An Overview of Self-Injury and Cutting

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Self-injury involves self-inflicted, nonsuicidal bodily harm that is severe enough to either cause tissue damage or to leave marks that last several hours. Cutting is the most common form of self-injury but burning, headbanging, and scratching are also common. Other forms include biting, skin picking, hair pulling, hitting the body with objects, or hitting objects with the body.

Symptoms

Self-harm is not always easy to detect because people often try to hide it. Some signs that a person might be self-injuring include:

  • Scars that occur in a pattern, sometimes restricted to one area of the body
  • Keeping sharp objects, such as knives, needles, or razor blades, on hand
  • Fresh scars, scratches, bite marks, or bruises
  • Repeatedly rubbing one area of the body
  • Wearing long sleeves and pants even in very hot weather
  • Low self-esteem
  • Negative self-talk, statements of hopelessness
  • Feelings of worthlessness
  • Unpredictable, impulsive behavior
  • Making excuses to explain away visible injuries

Warning Signs

People who self-injure become very adept at hiding scars or explaining them away. Look for signs such as a preference for wearing concealing clothing at all times (e.g. long sleeves in hot weather), an avoidance of situations where more revealing clothing might be expected (e.g. unexplained refusal to go to a party), or unusually frequent complaints of accidental injury (e.g. a cat owner who frequently has scratches on her arms).

Methods of self-injury can include:

  • Cutting
  • Burning
  • Scratching
  • Self-hitting
  • Pinching
  • Head-banging
  • Piercing skin with needles or sharp objects
  • Hair pulling
  • Inserting objects under the skin

People sometimes only engage in one form of self-injury, but it is not uncommon for multiple methods to be used. The arms are one of the areas that people self-harm most frequently, but other areas of the body including the legs and torso are also common targets. 

Causes

Self-harm is a complex condition that has no simple explanation. Although suicidal feelings may accompany self-injury, it does not necessarily indicate a suicide attempt.

Most often it is simply a mechanism for coping with emotional distress. People who select this emotional outlet may use it to express feelings, to deal with feelings of unreality or numbness, to stop flashbacks, to punish themselves, or to relieve tension.

Self-harm is not recognized as a mental illness, but the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists nonsuicidal self-injury as a proposed condition under the category of conditions in need of further study. 

Self-injury is also associated with certain conditions including depression, bipolar disorder, OCD, borderline personality disorder, PTSD, eating disorders, anxiety disorders, and alcohol and substance use.

Risk factors for self-injury include:

  • Sex: Females are thought to self-injure at a greater rate than males
  • Age: Teens and young adults are more likely to self-harm 
  • Mental disorders: Having another mental health condition can increase the risk of self-injury
  • Trauma: Past stress and trauma during childhood can increase the risk of self-injury behaviors
  • Drug and alcohol misuse: Cutting, burning, and other forms of self-harm may occur when a person is under the influence of a substance

Self-injury indicates a lack of coping skills for dealing with severe emotional distress. People who self-harm may struggle to understand and manage their emotions. They also may not have the necessary skills to cope with stress and trauma in healthy ways.

Although self-injury such as cutting is recognized as a common problem among the teenage population, it is not limited to adolescents. People of all sexes, nationalities, socio-economic groups and ages can be self-injurers.

While suicide is not the intent of self-injury, self-harm has a strong association with suicide attempts. In one study of adolescents, 46% who had engaged in nonsuicidal self-injury went on to attempt suicide before the age of 21.

Diagnosis

Self-injury is not a recognized disorder, but it is a sign that a person needs help coping. A doctor will start by evaluating whether or not the individual is suicidal and treating any physical injuries that are present.

A doctor or therapist will then evaluate the individual's health history including:

  • The emotions that are associated with the behaviors
  • How long the self-injury has been taking place
  • The severity and types of injuries that have taken place

The next step is to determine if the individual has a coexisting psychiatric condition and to evaluate if the person is at risk for suicide. Once these assessments have been made, the doctor can make recommendations for treatment.

Treatments

Medications such as antidepressants, mood stabilizers and anxiolytics may alleviate the underlying feelings that the patient is attempting to cope with through self-injury.

In addition to treating any coexisting psychiatric conditions, cognitive-behavior therapy (CBT) can be an effective treatment for nonsuicidal self-injury. This type of therapy addresses underlying negative thought patterns as well as the harmful behaviors themselves.

Another important aspect of treatment is learning better coping mechanisms to replace the self-harm behaviors. Once the individual is stable, therapeutic work should be done to help cope with the underlying problems that are causing their distress.

Some experts say that hospitalization or forced stopping of the self-injury is not a helpful treatment. It may make the doctor and involved friends and family feel more comfortable, but does nothing to help the underlying problems.

Further, the individual is generally neither psychotic nor actively suicidal and will benefit more from working with a doctor who is compassionate to the reasons that they are hurting themselves.

A desire to cooperate and get well is a major factor in recovery.

If you or a loved one has a life-threatening injury or might attempt suicide, call 911 immediately.

Coping

If someone you know is engaging in cutting or some other form of self-injury, there are things that you can do to offer support and assistance.

  • Offer non-judgemental support. People who engage in self-harm tend to be self-critical and struggle with feelings of worthlessness. Show that you care and are concerned and encourage the individual to reach out to a parent, counselor, or doctor. You might not understand the behavior, but it is important not to dismiss his or her emotions.
  • Don't threaten. If it is a child or teen who is engaging in self-harm, avoid making accusations or threats. Talk to your child's pediatrician or a mental health professional about what steps you should take next.
  • Encourage them to seek help. Offer to help them find a doctor or mental health professional.

A Word From Verywell

Self-harm behaviors such as cutting also present a risk of scarring and infection as well as a risk of accidental life-threatening injuries. If you are engaging in self-injury, no matter how minor or infrequent, you should talk to your doctor. Such actions are a sign of a larger problem that needs to be addressed, so the sooner you get help, the better the outcome.

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