Self Injury FAQ

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Table of Contents

What is Self-Injury?

Self-Injury (SI) is the act of physically hurting yourself on purpose without the intent of commiting suicide. It is a method of coping during an emotionally difficult time that helps some people temporarily feel better because they have a way to physically express and release the tension and the pain they hold inside. In other people hurting themselves produces chemical changes in their bodies that make them feel happier and more relaxed.

Five key components identify and define SI.

  • SI is a harmful act done to yourself. Do not mistake lashing out in anger at others as SI.
  • SI is only done by yourself. If anyone else does something to you that causes pain this is not SI.
  • An act of SI must include some sort of physical violence. Emotionally punishing yourself (calling yourself a bitch or thinking you’re stupid, ugly, etc.) is not SI.
  • An act of SI is not done with the intention of killing yourself. People who slit their wrists to kill themselves, even though they have harmed their body, are not SI-ing.
  • SI is done intentionally. Not accidentally, but with the intent purpose of hurting yourself.

Are behaviors that alter the body’s appearance such as tatooing, drug use, body piercing, ritual mutilation, etc. SI?

No, although these behaviors can be harmful to the body they do not have the purpose SI has.

Behaviors that alterate the appearance of the body are generally used to make the person look better. While in SI this is rarely, if ever, the case. Also, SI and body alteration are done by different methods. While SI is done by yourself, body alteration is typically done by another- someone usually licensed and/or trained to do so. Another difference is between the initial reasons for SI and body alteration. SI is often done because of feelings of loneliness and alienation, while body alteration is done because of discontentment with your body.

Ritual mutilation is the alteration of your body for society, religion, or a peer group. Several examples include genital mutilation, some types of tatooing, scarring of the face and body, and branding. Most people don’t undergo ritual mutilation by choice and they often perform the act in front of other people. Also, the scars, tattoos, brands, etc. that are the result of ritual mutilation are usually exhibited in in public. Wounds and scars from SI are usually hidden.

How does SI develop?

The origin of SI is usually difficult to determine or understand. Many people are unable to remember where they first got the idea of hurting themselves, and when they actually began to SI.

But a small number of people develop SI through observational learning (a process where a person learns a behavior by watching someone else do it). The chances of most people actually seeing another person SI are very slim, but in places such as psychiatric hospitals and prisons the odds are much higher. Remember, the chances of this happening are very small.

What is the course of SI?

People who SI usually begin by cutting themselves with a knife, razor blade, or other sharp object. From there the person tries other forms of SI, such as burning, hitting, etc., until they find their prefererred method.

Incidents of SI peak in the early to mid-twenties. Often because of the great changes that occur, and the new responsibilies and roles that produce great stress in an individual. But, often, SI incidents decrease with age, and most people stop SI-ing altogether by the time they reach their thirties.

Remember, this is the typical course of SI. There are people who begin SI-ing at a very young age, or at an old age. Some continue to hurt themselves after they reach their thirties. Everybody’s experience is different.

Who typically takes part in SI?


Both men and women hurt themselves. More often women are seen with this behavior in a therapist’s office, a psychiatric hospital, etc. Wheras more men are seen with SI in prisons.


SI behavior usually begins when a person is a teenager, escalates in a person’s twenties, and disappears by their thirties.

Substance abuse

Many people who SI have histories of drug and alcohol abuse. Often this is because drugs are another method of coping because they can temporarily ease internal pain. But rarely are people under the influence when they SI.

Eating disorders

Eating disorders, such as anorexia or bulimia, are common in people who hurt themselves. Like SI, eating disorders often have the same psychological effects. Sometimes SI and eating disorders occur simultaneously.

History of abuse

The majority of people who hurt themselves have suffered physical, sexual, or emotional abuse. But this doesn’t mean that everyone who SI’s has been abused. Or that everybody who has been abused will start hurting themselves.

History of psychological treatment

Often SI-ers seek therapy to discover answers for their behavior. But for most people who hurt themselves psychological treatment does not work out because of several reasons.

First, is because psychologists sometimes ignore SI out of inexperience, ignorance, or feelings of digust. The topic of SI is rarely adressed. Also, mental health professionals rarely ask about SI behavior. These reasons usually make it the SI-ers job to mention their behavior. And because the shame and secrecy people feel because of their behavior they rarely reveal the fact that they SI.

Second, the reactions and strategies for SI by psychologists are often distasteful to the SI-er. They may demand that the SI-er stop hurting themselves or risk being sent to a psychiatric ward or hospital. (Let me interrupt here, this happened to me! I was sent twice to College Hospital (a psychiatric hospital) because of this!)

What ways do people SI?

SI is usually split into three catergories: Psychotic, Organic, and Typical.

Psychotic SI

Types of Psychotic SI include the removal or amputation of body parts, such as eyes, limbs, ears, and genitals. These acts of SI are usually done in response to visual or audible hallucinations. This type of SI is severe and is easily identified.

Organic SI

Organic SI usually stems from autistic disorders, developmental disabilities, and other psychologically induced disorders. This type of SI is always influenced by physical or chemical problems in the body. Forms of Organic SI include head-banging and lip-biting.

Typical SI

Typical SI results because of emotional or psychological reasons not related to psychotic (hearing voices, seeing things that aren’t there, delusions) or organic (physical) conditions. The majority of the people who SI fall into this catergory. This type of SI is used to make yourself feel better and as a way of coping with your life. The following are the most common ways people hurt themselves:


Cutting, also known as slicing or slashing, is the most common way people hurt themselves. It is typically done with a knife, razor blade, piece of glass, or other sharp objects. Most of the cuts are done on the arms, legs, wrists, and chest; but other people cut on other parts of the body such as the stomach, face, neck, breasts, and genitals. But cutting on the arms and wrist is the most common because excuses can be made more easily (for example people can say that they had an accident while cooking).


Burning is another common way people hurt themselves. Usually done with cigarettes, lighters, matches, kitchen-stove burners, heated objects (branding irons or hot skillets), and burning objects. Sometimes people even use flammable substances such as gasoline, propane, alocohol, and lighter fluid. Similar to cutting, most people burn themselves on their arms, wrists, legs, and chest.

Interference with wound healing

Most people have unconsciously interfered with the healing of a wound but it is considered SI when it is done deliberately. Some people remove stitches prematurely, stick objects such as needles, pins, etc. into the wound, or do other things to reopen the wound.


Hitting themselves with their fists is another way that people hurt themselves that is most commonly done on the head or thighs. Although it may not seem as serious as cutting or burning it is done for the same reasons and results.

Extreme nail biting

It is common for most people to bite their nails. But when it is used as a form of SI it is more severe and frequent than normal. It can result in the injury and damage of the fingernails or cuticles. People can bite their fingernails so much that they draw blood.


Another common thing amongst most people scratching can become a form of SI. People who use it as a method of SI make it more extreme in frequency, intensity, and duration. Area’s of skin can become raw or sometimes even bloody. Usually the scratching is done with the fingernails but sometimes it is done with a sharp or semisharp object such as a knife, comb, or pencil. Sometimes it is done unconsciously.


Trichotillomania, ‘the excessive and recurrent removal of your own hair resulting in a noticeable loss of hair,’ is the only form of SI recognized as a psychological disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Usually the hair is removed from the scalp, eyebrows, or beard, but can be from any part of the body. The bald spots that result from Trichotillomania are usually covered with a hat, bandage, or sunglasses.

Breaking of bones

A form of SI that is more rare than the others, the breaking of bones is a serious and severe form of SI. Usually, people break their bones with an instrument such as a hammer, brick, or other heavy objects. But sometimes people throw themselves into walls or doors.


There are other ways people hurt themselves that are not listed here. The above are just the most commonly known.

Why would anybody intentionally hurt themselves?

Relief from feelings

Often people hurt themselves to try to relieve intense emotions and feel better. These intense feelings can seem uncontrollable, frightening, and dangerous. When people have them they may think that hurting themselves is the only way to escape these feelings.

People who hurt themselves often are unable to control their emotions. They cannot experience and express them the way most people do: by crying, screaming, yelling, etc. This can be due to a number of reasons.

  • It may have been unsafe — for psychological or physical reasons — to express your emotions at home, etc. The expression of your emotions may have been ignored, denied, or disputed.
  • Your parents or people you grew up with may have not been able to express their own emotions in a safe and direct manner. Or if they did express an emotion such as anger they did so through violence. You may have seen people relieve their feelings or depression or anxiety through drug and alcohol use. You may have never been shown how to express feelings in a normal and healthy manner.
  • You may have seen others SI to release their feelings, and have mimicked them.

People who SI often say that they feel depressed, isolated, alienated, isolated, or frustrated before they SI. This can cause an uncomfortable level of anxiety and torment, which they feel they must escape. SI will lessen these feelings temporarily.

Coping mechanism

A coping mechanism is a method of coping people use to help them get through difficult times. SI is an extreme method that provides a sense of relief — as you know by lessening physical or psychological feelings. Thy physical damage and pain cause the body to employ its own coping methods to deal with them. SI is a negative coping mechanism because it causes people further harm and puts them in dangerous or uncomfortable situations.

Stopping, Inducing, or Preventing Dissociation

Dissociation is “a psychological state in which the indivual experiences an alteration in consciousness, memory, and sometimes identity.” People who experience it may feel detached from their bodies, a floating sensation, or a sense that they are separated from their bodies, watching themselves. Everybody has experienced mild dissociation — for example tuning out when someone is talking to you. But some people use dissociation as a coping mechanism. The dissociative states they may experience sometimes become overwhelming because of how long they last or their intensity. SI is way to reduce, prevent, or stop a dissociative state.

This is how it generally occurs: The extreme anxiety that precedes SI often can cause people to dissociate where physical pain is lessened. Some people welcome their dissociative feelings because they can be a relief from emotional pain. However, other people feel that dissociation is uncomfortable, frightening, or alienating. SI increases self-awareness in these dissociative states and reduce or end it.

There is an extreme form of dissociation which can lead to alterations in identity, known as Dissociative Identity Disorder (formerly Multiple Personality Disorder). For some people with DID SI is a way to gain control, avoid, or end the switching of personalities.

While people SI dissociation block or reduce the feelings of physical pain. This can be very dangerous at times because people lose awareness of how much damage they’re inflicting on their bodies. They may hurt themselves more severely than they planned.

After SI-ing the level of dissociation decreases. You may return to a level of normal consciousness so that you might treat your injuries. SI helps you temporarily cope, tolerate, or reduce overwhelming emotions and control your level of dissociation.

Euphoric feelings

When people SI they, of course, are hurting their bodies. The body responds to the injuries by working to minimize pain and damage and to heal the wound quickly. The brain releases substances called endorphins (has similar effects to morphine) that work as pain-killers when you hurt yourself. Endorphins can also cause a pleasant physical sensation and can become addictive. So, some people SI to produce feelings of euphoria.

You may feel tingling sensations before hurting yourself. Or feel at peace or full of life while you are SI-ing. You may even feel sexually aroused. All these feelings are due to the endorphins.

But the problem is that the body can produce a tolerance to endorphins. The feeling of euphoria won’t be as strong in following SI acts. You may even injure yourself more severely to experience the high euphoric feeling you felt during your first SI experience.

Physically expressing pain

The physical expression of emotional pain causes some people to achieve certain goals such as:

  • Evidence (scars, etc.) that you are suffering psychologically. Sometimes people with SI minimize or doubt their internal feelings.


SI is sometimes used by people to express what they are thinking, feeling, or experiencing to others. By doing this you are more likely to get what you need from family, friends, or others. You might be trying to send out messages such as ‘I need help,’ ‘I hurt,’ etc. but that is not always the ways others perceive it. They might interpret your SI as ‘You’re crazy,’ ‘You’re trying to kill yourself,’ etc. Other people might see you using your SI as manipulation.


For many people SI provides them with a way of nurturing themselves physically when they are unable to do so emotionally. SI is sometimes used to heal yourself. To make the internal pain external so that you may nurture and heal what only used to exist on a psychological level. You are caring for your internal and external scars. The self-care may be the gratifying part of SI.

Often people who SI feel unloved or alone in the world. SI results in a situation where nurturing occurs, and you have to take care of yourself. Some people even have rituals for nurturing themselves after SI-ing.


Statistics show that more than half of the people who SI have been abuse physically, sexually, and/or emotionally as children. It is common for people to blame themselves for the abuse or to feel that they ‘deserve’ it. They may have been taught that certain thoughts, feelings, or behaviors deserve punishment. People who SI are often critical of themselves which leads to feelings of condemnation and shame which leads to SI.

Reenacting previous abuse

SI can be a way to reenact abuse that took place at an earlier time. You may do it to feel a sense of control, which you didn’t have when you were abused. Some people may act out the previous abuse as part of post-traumatic stress during a flashback (an episode where you think you are reexperiencing the abuse). Some individuals with DID have an alter personality that will injure another alter to reenact abuse. Since the personalities are in the same body this is SI.

You may replicate the abuse in exactly the same you were hurt as a child. Or in a slightly different way due to pysical or psychological limitations.

Establishing control

Control is a necessary part of people’s lives. and knowing we have some control is important for mental health. When we feel we are in control we feel better. SI is a way some people use to replicate a sense of control over their own bodies. Episodes of SI might be triggered by overwhelming feelings of depression, alienation, isolation, etc. which are out of your control. By SI-ing you are controlling your emotional states. Also, you may be using SI to control a dissociative state. Thoughts can also be controlled by SI. By changing your behavior, emotions, and physical feelings you affect your thoughts.

You may use SI to control your thoughts. So, in SI, a person has control in a situation, over their body, their thoughts, their emotions, and their behaviors. This feeling of control may make a person feel more controlled, at peace, and comfortable.

Remember, some or not any of these reasons may apply to you or a person you know who SI’s. They are just the one’s most commonly known.

What is the connection between Self-Injury and shame?

One of the most common factors connected to SI is shame. ‘Shame is a powerful emotion, able to alter thoughts, feelings, and even behaviors.’ Any shame or embarrasment that comes from SI can have a big effect on all parts of a self-injurers life such as friendships, school, and job performance. Also, shame is often a feeling that precedes SI, coming from events that happened earlier in the individual’s life. As has been stated earlier there is a obvious relationship between self-injury and child abuse. For many self-injurers, SI-ing is connected with a traumatic childhood. Feelings of shame and embarrasment often follow the traumas they have experienced. Many people who have been abused feel that it is their fault, that they somehow encouraged, initiated, or/and deserved the abuse. These thoughts and feelings become connected with the memories of abuse, and then are transferred to SI behaviors. So, possibly if you feel shame or guilt or think you deserved to be punished, then you might act in ways that correspond those beliefs. You might hurt yourself if you feel that you deserve to be punished, for example.

The punishment or SI act then implies that you are at fault (because generally you are punished when you have done something wrong), which then fosters feelings of shame or guilt. So an SI act often can cause the feelings of shame that before preceded the act of self-injury. Also, the shame from SI “breeds secrecy.” Many people keep their self-injury secret because of their shame, and their fear of being judged or looked down upon by others. The stigma in our society placed on SI makes many people afraid to tell others about their SI behavior. The secretive nature of SI also increases the feelings of shame and isolation, which continues the cycle of self-injury.

The feeling of shame and embarrassment can result from many different parts of SI, such as scars, wound, bruises, cuts, feelings from past traumas, emotions, etc.

Wounds, bruises, and scars

In many people who hurt themselves scars or visible cuts, bruises, wounds produce feelings of shame. Scars from self-injury “may be a life-long reminder of the injurious episode and may produce shame from internal thoughts or feelings as well as from external sources. Scars and other visible wounds can also be embarrassing when other people see them. Bruises, bald spots, and other visible, yet temporary, marks from SI can be just as embarrassing as scars.

Many people find other people’s scars interesting and ask questions like: ‘What happened?’ ‘That must of hurt! How did you get it?’ These questions and comments can result from exposing your self injury by, for example, wearing a short sleeved shirt; and can trigger more feelings of shame and embarrassment. Scars or wound not coming from an act of SI don’t induce the same amount of shame; they might be slightly embarassing because they are not attractive, but some people wear them as ‘badges of honor.’ The reactions of other people to your scars or wounds depends on their source, and those reactions will affect your thoughts and feelings.

Most people don’t understand self-injury and react akwardly when it is mentioned. Other people’s responses often help increase your feelings of shame and embarrassment. By exposing scars, wounds, etc you risk people seeing, questioning, and reacting to your self-injury. So when other people question your scars you, anticipating their disgust, you might feel compelled to lie about their source. (Let me interrupt here: A excuse I used was that my aunt’s Doberman had attacked me. This was a complete lie because my aunt doesn’t own a Doberman.) For this reason you might hide or cover your scars and wounds.

Many people who self-injure try to hide their scars or injuries. You might wear long-sleeved shirts, long pants, or hats in the hottest weather to cover your injuries. While you are SI-ing you may even consider where you’re hurting yourself and how hard it will be to conceal.

Therefore shame and embarrassment from SI can be very extreme. It is very hard to handle judgement and misunderstanding from others. And, sometimes the responses of other people to your SI will cause to lie about your SI, conceal it under clothes, etc. But by hiding your scars or wounds, or lying you are continuing the cycle of shame. ‘Remember your scars represent survival. Your body carries indelible reminders of how strong you can be. It is important to view these marks with pride and respect. Only when you respect yourself can you begin to demand respect from others.’

Isolation and alienation

People who SI often feel shame because of the very nature of the behavior. You might feel alone in your SI activities. This may be due to the fact that you previously did not know anyone else intentionally hurt themselves. SI is a behavior that’s rarely discussed in society and has not been exposed by the media; and for these reasons you might have felt alone. You may feel different or “crazy” or abnormal. You may feel shame about your SI because you have not yet realized that there are other people who also hurt themselves.

Self-Injury is different from other behaviors. Drug and alcohol abuse, eating disorders, gambling, etc. have gotten a large amount of media attention. The recognition of these behaviors may make those who have them feel less different, less isolated. Also for these behaviors there are often support groups in many cities. But although there are many people who SI, rarely do you find large amounts of support and attention for this behavior.

Along with feeling different from other people some individuals feel embarrassed by the actual act of self-injury. The violence that goes with SI may cause you to feel shame. You may feel guilty about hurting your body; about drawing blood, about causing permanent scars.

Vulnerability and loss of control

Seeing your own blood or wounded flesh may also cause feelings of shame. Exposing parts of your physical being that used to be hidden may cause you to feel embarrassed or ashamed.

Another source of shame is feeling unable to control your SI behavior. You may feel that hurting yourself means you are weak. You may have tried to stop SI-ing but found yourself unable to, which may cause feelings of failure and regret. If you have talked to anyone about your SI you may not want to tell them about any new injuries. You may be embarrassed or ashamed that you hurt yourself again. You might even berate yourself for SI-ing, which is a behavior that helps you cope. But scolding or berating yourself doesn’t usually help. Actually it might even increase your feelings of shame and embarrassment. The shame is caused by your perceived loss of control or failure.

For some people it is not the act of SI that makes them feel shame and embarrassment, but their inability to remember the SI incident. As has been stated earlier many people who SI are in a dissociative state while they engage in their behavior. ‘Dissociation distorts the conscience as well as decreased the experience of physical pain.’ Some people dissociate more than others. You may even dissociate so much that you are unable to remember hurting yourself. This may cause you to feel shame, embarrassment, surprise, and confusion. This level of dissociation is not common but it can cause severe emotional consequences including large amounts of shame.

Overcoming shame

Shame can be a useful and appropriate feeling at times but it can also be very hurtful. ‘Secrecy, isolation, alienation, depression, and self-hatred are all consequences of shame. Many of these consequence will increase your desire to hurt yourself, thus playing a major role in the cycle of self-injury.’

There are two main ways to reduce shame. One is to stop the behavior that causes those feelings. But SI is probably your way of coping, and while stopping your SI behaviors will reduce your shame it is not a practical approach. Two is to change the way that you view SI and how you think about it. SI is a coping mechanism that you and many other people use to stay alive or control dangerous feelings. It may have even kept you alive, an alternative to suicide. The scars on your body and your memories are evidence of your ability to survive. If you begin thinking of self-injury as a ‘method of coping, surviving, and caring for yourself, you are likely to decrease (and hopefully eliminate) shame and increase feelings of pride.’

What are rituals in SI?

Self-Injury often follows a ‘ritualisitic procedure. A ritualistic procedure is way of doing something, in this case SI, that follows a certain pattern or that might be considered ceremonial.’ SI may be ritualistic in environment, instrument (razor, lighter, etc.), and/or procedure. Many people will not SI if they are unable to conduct their ritual and might even arrange their lives so they can do so. But some types of self-injury are less likely to have ritualized patterns such as pulling out your hair, hitting yourself, etc. These types of SI are possible without the use of objects (knives, razors, matches, etc.) so they can happen without a lot of planning or thought.


Many people only hurt themselves in certain places. For the majority of these people this place is home, because it offers privacy and seclusion. Also, the feelings of isolation and solitude which often precede an act of self-injury are more likely to occur when you are alone. So it makes sense that self-injury is usually done at home.

You probably have a specific place in the house where you usually SI; a bedroom, a bathroom, etc. You may even ‘tailor your environment’ in different ways: by adding candles, closing the curtains, etc. You also may even have a specific time of day when you hurt yourself. Many people hurt themselves in the evening, because they are more likely to be alone, their other coping mechanisms have failed or are no longer effective enough.

‘Because SI often reenacts previous abuse, if you have been abused in the past — particularily if you suffered abuse on a regular basis — you may find yourself engaging in self-injurious activities at the same time of day, day of the week, or same time of the year as the original abuse.’


You may also use specific instruments when you hurt yourself. Many people who SI use only one particular object or type of instrument to hurt themselves. They will not use any other type even if it will hurt them in a similar manner.


Many people follow rituals when hurting themselves; preparing their environment, getting the instruments, and “engaging in some preinjury activity” are common parts of this ritual. You may even find the rituals you have before you SI almost as calming and satisfying as the actual act of self-injury. Or maybe you need to complete the rituals to actually begin hurting yourself. The exact nature of this ritual is probably very personal and unique.

There are often rituals after the act of self-injury. You may bandage or tend and nurture you wounds the same way every time you hurt yourself. Or you may apply a certain type of ointment or disinfectant after SI-ing. Or take a bath, or possibly even take picture or write about the incident in a journal.

Is Self-Injury impulsive?

The question of the impulsivity of your self-injury is an important one. SI acts that are impulsive are more difficult to control. On the other hand, SI acts that take more planning and premeditation are easier to manage or control. Therefore, you are more likely to be able to control SI behaviors that are not impulsive.

The degree of impulsivity associated with self-injury in general is difficult to determine. Researchers studying this phenomenon have presented contradictory results, sometimes finding that SI relates to impulsivity and sometimes finding that it does not. It appears that SI and impulsivity have a complex, variable, unpredictable relationship.

Sometimes it can vary depending on the situation. In some situation you may feel the urge to hurt yourself but may find yourself in a situation where it wouldn’t be ‘safe’ to do so. So you may postpone your act of SI for later. This is planned. But also if you SI-ed at the time you felt the need to do so it might be considered impulsive.

The degree of impulsivity in SI is also partly dependent on the type of SI. Some types of SI, such as hitting, hair pulling, etc. don’t need any preparation and can be done sometimes without drawing attention. You might not even be conscious of hurting yourself. So because these types of SI don’t need preparation they tend to be more impulsive than other forms of SI, which tend to need more planning and premeditation.

Also, the rituals associated with self-injury suggest that this behavior requires more premeditation than researchers originally believed. And you may decide not to hurt yourself if you’re not in the right environment or don’t have the right instrument. Therefore you may plan to hurt yourself at a later time.

Like many other coping mechanisms SI occurs when a person needs it, so it may occur without forethought. If you feel the need to hurt yourself and there is nothing to stop you, you will probably hurt yourself. And at times you may be in a situation where it isn’t ‘safe’ to hurt yourself (school, work, etc.), but you can’t control your SI impulses. Sometimes your need to cope is greater than your need for secrecy and privacy.

As you have seen there are many factors that determine the role of impulsivity in SI. Therefore it is not surprising to hear of the many contradictory results found in research. But what has been found is that impulsivity is likely to vary depending on the person and the situation.

What is the relationship between thoughts and SI?

You may not be aware of this fact, but most likely your thoughts follow a predictable cycle throughout the course of SI.

Thoughts before SI

There are many things going through your mind before you hurt yourself. You are probably aware of some of these thoughts such as how you are going to hurt yourself, where you’re going to, or even thinking about if you’re even going to hurt yourself after all. However you are probably having many other thoughts that you may not even be aware of. These thoughts are often the ‘primary sources of motivation to hurt yourself.’ Therefore, if you are going to change your behavior you will have to identify and understand the thoughts you have before hurting yourself.

Thoughts you may have before hurting yourself:

  • I hate myself
  • I’m so ugly.
  • I hate everyone.
  • I want someone to care about me.
  • Life sucks.
  • I’m stupid.

Sometimes your thoughts will come from identifiable events. Example: you get a bad grade on a report card, and think that you are a bad student. But at other times the source of your thoughts won’t be so easy to identify and will be more complicated. Example: you may think you are stupid or ugly but may not be able to tell where or when you first got the idea for these thoughts.

Regardless of the origins of these thoughts, most of them are probably negative. Before you SI you are probably thinking of yourself and the world in a pessimistic way. These negative thoughts are the ones that lead to the desire to hurt yourself.

Some people use self-injury to control their negative thoughts (and emotions). When your are experiencing negative and destructive thoughts you probably want to make them stop. Self-Injury is an act you can focus on, instead of thinking thoughts like I’m worthless you replace them with I’m going to hurt myself. And once you begin concentrating on hurting yourself, you push aside the original thoughts that made you feel the desire to hurt yourself.

Although, self-injury is one method that can help you control your thoughts and let you escape negative thoughts, there are other options.

Thoughts during SI

As has been mentioned earlier many people who self-injure enter a dissociative state before hurting themselves. In this state they may feel detached from themselves or like they’re floating, or even like they’re watching themselves. And one of the functions of a dissociative state is to stop the body from feeling pain, and it doesn’t let you feel much pain when you are hurting yourself. Dissociation can be helpful in a way, but it can also be negative. It can make it very hard for you to be aware of what you were exactly thinking at the time you hurt yourself. But it is during this time when your thinking is most irrational and destructive.

Thoughts you may have immediately before hurting yourself or during:

  • I need to hurt myself.
  • ‘Only a few more (cuts, burn, bruises, etc.) and I’ll be ok.’
  • ‘This is the only way I can feel better’

Each of these thoughts are illogical, but at the time you are hurting yourself they seem to make perfect sense. (Let me interrupt: I’ve had these thoughts and they do make perfect sense when I’m hurting myself.)

Thoughts after SI

After hurting themselves many people say that they are unable to ‘access their thoughts. For many people, the physiological process associated with SI causes their thoughts to become disorganized or scattered.’ But a little while after they hurt themselves they once again become aware of their thoughts. The thoughts they have at this time usually follow three major themes: shame, guilt, and relief.

Thoughts you may have after hurting yourself:

  • I can’t believe I just (cut, burned, hit, etc.) myself again.
  • I’m so stupid and weak for hurting myself.
  • I’m not going to tell anyone, they wouldn’t understand.
  • Hurting myself makes me feel better.

These thoughts of guilt and shame may feel hard to resist, but they are negative. And, probably it is negative thoughts and feelings that are a part of the reason you want to hurt yourself. Letting yourself think these thoughts will probably only make you want to hurt yourself even more. Instead you should find ways to stop or change these thoughts. (I’m interrupting once again: this is a lot harder than it sounds, at least for me. I haven’t been able to accomplish this yet.)

What is the relationship between emotions and SI?

Quite similar to thoughts, emotions felt during self-injury also follow a predictable pattern. It is true that not everybody experiences these feelings but the majority of the people who self-injure come across some of them. You may not even be aware of what you’re feeling at various times while you’re hurting yourself.

Emotions before SI

Before an act of SI most people feel ‘strong negative feelings that are overwhelming and intolerable. While the source of the feelings may vary, the emotions generally fall into several distinct, yet similar categories: anger and frustration, alienation, and depression.’

Generally, people feel angry and frustrated when they have an inability to fufill a desire, but these feelings can also come from a large number of situations. So, frustration may come from an inability ‘to meet a variety of demands or wishes.’ Sources of frustration are too numerous to count and every act of SI may be related to distinct source of this emotion.

Anger is an emotion similar to frustration in some ways but generally comes from feelings of hostility. Unlike frustration, anger is often caused by interactions with others (talking, etc.) that don’t go as you planned. And this anger is often directed at a single person. Also, anger may be a response to treatment you see as unfair by others.

Anger and frustration can be useful feelings at times but they can also be destructive and dangerous if not handled properly. Feelings or emotions that are not released or changed can have negative side effects. It has been found that hostility is related to the occurences of heart disease.

Alienation is the second emotion that often is felt before an individual hurts themselves. Feelings of alienation, loneliness, and isolation can come from a large number of events (example: rejection, abandonment, mistreatment, separation from a loved one, etc.) Feelings of disconnection are common before an act of self-injury. And because SI is an act that is usually done in isolation these feelings of isolation and disconnection are often increased. It is hard not to feel alienated or disconnected if you have secluded yourself.

Also, you may notice that after you have hurt yourself you may tend to isolate yourself from others even more. You may do this isolation physically (by staying away from other people) or emotionally (by hiding your self-injury or how you are feeling). Therefore, alienation, disconnection, and isolation are feelings that often come after an act of self-injury as well as before it.

Depression is the third feeling often felt before an act of self-injury. Feelings of sadness, unhappiness, or melancholy often come before a person hurts themselves. People feel depression in many different ways: a feeling of boredom or emptiness or dissatisfaction with their life. But no matter how its felt these emotions often produce other emotions of pointlessness and hopelessness.

These three feelings of anger, alienation, and depression can combine ‘to form the ideal emotional environment for an act of self-injury.’ If you feel frustrated, alone, and hopeless you are likely to hurt yourself to escape these often overwhelming feelings. There is also a high tension level that stems from the interaction of these feelings that may make you want to hurt yourself even more. It is possible to change or lessen this emotional state but many people with self-injury don’t know how to without hurting themselves.

Emotional states during SI

During an act of self-injury it may be difficult to identify your emotional state. As has been said before, one of the goals of self-injury is to change or mask the experience of emotions that are overwhelming. Because SI does this, most people are unable to identify their emotional state while hurting themselves.

Many people also dissociate while hurting themselves. “Dissociation can be both an emotional as well as physical state.” Therefore during dissociation you level of consciousness is change, which may distort or obscure your memories and make your feelings more difficult to identify. Last of all, the release of endorphins (‘neurotransmitters that help block the feeling of physical pain’) that come in response to the self-injury also masks feelings.

Emotions after SI

After an act of self-injury most people go throught two distinct stages of emotion. First is the experience of a great sense of relief. Hurting yourself has dissipated the large amount of tension that you felt previously. Also, you may feel a sense of calmness and happiness which has been produced by the endorphins that were released. These feelings may continue for some time. Because of this, immediately after hurting yourself, you probably feel pretty good. These good feelings are probably part of the reason that SI is so addicting. Most people would like to feel that way more often. But most don’t go to the lengths that self-injurers do.

The second emotional state is where many people feel guilt, regret, shame, and the return of emotions that they felt before hurting themselves. This often occurs after the positive feelings have worn off. When you reach this stage you may even feel worse than you did before hurting yourself. You may even feel so bad that you want to hurt yourself again. ‘It is precisely this emotional experience that creates the cylic pattern of SI.’

What are the different models of SI?

A psychological model is used to explain complex ideas in a simpler way. These models are made up of concepts (‘concepts that represent the inner workings of a behavior, thought, idea or feeling — things that can’t really be seen.’) Psychological models help us to understand ‘their subject as a whole.’

There are several models used by psychologists to better understand the ‘nature and cycle’ of self-injury. Each of these models have some validity but use your own ‘experiences to judge the accuracy of each model as it applies to you.’

The addiction model

The first model of self-injury has many similarities to models used to explain various addictions, such as substance use, eating disorders, etc.

Negative emotions

Negative emotions usually begin the self-injury cycle. These negative feelings may come from a large number of sources and tend to fall into three categories.

  • Anger, hostility, and frustration
  • Alienation, isolation, disconnection, rejection, and loneliness
  • Sadness, depression, and simply feeling bad

Most often these feelings are experienced as overwhelming, uncontrollable, or fragmenting (‘a feeling of being scattered or not whole’). These uncontrollable feelings make you want to find a way to feel better fast. Event thought the lasting effects of self-injury may be ‘extremely detrimental in the long term,’ SI does provide a short-term yet effective way of overcoming these strong emotions.


Once you decide to hurt yourself you may change to a emotional state of tension and anxiety. So, even though you may have started out as feeling angry and frustrated, depressed, etc.; now you are dealing with feelings of tension and anxiety. Part of the tension stems from the anticipation of hurting yourself. Once you start thinking of hurting yourself, you begin to anticipate the actual act of self-injury.

‘Because you SI may be either desired or undesired, or both, your anticipation may contain elements of excitement and/or anxiety, either of which will make you feel tension.’ The feeling excitement before self-injury comes from the fact that SI can produce feelings of euphoria and relief. So, while anticipating hurting yourself you may feel a type of stress called eustress, which is ‘stress or tension coming from a positively viewed source.’ However, you may also feel fear or anxiety when you anticipate an act of self-injury. You may feel that you need to hurt yourself, but you don’t want to. Or you may feel anxious about the danger of hurting yourself or because you feel you are unable to control your emotions like most other people. You might even see self-injury as a last resort, an attempt ‘to retain a sense of sanity.’


This is the next stage of the Self-Injury cycle. Dissociation comes directly from the high tension level produced by strong and overwhelming emotions. Dissociation serves dual purposes: to act as a coping mechanism, and to allow you to withstand intense emotional and physical pain, reduce your experience of tension and masks the physical pain caused by self-injury.

The self-injury act

During this stage you are engaging in self-injury. Cutting, hitting, burning, bruising, pulling hair, excessive scratching, etc. are the common self-injury behaviors. At this stage dissociation is usually at its hightest, masking the experience of physical pain. Also, at this time endorphins are being released, helping dissociation in limiting how much pain you can feel. It is the combination of endorphins and dissociation that allows some people to hurt themselves with a surprising lack of physical discomfort.

Positive effects

Immediately after the act of self-injury comes a sense of relief. The endorphins that were released during self-injury are still present, allowing you to feel a sense of euphoria (joy and calmness) and well-being. Also, the act of SI has allowed you to change your negative feelings into something physical and controllable. ‘By performing and then nurturing the self-injury, you have turned a negative psychological state into something manageable, regaining control over your emotional and physical states. It is the effectiveness of this coping mechanism that allows SI to provide such a strong and necessary sense of temporary relief and freedom from psychological distress.’

Negative effects

One of the problems with self-injury as a coping mechanism is that its effects are only temporary. Once the endorphins dissipate and the consequences of hurting yourself become clear, you may experience feelings of guilt, shame, and remorse. Also, the negative feelings you experienced before hurting yourself may come back at this point or shortly therafter. So, as a result of self-injury, you may feel even worse than you did before hurting yourself. And these negative emotions can be the beginnings of another act of self-injury.

The operant conditioning model

The second psychological model used to explain self-injury is operant conditioning. ‘Operant conditioning states that what happens following a behavior (the consequences) influences the likelihood of that behavior reoccuring. According to this theory behaviors followed by positive outcomes (reinforcers) will be strengthened, wheras behaviors followed by negative outcomes (punishments). This theory of learning and behavior is called Thorndike’s Law of Effect.’

Basically this says that the consequences of an act of self-injury will affect the chances that you will hurt yourself in the future. For example, if you hurt yourself and it made you feel better, then there are better chances that you would hurt yourself again. On the other hand, if you hurt yourself and it hurt a lot more than you expected, you will less likely hurt yourself again in the future.


Reinforcement is a psychological term that basically means the same thing as reward. When you experience reinforcement, you recieve a reward or pleasurable consequence for a behavior. Reinforcement makes the chances of you repeating a behavior much more likely.

Reinforcers can be both positive and negative, but they are always rewards or pleasurable consequences. In this case positive and negative does not necessarily mean good and bad, the definitions are slightly different. Positive reinforcement ‘means to provide a consequence that is desired.’ Self-Injury produces several positive reinforcers: the feeling of euphoria produced by the endorphins, self-nurturing of wounds, physical expression of feelings. Because of the many rewards and positive consequences your SI behavior is likely to be strengthened.

The second type of consequence that strengthens behavior is Negative reinforcers. The definition for negative, in talking about operant conditioning, is the removal of something. This is the exact opposite or receiving something or a positive reward. Negative reinforcement occurs when something that is not wanted is taken away or lessened, thus strengthening the behavior that takes away or lessens the unwanted thing. For, example, if your SI behavior removes or lessens negative feelings you are experiencing, then the chances of you using that behavior again are more likely. SI often removes negative feelings, or ends or lessens dissociative states that are not wanted. Because self-injury does so well at doing this, these are part of negative reinforcement.

All of these reinforcements, whether positive or negative, help strengthen the chances the self-injury will occur again.


When a behavior causes a consequence that you don’t like, then it’s called a punishment. A punishment, the exact opposite of a reinforcement, lessens the chances of a behavior reoccuring. But, like reinforcement, it can be both positive and negative. Positive punishment is when something unwanted is presented. Negative punishment is when something you enjoy or want is taken away from you.

Both positive and negative punishments lessen the chances that you will repeat the behavior. Self-Injury has positive and negative punishments. Forms of it’s positive punishments are unwanted scars or wounds and feelings of shame, regret, etc. Forms of its negative punishments are slightly different and are not as obvious. For example: you may wear long sleeves or pants to hide your scars, so SI is keeping you from going swimming or wearing more comfortable clothes. SI may also ‘reduce the honesty, pride, and connection with others you experience. Because these desired things are removed or reduced by your self-injurious activities, those activities are exerting a negatively punishing consequence.’

The meaning of all this, that self-injury produces reinforcing and punishing consequences, will be explained. Consequences that occur immediately after, during, or even before a behavior are the one’s that make the best impression of your behavior and its future. In the “Addiction Model of SI” you learned that before, during, and after an act of self-injury you feel better, endorphins are released, etc. These are all reinforcements. It is not until later that you experience physical pain, feelings of shame, etc. which are punishment. So, because the reinforcing consequences are felt initially before, during, and after self-injury the chances that SI will recur is great.

Opponent process theory

Opponent process theory states that a reaction to an even will automatically produce the opposite reaction.’ ‘Feelings of great tension and fear before SI are later replaced by the opposite emotional state, relaxation and peace, the opponent process of relief.’

As you continue to hurt yourself you begin to expect the sense of relief. And because you have learned to expect this feeling, you may begin to enjoy hurting yourself. You may even begin instigating negative feelings or situations so that you will self-injure.

Observatinal learning

Observational learning is when we do what we see. It is a known fact that we learn by watching others. And if we see a person engaging in a behavior that appears to have positive consequences, we may try that behavior ourselves. And, when we see someone engagin in a behavior that has negative consequences, we are less likely to try that behavior.

This model of learning can be applied to self-injury. For example: you see someone in great emotional pain, you watch this person hurt themself, and then you see the great relief they get from this behavior. You may even see this person get additional attention from other people or get treated in a desirable way. So, the next time you are in great emotional pain, you may remember the incident you witnessed, and may try to hurt yourself.

If you have ever been in a “confined setting such as a psychiatric ward of a hospital or a prison you may have seen others use SI.” You may have even copied the behavior you saw and began hurting yourself. Within these confined environements copying or ‘modeling’ of behavior can and does happen, which spreads the occurences of SI. (Let me interrupt: At the hospital I met a girl who started hurting herself because she was copying a friend she had met at a hospital who had been a cutter.)

If you have never been in any of these setting the chances of you seeing another person hurt themselves are very small. This is because SI usually happens in isolation and is a secretive behavior. However, even though you never saw anyone hurt themselves, you may have been exposed to SI in a less direct or obvious way. You reaction to these events would also ‘influence the chance that you would hurt yourself.’

Psychodynamic explanations

‘The psychodynamic perspective of pychology basically states that behavior stems from hidden forces within our personalities. According to thus theory, our actions are strongly influenced by those thoughts and feelings that remain hidden beneath our conscious awareness.’

This psychological model is general, and explains how and why self-injury occurs. These ideas may be useful for some people, but overall many people may not find it helpful. And many people may not agree with them.

There are many psychodynamic explanations for self-injury, but only a few are discussed here.


One psychodynamic explanation is that self-injury is a form of partial suicide, that self-injury is a wish to die, and an act of it is a botched suicide attempt. This may be true in a small number of cases, but generally suicide is not a goal of an act of self-injury. Actually, many people use it as a coping mechanism, a way of staying alive. It is possible to cause severe injuries during an act of SI, but usually these are accidental, not being the goal of SI.


Another psychodynamic explanation is that self-injury is an action rooted in depression. Another theory is that depression is anger directed at one’s self. So, this says that SI is an intense expression of this anger.

Another psychodynamic theory of depression is a sense of helplessness or hopelessness. You choose to hurt yourself because you feel unable to direct your anger towards others or ‘a direct expression of your anger would be futile or useless. Consequently, you choose to injure yourself to express and release the anger that stems from your helplessness.’


Another basic psychodynamic explanation is that self-injury is a method of reintegrating your sense of physical being. Before you hurt yourself you may feel fragmented, zoned out, or not all there. Self-Injury allows you to ‘physically reconnect to yourself as a whole, unique, living being.’

What other psychological factors influence Self-Injury?

Other factors influence, result from, and are related to Self-Injury. Some of these factors may contribute to your desire to hurt yourself, such as remembering traumatic events from your past. There are factors produced by self-injury such as feelings of shame and embarrassment. And some factors, such as eating disorders or substance abuse, coexist with self-injury.

It can be difficult to understand the different types of relationships other factors have with SI. They can be distinct problems, that coexist, but don’t have any influence on each other. Or one factor may cause or encourage another factor. Or both the factors may be related and are part of a greater problem.

It’s evident that the ways factors relate to each other can get a bit confusing. In your case, you may find that certain factors, such as trauma and an eating disorder, have any or all of types of relationships with self-injury. So, SI can influence (or be influenced), coexist with, and/or relate to other psychological disorders.


A huge number of individual with self-injury have suffered some form of childhood abuse. ‘Significant correlations exist between both sexual and physical forms of childhood violence and SI. Other violence within the home has also been determined to be related to self-injury, as has emotional abuse.’ SI has also been linked to having witnessed or been part of ritual abuse. ‘The short- and long-term effects of abuse are far reaching and severe, impacting emotions, memories, relationships, self-esteem, behaviors, and even identity.’

In some ways self-injury may be a reaction to abuse. ‘If you have endured and survived trauma or abuse, you can attest to the horror of these events.’ During episodes of abuse you have probably felt feelings of violation, helplessness, and powerlessness- as if you have little or no control over your environment or even your own body. You may be confused by the way in which you were treated. You may have felt even guilty. The psychological effects of trauma are so intense and severe that it became essential that you find a way to cope. Self-Injury may have helped you cope or deal with the aftereffects of your past traumatic experiences by giving you a way to escape negative feelings and to feel in control for once.

SI can be used for many uses. It may be a way of recreating some of the abuse you went through or witnessed as a child, allowing you to reenact the trauma through self-injury. Recreating previous traumatic experiences can be used as a way to symbolically alter the original course of the abuse, becuase when you hurt yourself, you are the one in control. This feeling of control can help change your reaction to these past abuses. By hurting yourself to recreate trauma, you are able to change from a situation where you felt helpless and powerless to one where you were in complete control, and had complete power.

Self-injury may also be used to relieve psychological tension. This extreme form of tension may directly result from past traumas (‘as in the case of memories or flashbacks’) or may indirectly result from past traumas (‘such as an extreme reaction to loss or isolation’). You may experience moments when you are unable to get rid of painful images or memories of the trauma. At these times you may use self-injury as a way to get rid of these overwhelming memories.

Abuse and trauma both have so many related consequences, it is likely that you have used self-injury to cope with some of these. For example: if the people who were hurting you were the people who were the closest to you, you would not have been able to trust them. Or, because of the abuse you may have had to keep secrets from other friends and family members, which also interferes with your ability to connect with other people. You may also have used SI as away to lessen emotional pain related to the abuse. The lack of connection with other people, and the difficulty in trusting fosters the same feelings that lead to self-injury. ‘Because of the patterns set up in your abusive past, you may used SI to both replicate these patterns as well as control and relieve the accompanying intense emotional pain.’


An area that is damaged by abuse, especially sexual abuse, is that of boundaries. ‘Boundaries are limits we place on ourselves and others that help us to maintain our sense of separateness and independence.’ When we are children we learn to separate ourselves from other people and to experience ourselves as a single, independent human being. A part of learning boundaries is determining what is ours and what is not ours. One of the things that children own is their body, they learn to believe that it is their own, and that no one else is allowed to touch, use, or disturb it without permission. These rules, or boundaries are often carried into adulthood. But children who have been abused often are not allowed or haven’t had the chance to learn their boundaries. ‘Sexual or physical abuse leads to confusion over these very basic rules of ownership.’ Children who have been abused may learn that their body is to be hurt and abused or manipulated by others. They learn that their bodies are not their own. Their boundaries are variable or nonexistant.

Self-Injury allows people to experience their body as their own. In some way, it helps ‘illuminate or restore some basic boundaries lost due to childhood trauma.’ Hurting yourself may make you feel more real, more separate, more whole. You are the person who is hurting yourself. You are the one who is changing your body. ‘You, and you alone, are in charge of your body.’


Dissociation is a big part of self-injury. But dissocation is also related to trauma or abuse. To survive abuse situations some people have to use dissociation as a tool. Dissociating from the physical or emotional pain may have helped you cope with the trauma. But, as an adult you have difficulty in regulating your dissociative states. SI is an effective way to control dissociation, letting you enter or end a dissociative state.

Eating disorders

The relationship between SI and eating disorders is interesting and complex. Research has shown that most women who hurt themselves also have some type of eating disorder.

There are many types of eating disorder, but as of yet only two are recognized by the American Psychiatric Association as distinct and diagnosable problems: Anorexia nervosa and bulimia nervosa. Anorexia nervosa is when an individual starves themselves to make themselves thin, resulting in body weight that is significantly lower than what is considered normal for that person’s age and height. People with anorexia often have distorted views of their body shape and size. Bulimics, unlike anorexics who are extremely underweight, generally weigh within the normal range for their age and height. They engage in episodes of binging, or eating huge amounts of food while experiencing a feeling of lack of control over food intake, and some bulimics also purge, eliminate the food they ate by making themselves throw up, using laxatives, exercising excessively, or using another method. Fad diets and compulsive eating may also be considered as types of eating disorders.

As in SI, childhood trauma has often been experienced by those with eating disorders. An estimated one-third of people with eating disorders have experienced some type of trauma as a child. Like SI, eating disorders may be a coping mechanism where you gain control. But there are many other factors that can lead to the development of an eating disorder. But this represents the most frequent roots of eating disorders.

Dissociation is also more common is people with eating disorders. If you have an eating disorder you may experience dissociative states similar to the ones felt when you hurt yourself. Actually, the overall pattern of an eating disorder is similar to that of self-injury. The cycle of bulimia is similar to the ‘Addiction model’. Negative emotions produce a state of tension, which leads to a state of dissociation, which then lead to an act of binging or purging, which then induces feelings of euphoria, which dissipates and leads to feeling of guilt, shame, or regret. Then the cycle continues.

If you have an eating disorder you may alternate between self-injury and the eating disorder. Or the two may occur simultaneously. Both may be used as a way of coping with great internal pain. And both can provide a way to relieve or release tension, a way to communicate to others your emotional state, to control dissociative states, and to physically express your internal pain. Eating disorders and self-injury have a great deal in common.

Trauma > Dissociation > Eating Disorder or Self-injury

Trauma or abuse leads to a tendency to dissociate, a coping mechanism that may have been crucial to survive the event physically and psychologically. The dissociation can, but doesn’t always, lead to an eating disorder behavior or self-injury or both. Trauma is the common source for both these behaviors ‘and is responsible for the apparent relationship between eating disorders and self-injury.’ This does not mean that everyone that experiences trauma or that is abused will develop an eating disorder, or develop SI. And eating disorders and self-injury can develop without the presence of trauma. ‘It seems that both of these behaviors, while often stemming from common sources, also provide similar functions as coping mechanisms.’

Substance abuse

Substance abuse can mean the abuse of any drug (over-the-counter, prescription, or illegal), which includes alcohol, nicotine, and caffeine. These substances may be inhaled, ingested, or injected. It includes chemicals that are purposely inhaled with the intention of getting high.

Substance-related disorders is the general term that includes a wide variety of specific uses of substances and pattern of involvement with them. The terms that refer to the different degrees or impact that drugs have or your life are: substance use, substance abuse, and substance dependence. Also, the drugs may cause many side effects, such as imsomnia and brain damage, that lead to other problems. Like self-injury, drugs are used to change our psychological or physical state. SI is typically used to change the way you feel: To decrease tension, increase euphoria, or alter you state of dissociation. And in this way, self-injury has similar effects to some drugs. Even though the two may serve a similar function they are not closely related.

Many people begin and continue using drugs as a way of regulating their moods. When you feel angry, or depressed, you may wish you had a way to change how you feel. Drugs do this effectively, although they have a large number of sometimes dangerous or lethal side effects. Many of us use one chemical or another at a time to regulate our moods and physical state.

The use of substances such as caffeine, alcohol, and/or nicotine is widely accepted by society and is more common than the use of other drugs, such as marijuana, cocaine, etc. Most of us have a type of substnce to help us get through the day. However, most of these substances are legal and ‘culturally sanctioned,’ which makes them more difficult to identify, accept, understand, or recognize as a problem.

The relationship between self-injury and substance abuse has not been identified or understood very well. In part, this is because a lot of substance abuse goes unrecognized. You probably don’t think of yourself as a drug addict, or dependent on drugs. And you may not even realize that you are changing your state of being with chemicals, such as drinking coffee to stay awake in class or at work.

Most people who hurt themselves do not use or abuse illegal substances. Fewer than one-third of people who hurt themselves have ever tried street drugs. In fact, the majority of acts of self-injury do not occur under the influence of any substance, legal or illegal. The reason for this is that substances and self-injury are both short-term ways of coping. Different people have different ways of coping. And some ways work better than others on different occassions. Using drugs and hurting yourself at the same time is unnecessary because both present a temporarily effective way to cope. If you have found something that works you don’t need to use another coping mechanism because the immediate problem is solved.


Suicide is the ending of life. Chronic feelings of depression and anxiety can lead to someone deciding to end their life. Suicide is often the result of overwhelming feelings of hopelessness and helplessness and of great psychological discomfort. In some cases the psychological pain comes from overwhelming and enescapable physical pain, as in the case of the terminally ill. Suicide is used to end psychological pain, people who attempt or succeed in killing themselves are not looking for a way to adapt to their psychological state. ‘In contrast, self-injury is used to cope — to adapt to severe psychological discomfort.’

SI is not used to make life-threatening injuries. You hurt yourself so you can feel better. This is a goal that is infinitely different from that of suicide, which is to feel nothing at all. ‘The means, intent, and often the result of self-injurious acts are vastly different than those of suicide.’ Self-injury is not a mild form of suicide, nor is it a suicide attept gone awry. Instead, SI is a means of coping during a time of intense or overwhelming distress.

Borderline personality disorder

Of the large variety of psychiatric diagnoses self-injury is most often associated with borderline personality disorder (BPD). Borderline Personality Disorder is the only psychological diagnosis that specifically identifies self-injury as a criteria for diagnosis, with the exceptions of trichotillomania (the pulling out of hair) and sexual masochism (which can involve SI activities). Because of this some psychologists might diagnose some self-injurers with borderline personality disorder, only because of this one behavior. Because of the lack of diagnoses you may have been incorrectly diagnosed with BPD.

Borderline personality disorder has many criteria for diagnoses other than self-injury. ‘Personality disorders — whether borderline or another type — are characterized by long-term patterns of behavior that leads the person to feel distressed or impaired in some matter. Usually these patterns of behavior will affect functioning in several areas of life, including employment or school, social relationships, and/or personal well-being. In general terms, BPD is characterized by chronic, intense instability and chaos. This instability can present itself in the realms of identity, relationships, moods, and impulsivity.’

People with BPD fluctuate between extremes. Unlike most people, people with BPD view the world in terms of black-and-white, all-or-nothing experience. They usually feel life is either great or terrible, effortless, or hopeless; but nothing in the middle of these two extremes.

Also, people with BPD do things to undermine their own success. Just before completion, goals are thrown aside. Graduation, relationships, and promotion may be tossed aside before successful completion. Behaviors that are self-defeating such as substance abuse, overspending, and physical altercations are common.

Lives of people with borderline personality disorder are chaotic. When life gets too calm or stable, they will begin to experience feelings of tension, vulnerability, and anxiety. Rather than experience these negative feelings they will seek out new chaos. So their life is a cycle of creating and repairing chaotic situations.

For people with BPD self-injury is a direct response to overwhelming psychological pain. It is a way of relieving and releasing intense emotions they experience at calm times in their lives. Also, SI is a way of releasing the feelings of fright they get from thoughts, memories, and emotions during their moments of calm. It also keeps these feelings at bay. Dissociation that may come with the self-injury may end those overwhelming emotional states.

Also, the injuries produced by self-injury are another chaos to focus on for those with BPD. These wound allow the attention of the person to be transferred from the original, distressing emotions to the new emotions and experiences that stem directly from the self-injury. Basically, self-injury plays a complex and interesting role within people with borderline personality disorder. “Self-injury, for a variety of reasons, acts as an agent for producing internal states which are better able to be tolerated.

Dissociative identity disorder

Formerly called multiple personality disorder (MPD), dissociative identity disorder (DID) occurs when a person has two or more individual and complete personalities. Each of these identities, or as they are commonly known, alters, has its own personality, its own memories, its own style of thoughts, its own history and temperament. And some of these personalities may be unaware of the presence of the others; and other personalities are aware of and communicate with other different and distinct personalities. An estimated half (only roughly estimated) of people with dissociative identity disorder have between two and ten alters or personalities.

In some ways a person with DID is sort of like an extended family, except that it is a family that is inside of only one individual. “Each of the ‘family members’ has a distinct personality with particular strengths and weaknesses. One family member may be very artistic, one may excel at business, one may be depressed, one anxious, one angry. There may be children, adults, and adolescents. Some family members may be male, some female, some heterosexual, and some homosexual. Within the family, some of the members may communicate well with each other, some may communicate ineffectively, and some may not communicate with each other at all.”

Dissociative identity disorder generally occurs in individuals who experienced intense trauma and abuse as a child, often trauma that began before the age of three. Severe physical and sexual abuse is often experienced by those with DID. Also, ritual abuse is associated with dissociative identity disorder.

Dissociation is the psychological mechanism that allows someone to form and maintain different personalities. Since both abuse and dissociation are often connected with self-injury, it is not uncommon for dissociative identity disorder to coexist with SI.

Self-injury serves many purposes for people with DID. In addition to the usual large variety of functions that SI serves, “it has particular applications among individuals with dissociative identity disorder.” First, is the ability to control dissociation. Since high levels of dissociation often occur in dissociative identity disorder, control is important.

Sometimes SI is used to prevent another alter or personality from emerging. The physical feelings of self-injury may be enought reminder of reality to keep some personalities from coming out.

SI can also be used to induce the emergence of a certain personality. One personality may be in such physical or emotional pain that they need someone else to take over. This can be either purposeful or accidental.

Also, violence can occur between different alters. Many indivuals with DID have one alter that is angry, violent, and abusive. This identity may take its anger out on another alters — which in reality are their own physical selves.

Self-injury also occurs because of dialogue between different identities. Sometimes, one identity will produce and internal voice that directs another identity to hurt her- or himself. Depending on the strength of this alter, this may lead to an episode of self-injury.

Because of the high level of dissociation associated with DID it is not uncommon for an alter to find wounds they cannot remember causing. The inability to remember may actually be as disturbing as the actual injury. A common characteristic of this disorder is the inability to recall important events or information. This inability to remember may lead to feelings of anger and frustration, helplessness, and despair. And, as you probably know, these are often feelings that cause an episode of self-injury. ‘Thus the severity of the dissociation involved with dissociative identity disorder, as well as both the causes and results of this dissociation, will affect the likelihood of SI activities and sometimes the extent of the injuries also.’

DID is an extreme and complex type of psychological problem. If you know or suspect that you have dissociative identity disorder, and you want help with that or your SI, it would be best for you to seek professional help so you can treat the root of these issues.


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