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Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted destruction of body tissue resulting in immediate damage. There is no suicidal intent to the act and it would not be culturally sanctioned such as piercing or tattooing.
Acts of self-injury include, but are not limited to:
- intentional carving or cutting of the skin
- subdermal tissue scratching
- burning oneself
- banging or punching objects or oneself with the intention of hurting oneself
- embedding objects under the skin
Cutting is the most frequent method of self-injury and is often done repeatedly; it is rarely a one-time event. It is usually done with sharp objects, such as razor blades, knives, pins/needles, sharp stones, and broken glass. In desert regions, cactus needles have been used to cut. Cutting can be performed on any part of the body with the hands, wrists, stomach and thighs being the most common locations. The act can result in superficial damage or cause permanent scarring. Although many injure themselves to the point that medical intervention is warranted, only 6.5% of these individuals had ever been treated for any of their wounds. Of course, this is due to the fact that self-injurers do not want to be “caught,” then somehow forced to discontinue the behavior.
Self-harm is far more prevalent among girls than boys. The parents of these teens are often baffled and horrified by the behavior. They cannot imagine why their daughter would intentionally inflict pain or cause injury to her own body? Unfortunately the answer is nearly as difficult to understand as the behavior itself. By and large, she does it as a method to cope with unpleasant thoughts or painful emotions.
Adolescence holds intense challenges for young girls: physical maturation, hormonal shifts, and social pressures. Many teenage girls feel the intense need to be perfect, which usually includes being thin. This pressure to remain a small size is greatest when she has the least amount of control over her developing body. Add stress about grades, possible problems at home, conflicts with friends or boyfriends, and the result is a high level of emotional distress. A girl may feel highly anxious, angry, depressed, lonely, rejected, or any number of painful feelings. If she has not learned healthy coping skills, she may turn to a behavior such as cutting. This is because it achieves the desired result. While she is fully focused on the act of cutting herself, she is no longer enraged, depressed or anxious. In fact, she probably feels rather relaxed and peaceful, due to the calming chemicals released by the brain in reaction to the injury. This behavior becomes addictive because it works. Those who cut begin to believe that they genuinely cannot cope with life without cutting themselves.
Although the primary cause for cutting is emotion regulation, there are some notable exceptions. Some young girls genuinely believe that they are just plain “bad.” They often arrive at this conclusion due to their perceived culpability in something unfortunate. It could be an event as commonplace as parental divorce. A marital breakup could result from a variety of reasons: infidelity, disparate goals or values, finances or simple incompatibility. However, unaware of these complex issues, a girl may conclude that it is her fault. She wasn’t the “good” daughter they wanted–her grades weren’t high enough, she wasn’t an accomplished athlete, she got in too many fights with her sibling, or she was the topic of much parental conflict. Therefore, she is bad, and as such, she deserves to be punished. Punishment comes in the form of harming her body.
Another cause of self-injury is sexual trauma. If a young girl or adolescent has been molested or raped, she may embrace self-injurious behavior. She may believe her body caused the violation, and therefore, it must be made to pay. Another reason is predicated on fear – the fear that the abuse may be repeated. She thinks that if she mutilates her body enough, its unattractiveness will prevent a future assault.
There are two factors that are not behind self-injury: attention seeking or suicidality. Those who harm their bodies are not trying to get attention. We know this because they usually cut or burn in areas that cannot be seen such as the lower abdomen or inner thigh. Those who cut on their arms or wrists often wear long-sleeved shirts to cover up the wounds, even during the summer months. Additionally, suicide is not the goal. They do not want to die; they just want their emotional pain to stop, even if it’s just for a moment.