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Self Injury (SI)

Questions and answers about SI
Signs of SI
Dangers of this behavior
Conditions with which SI is associated
Getting help

Self-injury is a condition in which a person experiences the impulse and the need to injure themselves as a means of coping with difficulties in life. Some have estimated that the percentage of those who self-injure is as high as 1% of the population. Self injury is 7 times more prevalent in women than in men. The injury may be inflicted by any number of means, and for any number of reasons. Cutting oneself is the most common form of self-inflicted injury. Though some experts perceive self-injury as a cry for attention, many of those who self-injure are doing so as a means to keep their problems to themselves, and to relieve anxiety; they often feel ashamed of and embarrassed by this behavior. Self-injury may be a sign of another behavioral or mental disorder, such as depression or borderline personality disorder. Likewise, the tendency to self-injure does not mean that one is suicidal, but sadly, if help is not obtained for the underlying problems, the person may be at increased risk for suicide in the future. Self-injury, though it may temporarily relieve emotional pain and distress, comes at a high cost to oneís health, well-being, and future. It is important to remember that you are too beautiful, unique, and important not to take care of yourself both physically and emotionally.

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Questions and answers about SI
Q. What is self-injury?
A. Itís hard to believe, but some women actually injure themselves on purpose. There are different forms of self-injury, such as cutting, burning, scratching, punching oneís self or other objects, picking scabs or preventing oneís own wound from healing, pulling hair, infecting oneís self, poking objects through body openings, and breaking bones or bruising. About one in 100 people is a self-injurer, and more females than males suffer from this behavior. Recently, more teens and young adults seem to be hurting themselves by cutting. Cutting is when a person uses a razor blade, knife, or other sharp object to make cut marks in the skin, causing bleeding and scarring.

Q. Why would women want to hurt themselves?
A. Most women who hurt themselves have problems with low self-esteem, which means they donít like themselves very much, or worry that no one else likes them. They may also feel empty inside, numb, unloved by family and friends, and have problems with showing sadness or anger. Sometimes they also may have an eating disorder, may be abusing alcohol or other drugs, and may have suffered from physical or sexual abuse during childhood.

Q. Why would this lead to self-injury?
A. Because of these feelings, they may want to hurt or punish themselves. But most self-injurers do it because they feel so full of emotion that they will burst, and self-injury is a way of letting the tension go. In a strange way, when they injure themselves they may also feel relief, even pleasure, since the bodyís defense to injury is to release natural chemicals that may act like painkillers. Some people who self-injure say that the pinch of pain and sight of blood give them feeling again. Women who use self-injury to help deal with their feelings soon realize it doesnít help them solve their problems. If they donít get help, they may self-injure more often and may even begin to think about suicide.

Q. Are these just small, harmless injuries?
A. There are hidden, serious dangers in self-injury, especially cutting. For example, people who start cutting themselves donít really mean to hurt themselves seriously or to commit suicide, but may not realize how deep they are cutting. They may need medical care for stitches, infections, or more serious injuries. They could also accidentally kill themselves. Also, just as drug abusers who share needles, people who share the same tool to cut themselves are at a high risk of getting and spreading diseases like HIV and hepatitis. [1]

Q. Why do people injure themselves?
A. It can be hard to understand, but people who injure themselves sometimes do it because it actually makes them feel better. They are overflowing with emotions ñ like sadness, depression, or anger ñ that they have trouble expressing.

You can probably recall a time when youíve experienced intense emotions. You may remember how your whole body felt different. Your body may have felt tense, as if it were getting ready for action. Maybe you relieved that tension by crying about your loss or by shouting angrily at a friend. These physical actions probably helped you to release the tightness in your body and let it return to a more relaxed state.

People who injure themselves are often full of intense emotional pain, but they have difficulty relieving the tension this causes in the usual ways. They may think that they have to be strong, and so they may not allow themselves to cry. They may have been taught as children that expressing emotions is wrong. But the tension inside their bodies and their minds becomes almost unbearable, and they find that injuring themselves somehow relieves that tension. It actually calms them, at least for a short time. It helps them feel as if they are in control of their situations and their moods.

Sometimes when people canít cope with strong emotions, they feel numb or as if whatís happening to them isnít real. Some people say that they feel like theyíre watching themselves in a TV show or movie. When this feeling of numbness and ìunrealityî gets too strong, they may injure themselves as a way of ìwaking upî from this state. Self-injury may make them feel alive and grounded in reality.

Cutting isnít the only form of self-injury. People hurt themselves in other ways like burning themselves, hitting themselves with objects or their fists until they bruise themselves or break their bones, pulling out their hair, or picking at scabs and preventing sores on their bodies from healing. Cutting and other self-injurious behavior isnít confined to a particular group, either ñ self-injurers can be male or female, any race, and any age (although most are in their teens, 20s, and 20s, and more women than men injure themselves).

No one knows for sure why some people injure themselves. Research suggests that it could be a combination of several factors. These include low levels of a chemical called serotonin in the brain, which has also been linked to depression. Family background may play a role; people who self-abuse may have been discouraged from expressing their feelings as children. A history of physical and sexual abuse may also be associated with self-abuse.

Self-abusers donít usually intend to hurt themselves permanently. In fact, many would say that self-injury helps them relieve the depression that might lead to suicide. But many theorists believe cutting and other self-injurious behaviors are addictive behaviors, and that self-injurers will need to make more and deeper injuries as time goes on to relieve the pain theyíre feeling. This can lead to serious medical complications. [2]

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Signs of SI
Here are some signs of a person who is a self-injurer:
  • Cutting
  • Carving
  • Scratching
  • Burning/abrasions
  • Branding
  • Marking
  • Picking and pulling skin and/or hair
  • Biting
  • Head banging
  • Bruising
  • Hitting, punching
  • Tattooing
  • Excessive body piercing
  • [3]
You may be wondering why your friendís cat has suddenly turned vicious and is ìscratchingî her all the time. You may have a friend who frequently has cuts on his legs, and when you ask him why, he just mumbles something about getting caught in a sticker bush near his house. Both of these friends may be isolating themselves socially and may wear clothing that covers up their arms and legs, even in hot weather. Most self-injurers feel ashamed of what theyíre doing and try to hide it from their friends and families. You may know someone who has a cut and is constantly picking at the scab or playing with it so much that it repeatedly reopens the wound. Everyone gets hurt accidentally from time to time, but you should suspect self-injury if your friend has a continuing pattern of unexplained or poorly explained cuts, scratches, or wounds that never seem to heal. If you see this happening, encourage your friend to seek help. [4]

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Dangers of this behavior
Although self-injurers donít intend to hurt themselves permanently, they are at risk each time they injure themselves. Self-cutters, for instance, may misjudge the depth of a cut and require stitches, or in extreme cases, hospitalization. Cuts can become infected because the person uses dirty cutting instruments ñ a self-cutter may use razors, scissors, pins, or even the sharp edge of the tab on a can of soda. If two self-cutters share one cutting instrument, they risk spreading blood-borne illnesses such as hepatitis and HIV.

Self-injurers often indicate that what they do makes suicide less likely because it relieves their depression and anxiety. Sadly, though, those who injure themselves may increase their risk of committing suicide in the future if they donít get help with their underlying problems. Also, a cut may sever a vital artery, causing hemorrhaging.

People who injure themselves often have other problems, too, like an eating disorder, bipolar disorder, or drug or alcohol abuse. Theyíre often trying to find ways of numbing their emotional pain and avoiding the problems that are behind their self-destructive behaviors.

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Conditions with which SI is associated
Conditions with which SI is associated include:
  • Borderline personality disorder
  • Dissociative disorders
  • Other mental illnesses
Being a self-injurer does not mean you have one of these conditions, but injurious behavior may occur in individuals with these disorders.

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Getting help
If you have a friend who cuts herself, you canít force her to stop. But you can let her know that youíre there to help. It can be tough to remain calm when talking about it because itís such an upsetting subject, but itís very important to let your friend know that you care about her. If you yourself are a self-injurer, you may not be able to stop without the help of family and loved ones, as well as a mental-health professional.

Find a doctor or therapist whom your friend can trust. If your friend canít speak directly to this person, maybe she can write about what sheís doing in a letter or journal that the doctor can read. The important thing is to encourage her to talk to someone who can help her to stop the behavior and deal with her underlying problems and who can recommend the best treatment plan for her. This may include a combination of behavioral therapy, medication, and specialized treatment for associated problems such as eating disorders.

Cognitive-behavioral therapy may help in blocking the thoughts associated with self-injury and in developing coping strategies. Some people have also found that using other means of relieving stress "like hypnosis, exercise, or art therapy" helps them to fight the urge to injure themselves.

Although stopping self-injury can be difficult, it is possible. Once the self-abuser gets help in solving the problems that are at the root of the behavior, chances are good that sheíll be able to stop hurting herself and be able to lead a happier, healthier life.

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[1] Adapted from Mind over Matters: Self Injury (
[2] Adapted from TeensHealth: Cutting (
[3] Adapted from Self-injury in Adolescents (
[4] Adapted from TeensHealth: Cutting

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American Psychological Association
Center for Parent/Youth Understanding
Focus Adolescent Services


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