Self-Harm Counseling & Therapy

Melanie Wells

LPC, LMFT, LPC & LMFT Supervisor

After eight long years of rock-busting in conventional counseling practices, Melanie Wells founded The LifeWorks Group in 1999 to offer clients a fresh, innovative approach to the everyday problems of life. Since that inauspicious beginning (we had two pleather chairs, a broken copier and about $7 in the bank) LifeWorks has trained hundreds of interns and helped tens of thousands... Read More

What Is Self-Harm, Self-Mutilation, Or Self-Injury?

Discovering that your teenager or young adult engages in self-injury is enough to send most parents into a tailspin of panic. Although you’re not wrong to be concerned, there is some good (-ish?) news: the majority of self-injurious behavior is performed to self-soothe rather than to convey an underlying suicidal intent. But this is not to be misleading: Of individuals who do go on to commit suicide, self-harm is often considered an antecedent (or precursory) behavior.

Non-suicidal self-harm (also termed self-mutilation) refers to deliberate acts of self-inflicted pain, injury, or aggression. The impulse to self-harm usually emerges in adolescence to early adulthood as a defective coping mechanism for dealing with extreme stress—or inversely—emotional detachment; but individuals from all age brackets may struggle with self-injury.

Although there are infinite ways to self-harm, 10 of the most common include:

  • Cutting yourself with razor blades, knives, or sharp objects
  • Punching objects until your knuckles bleed
  • Punching or hitting yourself
  • Banging your head against a wall
  • Biting, burning, pinching, scraping, or scratching yourself
  • Perforating, or puncturing, your skin with pointed objects
  • Irritating wounds to prevent them from healing
  • Carving words or symbols into your flesh with knives, scissors, glass, etc.
  • Pulling out your hair with the intent to self-injure (Note: most forms of hair-pulling are considered obsessive-compulsive in nature rather than self-injurious)
  • Swallowing objects or substances with the intent to make yourself sick

 

Why Do People Engage in Self-Harm?

Self-mutilating and attention-seeking behaviors are often confounded as being identical; but for many individuals who self-injure, the activity is conducted with the utmost secrecy, concealing wounds from family and friends and reporting shame when confronted about the condition. More commonly, individuals who self-harm report doing so in an effort to:

  • Relieve oppressive, unremitting anxiety, stress, or depression
  • Induce pain (an extreme sensation) as an alternative to chronic numbness—or the absence of feeling
  • Force internal scars to appear externally, where their visibility evokes comfort
  • Exert autonomy (or self-control) over a chaotic situation, deriving security from pain that is self-created instead of other-created
  • Punish yourself for capitulating to your emotions (for example: for expressing anger to a romantic partner) or for falling short of perfection
  • Achieve endorphin-release or euphoria (also known as the cutter’s high)
  • Vent impulsive anger
  • Cope with trauma; physical, emotional, or sexual abuse; interpersonal difficulties (e.g. bullying, breakups); or a mental health concern (substance abuse, eating disorders, borderline personality disorder, bipolar disorder, PTSD, etc.)

 

What Are The Signs & Symptoms Of Self-Harm?

The physical indicators for self-harm are similar to the warning signs for physical abuse; just as the psychological symptoms are analogous to the indicators for depression and impulsivity—with a few notable distinctions. Symptoms of self-harm may include:

  • Evidence of bruises, cuts, scratches, broken bones, burns, scrapes, bite marks, bald spots, or non-healing wounds
  • An over-abundance or unusual patterning of scars (e.g. scars that form distinctive shapes or that align in parallel lines)
  • Wearing weather-inappropriate or context-inappropriate clothing to conceal wounds (e.g. bulky sweaters and gloves in the summertime; wearing a hat to class—despite dress code regulations—to conceal self-inflicted hair loss)
  • Hoarding self-harming implements of choice (razor blades, broken glass, miniature scissors) for easy access
  • Developing rituals for self-harm (arranging tools for self-mutilation in a particular manner prior to use; only harming oneself in the bathroom where cleanup is quick and easy, etc.)
  • Social withdrawal (to facilitate hiding scars or time spent engaging in self-harm)
  • Claiming to be accident-prone, or asserting flimsy excuses for injuries
  • Co-occurring Depression/Anxiety, anger, guilt, shame, numbness, impulsive behavior, substance abuse, emotional & personality instability, more+

 

How Can Counseling & Therapy For Self-Harm Improve My Condition?

Although most self-injurious behavior is non-suicidal in nature, risks associated with self-harm include infection, accidental death, or worsening suicidality. However, several therapeutic interventions have proven effective for managing and reducing self-harm. Your therapist may recommend:

  • Traditional Talk Therapy, to uncover the roots of your self-harming behavior; to equip you with the tools you need to effectively cope with emotional pain or detachment; and to address co-morbid conditions, including anxiety, depression, substance abuse, and more+ that may occur in conjunction with your condition
  • Cognitive Behavioral Therapy, which respectfully challenges the reasons why you self-injure (e.g. you may burn yourself to exert control over an out-of-control situation… when doing so actually makes your life more chaotic) & assists you in adapting your behavior (e.g. by identifying more constructive ways in which you can seize control of your situation without relying on burning to self-soothe)
  • Dialectical Behavioral Therapy, which utilizes the principles of Cognitive Behavioral Therapy but delves deeper into emotional regulation and interpersonal relationships; this form of counseling is particularly useful for individuals with borderline personality disorder
  • Family Therapy, to assist family members in best supporting an individual who engages in self-harm, and to address family dynamics that may exacerbate an individual’s condition
  • Group Therapy, to connect you with other individuals in various states of healing from self-harm to form a vaster support network to supplement your recovery
  • Alternative Therapies, including mindfulness, meditation, psychotherapeutic yoga, and equine therapy to expose you to innovative methods for self-relaxation that can help curb your impulses to self-injure
  • Inpatient/Residential Care, as needed, your therapist may refer you to a higher level of care, where you can receive around-the-clock assistance as you work to eliminate self-harming urges

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