Self-injury is the act of deliberately harming your own body, such as cutting or burning yourself. It's not meant as a suicide attempt and isn't part of a socially acceptable cultural or artistic expression or ritual, such as tattooing. Rather, self-injury is an unhealthy effort to cope with overwhelming negative emotions, such as intense anger, tension 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. Self-injury is often done on impulse, so it's sometimes considered an impulse-control behavior problem. Self-injury may accompany a variety of mental illnesses, such as depression, eating disorders and borderline personality disorder. Self-injury is also known as self-harm, self-injurious behavior, self-mutilation and parasuicide.

Because self-injury is often kept secret, it may be difficult to spot signs and symptoms. Self-injury symptoms may include:

• Scars, such as from burns or cuts
• Fresh cuts, scratches or other wounds
• Bruises
• Broken bones
• Keeping sharp objects on hand
• Spending a great deal of time alone
• Wearing long sleeves or long pants even in hot weather
• Claiming to have frequent accidents or mishaps

Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or scratches on your body with a sharp object. But there are many other forms of self-harm, including:

• Cutting
• Burning
• Poisoning
• Overdosing
• Carving words or symbols on the skin
• Breaking bones
• Hitting or punching
• Piercing the skin with sharp objects
• Head banging
• Pinching
• Biting
• Pulling out hair
• Interfering with wound healing

Self-injury is usually repetitive behavior, occurring multiple times, rather than just once. 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 subjected to self-injury. Self-injury may be painful or not, largely depending on your state of mind at the time.

Self-injury frequently is an impulsive act. You may become upset, or triggered, and develop an urge to hurt yourself. Other times, though, self-injury is a planned event, inflicted in a controlled, methodical manner.

When to see a doctor
If you engage in any form of self-injury, even minor, or 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. Self-injury contributes to a life of distress and chaos. It also poses the risk of serious injury, infection or disfigurement, or even death. And self-injury has some addictive qualities, making it very hard to overcome on your own.

While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help. Getting appropriate treatment can help you learn healthier ways to cope — ways that won't leave your body permanently scarred. Try to work up the courage to confide in someone you trust, whether it's a friend, loved one, health care provider, or a school or university official. They can help you take the first steps to successful treatment.

When a loved one engages in self-injury
If you have a loved one who engages in self-injury, you may not know what to do. You may be shocked, dismayed and scared. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach.

If your loved one is an adult, gently encourage him or her to seek medical treatment. If it's 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 — that may just make the situation more volatile.

Emergency situations
If you have injured yourself severely or believe it may be life-threatening, call 911 or your local emergency services provider. If a loved one has injured himself or herself severely, take him or her to the hospital or call for emergency help. If possible, take away any instruments used for self-injury.

There's no one single or simple cause of self-injury. The mix of emotions that triggers self-injury is complex. In general, self-injury is usually the result of an inability to cope in healthy ways with deep psychological pain. For instance, you may have a hard time regulating, expressing or understanding your emotions. Physical injury distracts you from these painful emotions or helps you feel a sense of control over an otherwise uncontrollable situation.

When you feel emotionally empty, self-injury is a way to feel something, anything, even if it's physical pain. It also offers an external way to express internal distress and despair. You may also turn to self-injury as a way to punish yourself for perceived faults. Sometimes self-injury is an attempt to seek attention or to manipulate others.

Self-injury can affect anyone, from pre-adolescents to older adults. But certain factors may increase the risk of self-injury, including:

• Age. Most people who engage in self-injury are adolescents. Self-injury often starts in the early teen years, when emotions are more volatile and children face increasing peer pressure, loneliness and conflicts with parents or other authority figures.
• Sex. Self-injury was thought to be more common in females than in males, but recent research shows that the rates are generally about the same.
• Family history. Some evidence suggests that self-injury is more common in people who have a family history of suicide, self-injury or self-destructive acts.
• Life issues. Some people who injure themselves were sexually, physically or emotionally abused as children or adults. They may also have experienced neglect in childhood. Social isolation and living alone may also increase the risk. Unstable living conditions, such as unemployment and divorce, also may be factors.
• Mental health issues. Among those at highest risk are people who experience many negative emotions and are highly self-critical. People who self-injure are more likely to be impulsive and to have poor problem-solving skills. Also, self-injury is commonly associated with certain mental illnesses, including borderline personality disorder, depression, anxiety disorders, substance abuse disorders, post-traumatic stress disorder and eating disorders.
• Alcohol or substance misuse. People who engage in self-harm often do so while under the influence of alcohol or illicit drugs.

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

• Worsening feelings of shame, guilt and low self-esteem.
• Infection, either from your wounds or from sharing implements.
• Life-threatening problems, such as blood loss if major blood vessels or arteries are cut.
• Accidental or deliberate suicide. You may unintentionally injure yourself fatally, especially if you engage in self-injury while under the influence of alcohol or illicit drugs. You're also at higher risk of deliberately taking your own life.
• Permanent scars or disfigurement.

Your first appointment to start treating your self-injury may be with a school nurse or counselor, your family doctor or a general practitioner. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.

What you can do
Being an active participant in your care can help your recovery efforts. One way to do this is by preparing for your first appointment. Think about what your needs and goals for treatment are. Also, write down a list of questions to ask. These may include:

• Why can't I get better on my own?
• How do you treat self-injury?
• Are there medications that might help?
• How often will we meet?
• What should I do if I have an urge to self-injure between therapy sessions?
• How long will treatment take?
• What can I do to help myself?

What to expect from your doctor
Your doctor is likely to ask you a number of questions about your self-injury and emotional state. Your doctor may ask such questions as:

• When did you first begin harming yourself?
• How frequently do you injure yourself?
• What methods do you use to harm yourself?
• What feelings and thoughts do you have before, during and after self-injury?
• What triggers you to harm yourself?
• What makes you feel better or worse?

Unless you want to recover from self-injury and disclose your behavior, it can be difficult for a doctor or therapist to diagnose self-injury. Sometimes self-injury is discovered accidentally. For instance, a doctor doing a routine medical examination may notice signs, such as scars or fresh injuries.

In any case, there's no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. During an initial evaluation for self-injury, a health care provider may ask you such questions as:

• When your self-injury began
• How often you engage in self-injury
• What types of self-injury you use
• What seems to trigger your self-injury
• What emotional issues you face
• What social networks or relationships you have
• What previous treatment, if any, you've had
• Your feelings about the future
• Whether you have thoughts of suicide

A definitive diagnosis may require evaluation by a mental health provider with experience in treating self-injury. A mental health provider may also evaluate you for other mental illnesses that may accompany self-injury, such as depression or personality disorders.

There's no one best way to treat self-injury. Treatment is tailored to your specific issues and any related mental health conditions you might have, such as depression. Treating self-injury can take time, hard work and your own desire to recover. Because self-injury can become such a major part of your life and it's often accompanied by serious mental disorders, treatment with a mental health professional experienced in self-injury issues may be necessary.

Treatment options for self-injury include:

Psychotherapy
Also known as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injury. Therapy also can help you learn skills to better tolerate stress, regulate your emotions, boost your self-image and improve relationships.

Several types of psychotherapy in particular may be helpful, including:

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Psychodynamic psychotherapy

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

Medications
No medications specifically treat self-injury. However, your doctor may recommend treatment with antidepressants or other psychiatric medications that can help improve depression, anxiety or other mental disorders commonly associated with self-injury. An improvement in these symptoms may help you feel less compelled to hurt yourself.

Psychiatric hospitalization
If you injure yourself severely or repeatedly, your doctor may recommend admission for psychiatric hospitalization. Hospitalization can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.

While you generally shouldn't try to treat self-injury on your own, you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips for self-injury:

• Stick to your treatment plan, including attending psychotherapy appointments and taking prescribed medications as directed.
• Fully disclose incidents of self-injury to your doctor.
• Try to find ways to cope other than injuring yourself, such as reaching out to a friend, practicing relaxation techniques, contacting a support group or getting in touch with your doctor.
• Resolve not to underestimate the ability to change your life in positive ways.
• Avoid alcohol and illicit drugs, which can make you more likely to engage in self-injury.
• Shun Internet sites that support or glamorize self-injury. Instead, seek out sites that are supportive of your recovery efforts.
• Care properly for your wounds when you do injure yourself, such as seeking medical treatment when necessary and following appropriate first-aid guidelines.
• Don't share instruments used for self-injury, which raises your risk of infection.

There is no sure way to prevent self-injury. Prevention strategies may need to involve both individuals and communities, including parents, schools, medical professionals and coaches, for instance.

Ways to reduce the risk of self-injury may include:

• Identifying people most at risk and offering help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
• Expanding social networks. Many people who self-injure feel lonely and disconnected. Forming connections to others can improve relationship and communication skills.
• Raising 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 self-injury.
• Promoting programs encouraging 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.
• Offering 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.