a suicide attempt but rather unhealthy ways of coping with frustration and anger.

These acts may give sense of calmness for few moments but is followed by intense pain, feeling of guilt and shame. Also such acts may lead to life-threatening bleeding.   

Typical signs and symptoms of self-injury include:

• scars,
• fresh wounds,
• burns,
• excessive rubbing of an area,
• keeping sharp objects in hand,
• wearing long sleeves and full pants in summers,
• problems in personal relationships,
• persistent questions about personal identity,
• emotional instability,
• hopelessness.

A patient uses the following ways to harm himself or herself:

• cutting or severe scratches with sharp objects,
• burning with lit matches or cigarettes,
• carving words or symbols on the skin,
• piercing the skin,
• pulling out hair,
• interfering with wound healing.

People target their arms, legs or front of the torso to harm themselves and use more than one methods to injure. Many people harm themselves once or few times in response to stressful situation but for other people it may becomes a chronic problem. 

Self-injury, in most people is caused by more than one factors and some of them include:

• inability to cope with psychological pain,
• feelings of worthlessness,
• loneliness,
• panic,
• anger,
• guilt,
• rejection,
• self-hatred or confused sexuality.

By injuring himself or herself, the person tries to:

• reduce severe distress,
• distract oneself from painful emotions,
• have control over feelings and situations,
• feeling anything (even pain) when feeling emotionally empty,
• communicate with the outside world about their feelings,
• get a feeling of punishments for their guilt.    

Diagnosis of self-injury is based on:

• physical examination in which the doctor may have a close look at all the scars and burns,
• mental evaluation in which the doctor evaluates the mental stability of the person by some additional tools like questionnaires or psychological tests.

In such case, it is recommended to seek psychological help but other doctors may also provide adequate help.

There are no special tests for self-injury.

Only after proper diagnosis of the disease and the cause, proper treatment for self-injury can be given.

Self-injury is a complex condition induced by number of cause or it can occur due to some underlying mental disorder.

The following treatment methods are used:

• Psychotherapy which includes CBT (cognitive behavioral therapy) in which the patient identifies negative, unhealthy behavior and replace them by positive ones;
• dialectic behavior therapy in which a person learns to tolerate extremely stressful situations and learns to manage them,
• psychodynamic psychotherapy which focuses on identifying past or hidden psychological problems and mindfulness-based therapies in which a person learns to perceive thoughts and actions of those people around them and to reduce stress and anxiety.
• Medications: there are no specific medicine of self-injury, but it is associated with depression or anxiety disorder, the doctor may recommend antidepressants.
• Psychiatric hospitalization in severe cases.

Individuals and communities, both are involved in reducing the risk of self-injury and prevent it. It involves the following ways:

• identify people of risk groups,
• encourage expansion of social networks,
• raise awareness,
• promote programs that encourage peers to seek help,
• by offering education about media influence.   

Some home remedies are recommended along with professional treatment like:

• sticking to the treatment plan,
• recognizing the situation of self-injury,
• asking for help from mental health provider,
• taking care by regular exercise,
• avoiding alcohol and drugs,
• taking appropriate care of the wounds.

Lifestyle and coping of self-injury include the following:

• Connect with others having the same problem,
• avoid websites or movies that support self-injury,
• learn to express emotions in positive ways,
• learning about the disease,
• avoiding and managing criticism from others,
• getting care from loved ones,
• supporting and cooperating with the treatment plans,
• sharing ideas with others that may help in such situation.

There are several risks and complications associated with self-injury.

The following risk factors should be taken into account:

• Age- young adults and teenagers who are unable to cope with peer pressure.
• Having friends who self-injure- those people who have such friends tend to begin self-injuring themselves.
• Life issues- those people who are unable to manage some psychological events in life tend to turn to such ways of relief from pain.
• Mental health issues- self injury is most frequently associated with certain mental disorders like personality disorder, anxiety disorder and eating disorders.
• Excessive alcohol or drug abuse- under the influence of alcohol and drugs people try to harm themselves.

Self-injury may lead to a variety of complications like:

• worsening of feeling,
• infections from sharp tools,
• permanent scars,
• fatal injury,
• worsening of underlying issues.

Self-injury can also increase the risk of suicidal attempts.