What is Self-Injury?

In general, self-injury (also known as self-harm or self-mutilation) occurs when an individual deliberately harms their own body as a way of coping with emotional distress or gaining a sense of control. Self-injury is a complex issue, often associated with underlying psychological or emotional difficulties, such as boredom, emptiness, frustration, anger, or rage.

The act of hurting oneself helps some people forget their feelings and emotional troubles and focus instead on their self-inflicted physical pain. I have come to discover that individuals may hurt themselves because the pain, and subsequent suffering, gives them a feeling of being alive. While these people may not be suicidal, they are consciously injuring themselves and may cause permanent damage, even accidental suicide.

What Are Common Forms of Self-Injury?

One of the most common forms of self-injury is cutting. An individual will often use a knife or razor to make cuts or deep scratches on different parts of their body. Although this is the most common, individuals may employ more than one method to harm themselves.

Forms of self-injury include:

  • burning,
  • scratching,
  • biting,
  • hair-pulling,
  • head-banging,
  • interfering with wound healing,
  • and ingesting harmful substances.

Are There More Nuanced, Hidden Ways of Self-Injury?

Beyond the conspicuous manifestations of bodily harm, there exists a realm of nuanced self-injurious behaviors. In my practice, I have encountered and explored the intricacies of covert self-injurious behaviors, witnessing firsthand the profound emotional damage they inflict. These behaviors deserve equal recognition and concern given their profound impact and emotional toll in addition to the risk of physical harm to the individual. Oftentimes, such actions indicate underlying emotional or psychological distress and are frequently used as maladaptive coping mechanisms.

The following are some examples of such self-destructive behaviors:

  • Substance use (e.g., excessive drinking, use of illicit drugs, smoking/vaping, taking more or less of a prescription or over-the-counter medication)
  • Recklessness (e.g., texting while driving, extreme sports, excessive thrill seeking, illicit activities)
  • Disordered eating (e.g., restricting, binging, purging, excessive exercising)
  • Risky sexual behaviors (e.g., unprotected sex, sex under the influence, multiple sexual partners without precaution, exploitative activities)

What Causes Self-Injurious Behavior? A Psychodynamic Perspective

Self-injury is a complex issue with multifaceted causes. These include societal pressures, maladaptive coping mechanisms, emotional distress, depression, anxiety, and trauma. Of note, the psychodynamic perspective offers one lens to understand self-injury. It is not the sole explanation, and other factors, such as biological and social influences (i.e., “social contagion theory”) also contribute to the development and maintenance of self-injurious behaviors.

While individual experiences and circumstances vary, the most common psychodynamic factors contributing to self-injury include:

  • Unconscious psychological defenses
    • Self-injury can serve as a defense mechanism against overwhelming or intolerable emotions.
    • It may function to alleviate emotional pain, distract from deeper and unknown painful thoughts and feeling, or regain a sense of control.
  • Emotional regulation difficulties: Self-injury may arise as a maladaptive coping strategy for individuals who struggle with regulating their emotions effectively. Inflicting physical pain can provide a temporary relief or release of tension, allowing for a momentary escape from emotional distress.
  • Childhood trauma or unresolved conflicts: Childhood trauma, abuse, or neglect can lead individuals to internalize intense emotions such as anger, shame, guilt, and powerlessness, often resulting in a belief that they are responsible for the traumatic events and deserving of punishment. Consequently, self-injury may be seen as a way to atone for these perceived faults.
  • Unconscious communication and relational dynamics: Self-injury can function as a nonverbal communication of distress or a way to elicit care and attention from others. It may serve as a means of establishing or maintaining relationships with significant others, even if the attention received is negative.

How Do I Treat Self Injury in My Practice? – Psychodynamic Psychotherapy

As a therapist, I find that psychodynamic psychotherapy is an effective treatment option for those who are interested in understanding the underlying causes of self-injurious behaviors. One of the benefits of this approach is that it helps create a safe and trusting relationship between you and me, your therapist. This can be particularly helpful when it comes to learning new coping skills to regulate one’s emotions. By exploring your thoughts and feelings, you'll also gain a deeper understanding of unknown painful thoughts and feeling that, oftentimes, lead to self-injurious behaviors. As you work through these emotions (with my support), you'll feel more able to tackle them on your own. Overall, psychodynamic psychotherapy can provide significant relief from any or all of the aforementioned destructive behaviors by helping you gain insight into and work through difficult emotions in a supportive environment.

In general, my goal is to help the individual identify triggers, patterns, and unconscious processes related to self-injury while working through unresolved emotional wounds. Together, we develop healthier coping strategies, enhance self-awareness and insight, and foster self-acceptance and self-compassion.

If you or someone you know struggles with self-injurious behavior and would like evaluation or treatment, please call my office today at 212-591-0152 or fill out the form at this contact page. From there, I can review your case and offer you a treatment plan to meet your needs.

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