When Survivors Self-Injure to Cope

You’ve probably heard of a practice called cutting. But you may think it’s something teenage girls engage in to get attention. The truth behind self-injury is that it’s much more complex an issue than that, and it affects many more people.

“Self-injury comes in many forms, including cutting, burning, hitting oneself, head banging, swallowing objects and pulling out hair,” says Ben Borja, MD, a psychiatrist at Sheppard Pratt Health System in Baltimore, Maryland. “We can define it as a repetitive self-directed behavior that causes physical injury.”

While the behavior often begins in adolescence, adults engage in self-injury, too. And it’s not uncommon. One study of college students, published in the journal Pediatrics, reported that 17 percent of participants had engaged in self-injury at some point in their life.

Self-Harm as a Response to Abuse

Why would a domestic violence survivor want to hurt himself or herself?

“Individuals who engage in self-injurious behaviors do it to relieve an intolerable stress,” Borja says. “They’re in pain and there is a lack of coping skills. By accident or by experimentation, they have found that by engaging in one of these methods, there is release of the pain.”

The National Center for PTSD says other reasons individuals might engage in self-harm can be:

• To distract themselves from emotional pain by causing physical pain
• To punish themselves
• To relieve tension
• To feel “real” by feeling pain or seeing evidence of injury
• To feel numb, zoned out, calm or at peace
• To experience euphoric feelings (associated with release of endorphins)
• To communicate their pain, anger or other emotions to others
• To nurture themselves (through the process of healing the wounds)

No matter the impetus, many liken the sensation to a drug-induced high. “It’s a very secretive, highly addictive and ritualistic behavior,” Borja says. “One patient said the calmness came so rapidly after [self-injury] that she was constantly seeking that feeling.”

No Quick Fix

If you or a loved one engages in self-injury, don’t expect the behavior to stop immediately.

“Treatment is complex and frustrating for the patient, family members and even for the therapist and psychiatrist,” Borja says. “It’s a long process.”

And it begins with treating the original source of the pain—the physical, emotional or sexual abuse that led to the behavior in the first place. This often requires some combination of medication, cognitive/behavioral therapy and interpersonal therapy, according to Mental Health America.

There are things you can do in the meantime to begin curbing the need to self-injure.

“You could try to substitute the behavior for another action,” Borja says. “For instance, you could snap a rubber band, squeeze an orange or rub ice against the skin where you normally cut.”

Borja also recommends other therapeutic practices, such as art therapy, listening to music and journaling.

Some survivors of domestic violence have difficulty taking care of themselves even after the abuse stops. To learn how you can start, read “ How to Go From Surviving to Thriving After Abuse.”

“It’s important for those of us who care about our students, friends and family who are going through hard times in their life emotionally to not treat their pain any differently than someone who comes to us with a bloody lip.”