Self-Injurious Behavior
Estimates are as high as one to two million Americans who practice “self-injury” through
repeated burning, cutting, bruising, scratching and mutilating. Also called “selfmutilation”
or “self harm,” self-injury is the fastest growing behavioral problem among
adolescents.
The behavior typically begins around the age of thirteen or fourteen and is slightly more
prevalent in females. Self-harm peaks between the ages of 18 and 24 and usually
decreases in the 30s and 40s.
Very little is known about the causes of self-injury among the general population.
Researchers have found links to a history of severe emotional, physical and/or sexual
abuse. Some studies find that the earlier and more severe abuse, the greater the risk of
self-injury. While there research is lacking about self-injurious behaviors in adopted
youth, a United Kingdom study found a prevalence and persistence in self-injurious
behavior in institutionally reared children from Romania. The primary factor affecting the
prevalence and persistence of the behaviors was the length of time the children had spent
in institutional deprivation.
Why Teens engage in Self-Harm
Oddly enough, most self-injurers say they are trying to relieve pain or to relieve
emotional numbness. Acting like a drug, self-injurious acts release endorphins that calm
and provide a temporary escape from life’s problems. Increasing amounts of pain are
needed as tolerance builds. Rather than being perceived as a “cool thing to do” among
teens, self-harm is typically done in private, away from peers who might consider it to be
strange behavior. Self-hurters usually hide the practice because they feel alienated and
powerless to stop. Intensely shameful feelings accompany self-injury, so parents and
care-givers need to be willing to listen without shock or judging to encourage the selfinjurer
to use his or her voice rather than the body for self-expression.
Self-injury is not suicidal behavior but because it may escalate as a way to reduce
tension, if left unattended, it could result in a suicide attempt. The self-soothing activity
may represent the best coping mechanism with the least projected amount of damage.
Self-injurious behavior can be reduced and even cured with a combination of
interventions. These might include individual and family therapy, self-help strategies,
medication, support groups and self-injurious behavior substitutes. Treatment should
include ways to help youth find coping skills to replace self-harm and build on the
strengths and talents the youth has.
Self-Injurious Behavior Substitutes
Bruce O’Leary, a family therapist with an expertise in treating self-injurious behaviors,
offers the following behavioral substitutes for anger, frustration and restlessness:
- Try something physical and violent that is not directed at a living thing.
- Slash an empty pop bottle or a piece of cardboard.
- Make a soft cloth doll to represent whatever frustrates you and tear into it.
- Flatten aluminum cans for
recycling.
- Hit a punching bag.
- Use a pillow to hit a wall.
- Rip up an old newspaper or phonebook.
- On a sketch or photo of yourself, mark in red ink what you want to do… or
tear the picture.
- Make clay models to cut or smash.
- Throw ice against a brick wall.
- Break some sticks.
O’Leary further suggests as a response to sadness and depression the following soothing,
slow activities:
- Take a hot bath with bath oil or bubbles. Curl up under a comforter with hot cocoa and a good book.
- Listen to soothing music.
- Smooth body lotion on the part of your body that you wish to hurt.
- Light some sweet smelling incense.
- Call a friend and talk.
As for craving sensations, depersonalization, dissociating or feeling unreal, O’Leary
advises doing something that creates a sharp physical sensation:
- Squeeze ice very hard.
- Put a finger in frozen food for a minute.
- Bite into a hot pepper.
- Slap a tabletop.
- Take a very cold bath.
- Stomp your feet.
- Snap your wrist with a rubber band.
- Rub liniment under your nose.
- Try some breathing in a mindful way.
For youth tempted to draw blood, O’Leary says to:
- Draw on yourself with a red felt-tip pen or red food coloring. Warm the bottle
of food coloring and slowly squeeze as you draw.
- Draw on yourself using ice made with food coloring.
- Paint yourself with red tempera paint.