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Self-injury/cutting

Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it's usually followed by guilt and shame and the return of painful emotions. And with self-injury comes the possibility of more serious and even fatal self-aggressive actions.

Because self-injury is often done impulsively, it can be considered an impulse-control behavior problem. Self-injury may be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms may include:

  • Scars, such as from burns or cuts
  • Fresh cuts, scratches, bruises or other wounds
  • Broken bones
  • Keeping sharp objects on hand
  • Wearing long sleeves or long pants, even in hot weather
  • Claiming to have frequent accidents or mishaps
  • Spending a great deal of time alone
  • Pervasive difficulties in interpersonal relationships
  • Persistent questions about personal identity, such as "Who am I?" "What am I doing here?"
  • Behavioral and emotional instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness

Forms of self-injury

One of the most common forms of self-injury is cutting, which involves making cuts or severe scratches on different parts of your body with a sharp object. Other forms of self-harm include:

  • Burning (with lit matches, cigarettes or hot sharp objects like knives)
  • Carving words or symbols on the skin
  • Breaking bones
  • Hitting or punching
  • Piercing the skin with sharp objects
  • Head banging
  • Biting
  • Pulling out hair
  • Persistently picking at or interfering with wound healing

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.

Because self-injury is often an impulsive act, becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. However, for others, self-injury can become a long-term, repetitive behavior.

Although rare, some young people may self-injure in public or in groups to bond or to show others that they have experienced pain.

When to see a doctor

Getting appropriate treatment can help you learn healthier ways to cope.

  • Reach out for help. If you're injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Talk to someone you trust — such as a friend, loved one, health care provider, religious leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help.
  • Emergency help. If you've injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider.

When a friend or loved one self-injures

If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you'd be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some options for help.

  • Your child. You can start by consulting your pediatrician or family doctor who can provide an initial evaluation or a referral to a mental health specialist. Don't yell at your child or make threats or accusations, but do express concern.
  • Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
  • Adult. Gently encourage the person to seek medical and psychological treatment.

There's no one single or simple cause that leads someone to self-injure. In general, self-injury is usually the result of an inability to cope in healthy ways with psychological pain related to issues of personal identity and having difficulty "finding one's place" in family and society. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.

Through self-injury, the person may be trying to:

  • Manage or reduce severe distress or anxiety and provide a sense of relief
  • Provide a distraction from painful emotions through physical pain
  • Feel a sense of control over his or her body, feelings or life situations
  • Feel something, anything, even if it's physical pain, when feeling emotionally empty
  • Express internal feelings in an external way
  • Communicate depression or distressful feelings to the outside world
  • Be punished for perceived faults

Certain factors may increase the risk of self-injury, including:

  • Being female. Females are at greater risk of self-injuring than males are.
  • Age. Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
  • Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
  • Life issues. Some people who injure themselves were neglected, or sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality.
  • Mental health issues. People who self-injure are more likely to be impulsive, explosive and highly self-critical, and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
  • Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.

Self-injury can cause a variety of complications, including:

  • Worsening feelings of shame, guilt and low self-esteem
  • Infection, either from wounds or from sharing tools
  • Life-threatening problems, such as blood loss if major blood vessels or arteries are cut
  • Permanent scars or disfigurement
  • Severe, possibly fatal injury, especially if you harm yourself while under the influence of alcohol or illegal drugs
  • Worsening of underlying issues and disorders, if not adequately treated

Suicide risk

Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-injuring. And the pattern of damaging the body in times of distress can make suicide more likely.

If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:

  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
  • Seek help from your doctor, a mental health provider or other health care professional.
  • Reach out to family members, friends, teachers or spiritual leaders for support.

If you think your friend or loved one is in immediate danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call for emergency help or take the person to the hospital, if you can safely do so. If possible, take away any tools used for self-injury.

There is no sure way to prevent your loved one's self-injuring behavior. But reducing the risk of self-injury may include strategies that involve both individuals and communities — for example, parents, schools, medical professionals, supervisors, co-workers and coaches:

  • Identify people most at risk and offer help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
  • Encourage expansion of social networks. Many people who self-injure feel lonely and disconnected. Forming connections to people who don't self-injure can improve relationship and communication skills.
  • Raise awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury and what to do when they suspect it. Documentaries, multimedia-based educational programs and group discussions are helpful strategies.
  • Promote programs that encourage peers to seek help. Peers tend to be loyal to friends even when they know a friend is in crisis. Programs that encourage youths to reach out to adults may chip away at social norms supporting secrecy.
  • Offer education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.
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