People who practice self-harm often use cutting, burning, scratching, hair pulling, or other self-mutilation methods in order to escape emotional pain. Approximately 80% of self-harm involves stabbing or cutting skin using a sharp object. The average number of emergency department visits for self-inflicted injury per year are 370,000. The number of people hospitalized due to self-inflicted injury was over 154,598 in 2005, according to the Centers for Disease Control. Often times the individual feels that self-induced physical pain will help release the pent-up emotional pain that is inaccessible or too difficult to deal with inside the individual. A common misconception regarding self-harm is that the person is acting out the behavior in order to gain attention or in an attempt to commit suicide. In most cases, neither are true. Those who engage in self-harming behavior are often embarrassed by the scars and marks their behaviors cause and try to hide them from family members and friends.
Causes of Self-Harming Behavior
Causes for self-injurious behavior are varied. Often, people who inflict self-pain do not suffer from any specific mental illness. Of those who are diagnosed with a mental illness, most commonly suffer from depression, phobias, anxiety, substance abuse, borderline personality disorder and/or conduct disorder. Psychological factors can also influence a person’s compulsion to self-harm, especially if he or she comes from a family where children’s feelings are invalidated and discouraged. Abuse, war, poverty, and unemployment can also contribute to the underlying causes. In rare cases, the most specific underlying condition behind self-injury is a rare genetic condition called Lesch-Nyhan Syndrome. This may cause the affected person compulsions to cut, head bang, bite others, and act out in other self-destructive ways.
Self-Harm and Substance Use
Alcohol is the most common variable involved in self-harm behaviors, linked to over half of all cases. The person may be withdrawing from alcohol or deeply intoxicated when acting out in the self-injurious behaviors. Drugs and alcohol overall are commonly associated with self-injurious acts. Benzodiazepine dependence and withdrawal can attribute to self-injurious behavior particularly in teens and young adults.
The Cycle of Self-Harm
Precursors and the cycle of self-injury can be best presented by describing a cycle of feeling, leading to a behavior, leading to a subsequent feeling, that circumvents back to the original feeling. Many people who fall into one of the high risk categories mentioned above may experience hyper-stress or dissociation, depending on their environment and background. When dissociation occurs, the person feels numb, alone, lost, disconnected, and unable to feel their feelings. When hyper-stress occurs, the person generally prone to anxiety becomes even more overwhelmed, unable to cope, exposed and vulnerable. In either case these feelings provoke a trigger to self-mutilate, as this act provides feelings of relief and control. For the person with hyper-stress, self-harm may calm them. For the person prone to dissociation, self-harm may help them feel alive and able to function in society. As the calming, relieving effects of the self-mutilation begin to wear off, the individuals in both cases are then faced with the reality of their scars and underlying problems still in effect.