Intentional self-injury: What is it and How to deal with it?

Have you ever come across a person and found them to occasionally engage in self-harming behavior? Or do you yourself struggle with resisting the urge to injure yourself? e.g. consciously wounding yourself using a knife, a blade, a burnt cigarette by stabbing, cutting or burning, etc. Do you wonder why this happens and what you can do to prevent it from happening? Read on to find out about this behavior called intentional self-injury.

A Quick Guide

Intentional self-injury, also known as non-suicidal self-injury, involves consciously harming one’s body as a coping mechanism, typically due to poor mental health. It includes behaviors such as cutting, burning, or hitting oneself, usually driven by the desire for emotional relief or punishment. Seeking professional help, recognizing the maladaptive nature of the behavior, understanding the underlying motives, and adopting alternative coping strategies are essential steps in addressing intentional self-injury.

What is intentional self-injury?

Non-suicidal self-injury or intentional self-injury is often observed in individuals with poor mental health. According to DSM-V, it includes the conscious act of intentionally harming one’s body. The person who engages in this behavior does not intend to die or commit suicide but knows that such behaviors are not life-threatening. We can say he/she is dependent on these behaviors to cope with the stresses of life.

Behaviors included in intentional self-injury

• Intentional self-injury includes behaviors like cutting, hitting, burning, or stabbing oneself for the purpose of creating bruises, pain, and bleeding. Bums left after touching lit cigarettes with skin is also a common method.
• Objects like knives, needles, razors and sharp objects are used to inflict such injuries. Consequently, the thighs and forearms of such individuals are often full of superficial cuts and their scars, usually 1-2 cm long.
• Particularly, the usage of multiple methods to inflict self-injury may be a sign of severe psychopathology

Behaviors not included in intentional self-injury

Social behaviors and rituals that involve self-harm or self-injury are not included in this. For example, people who are obsessed with body piercings, tattooing, doing religious rituals including self-wounding, nail biting, skin picking, etc are not intentionally inflicting injuries on themselves since their motives for doing so are purely recreational or social. Whereas, those who commit self-injuries are so overwhelmed with distress that they believe the only way to cope is to harm themselves.

Reasons for intentional self-injury

By committing such self-injurious acts, the person aims to:

• Get relief from negative emotions and thoughts
• Experience positive feelings
• Resolve relational issues
• Punish him or herself since they think they deserve to be in pain.

People who engage in intentional self-injury are often battling mental health issues like depression, anxiety, anger/ impulse control issues, or excessive self-criticism. Accordingly, the negative emotions and thoughts associated with these, drive them to commit such acts. In some cases, the person may feel so preoccupied with harming him or herself that they find it difficult to control themselves. Similarly, the majority of the time they think a lot about self-harming acts and crave to do so to get a sense of relief.  

Why does the intentional self-injury behavior continue?

Certain factors may reinforce and perpetuate a person’s self-harming behavior. So, a person may keep intentionally harming him or herself to:

• Feel relieved, relaxed, and experience a pleasant state
• Generate the attention of others or ask them for help
• Express anger or other negative emotions
• Avoid unpleasant emotions and distressing thoughts
• Punish oneself since he/she believes it would compensate for the distress caused to others due to his/her behavior.

How to deal with intentional self-injury

If you know anyone who engages in intentional self-injury or you yourself are struggling with it, you can utilize the following strategies to deal with it.

1. Seek help from a mental health professional

Motivational Interviewing (MI), cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and emotion-regulation group therapy (ERGT) are effective in managing intentional self-injury behavior. So, immediately seek help from a therapist trained in these approaches as a first resort.

2. Consult your doctor for medications to assist your treatment

Some psychiatrists may prescribe medications for managing mood-related issues. These can be used as an adjunct in treating intentional self-injurious behavior.

3. Recognize that this behavior is a maladaptive coping strategy

The first step toward treatment is to recognize the unhealthy aspects of this behavior. Although it may feel like you may lose your coping strategy due to this, but for healing, you need to understand that engaging in this intentional self-injury is harmful to your physical and mental health.

4. Identify the motive behind your behavior

You need to explore why you engage in this behavior.

• If it is to deal with emotional stress, consider using alternative stress reduction strategies e.g. relaxation exercises, distraction strategies, journaling, seeking social support, etc.
• If your motive is to feel something or make the feeling of being numb and empty go away, try using other strategies to do the same. For example, taking a cold shower, eating a hot pepper, etc.
• If your motive is to communicate your emotional needs or pain to others, try communicating it using a healthy way.
• If you do this behavior to punish yourself, consider going on a journey of self-forgiveness and self-acceptance.

5. Try replacement behavior

You can try using exercise or some other healthy physical activity as a replacement when the urge for showing self-injurious behavior is high.