Understanding Self-Harm

It seems like it's on the rise. Usually, it's well hidden and only seen when a shirt sleeve hikes up a little. One case I dealt with may offer some insight, but as is often the case with friends, family members and professionals alike, it is difficult to understand. It is not easy to comprehend why anyone would choose to inflict serious, traumatic injury to themselves. Called self-harm, self-injury or self-mutilation, the condition is often horrifying to discover in a person close to you.

Self-injury is defined as any sort of injury or pain inflicted on one's own body, and includes behaviors such as hair pulling, picking the skin, excessive or dangerous use of mind-altering substances such as alcohol, and eating disorders along with cutting and burning the skin. Extreme cases include amputation of limbs and genitalia.

The image above illustrates a new dimension to self-mutilating behavior called self-embedding. In this instance, teenage girls "deliberately embedded in their arms, hands, feet, ankles and necks objects such as needles, staples, wood, stone, glass, paper clips, pencil lead and crayons."

I worked with a 15 year old boy that self-mutilated, and by the looks of his arms, it was quite often. He came from a middle-class family, attended one of the best schools, was a football player, had good grades, then suddenly became out of control. His parents filed a PINS petition because he became physically threatening when they did try to control him. After an arrest, they were at their wits' end. The judge put him in a detention home, then allowed me to find an appropriate placement for him. I chose a specialized group home for him.

The boy was soft-spoken, polite and not at all threatening with me when I would visit him at the detention center. I found him very intelligent, creative and artistic, and honest. When I asked him to tell me about his arms, he said that it was his way of feeling, feeling anything, and that it lets him know that he is still alive.

When looking at the clinical cases of self-mutilation, there are two types: nondissociative and dissociative. In nondissociative self-mutilation, a child was "parentified," meaning there was a serious role reversal between the child and parents when the child was quite young. Dependence comes from the parents instead of the child who is then forced to be nurturing and supportive. In this case, the child finds that it is impossible to express anger and rage, and later uses self-mutilation to compensate. In dissociative self-mutilation, the child feels a lack of warmth or cruelty from parents with an overall sense of disconnection. In this case, self-mutilation centers the person and brings a sense of focus.

Most often, people who self-mutilate are between the ages of 15 and 35, and have difficulty expressing anger, rage, pain or sadness and use the sudden physical pain they inflict on themselves as a way of escaping those feelings. When under stress, they can't seem to think and feel overwhelmingly powerless, and turn to physical pain for relief.

Self-mutilating behavior is not an attempt at suicide, nor is it attention-seeking behavior. After an episode of cutting, for instance, the person usually feels better, and most often will cut in private and conceal the wounds.

Take note of the people in your lives, and if you see any clues that self-mutilation is occurring, do your best not to act horrified or stare at the wounds you see. Do not judge. Self-harm is a coping mechanism, and the best treatment is support and understanding and learning other coping mechanisms to take its place. Get professional help.

Note: I'm told that "cutting" is now a fad of sorts among teenagers, along with piercing and tattoos. It is not the same, though it may appear to be just as injurious. With body piercing, tattoos and now "cutting," the end result is the purpose, the trophy. It is not the same as self-harm for the sake of easing emotional pain.


  1. Interesting post Theresa, I once had a student who did this (cutting)and she would hide the wounds.
    At the time we (the staff) associated it with her difficult family circumstances. I might add that we were not sure how to deal with the girls problem.

  2. I'd say you were probably correct in thinking it had to do with a traumatic family life, and likely gave her the support and acceptance she needed, knowingly or not. It's good that you were there for her.

  3. I dont believe there is probably a genuine rise in the true mental illness associated with with self mutilation. Myself having 3 teens in the public school system I cant tell you the times my kids have walked in and mentioned another teen they know having become a "cutter" yeah its such the fad these days that the #1 dont hide it, #2 brag about doing it. There is even a very popular teen pop culture best selling author with a book titled "cutter" From what Im getting this is the latest ploy in shock factor behavior. What else do you do when green spiked hair, faces that look like they fell in a tackle box, your underwear shared with the world, and ear lobes permanantly disfigured with nickle sized ear plugs gets nothing from the older generation than a snore? Why become a "cutter" of coarse! That can still net a rebellious teen a pet counselor(so far) and to think that you, and I thought "a cutter" was a western horse that worked cows! lol!

  4. I would guess that it is the fact that a "true" self-harm practitioner would not advertise as the research reveals. Still, both are worth keeping an eye on. The same type of thing could be said to have started the bulimia and anorexia disorders. It may have started as a fad, but both became quite deadly.