People do all kinds of self-destructive things.
A lot of our clients cut or burn themselves, some of them carve entire phrases on their bodies, and others insert objects right under the epidermis and leave them there for hours.
Some pour boiling water on their skin, some intentionally bang their heads on something hard, and others smash their fingers and toes on purpose.
All of this would be considered self-injury, because it fits this definition: assault to the surface of the body, without suicidal intent, for the purpose of relieving emotional pain.
People also do other kinds of self-destructive things. They snort cocaine, drink excessively, have dangerous unprotected sex, starve themselves, binge-eat, stick their fingers down their throats, refuse to sleep, or accept stupid dares.
But none of these are considered self-injury from a clinical standpoint.
Sometimes compulsive habits look kind of like self-harm. People pull out their eyelashes or pull out so much hair on their scalp that they leave a bald spot. Other people pick at scabs or at their fingernails so much that they bleed.
These are also not considered self-injury from a clinical standpoint.
The reason therapists make a big deal out of distinguishing between these behaviors is because of the treatment. Not all self-destructive behaviors will benefit from the same kind of therapy.
In the case of a person who is cutting herself to feel better about something, a treatment plan that focuses on hidden rage and extreme social vigilance works better than anything else.
That same treatment, however, wouldn’t work as well with something like an eating disorder or substance abuse. Those kinds of problems are different in cause, course, and nature, and therefore require a different treatment.
And problems like skin-picking or hair-pulling are even further removed from what we consider self-injury and require a different approach altogether.
Self-injury is usually rage-based, whereas other kinds of problems are typically anxiety-based or depression-based. Because they don’t all respond to the same kind of treatment, it’s important to understand what “counts” as self-injury and what doesn’t.
As a general rule, any kind of self-inflicted wound that is on the surface of the body where the wound itself serves the purpose of relieving emotional pain counts as self-injury.
Even though excessive vomiting can cause damage to the stomach, esophagus and teeth, it isn’t considered self-injury because
1) the purpose of the vomiting isn’t to damage those organs—that’s just a byproduct, and
2) that behavior wouldn’t respond very well to a rage-based treatment since rage isn’t really the nature of that problem.
Same thing with drugs and alcohol. Even though abusing those substances could damage the liver, teeth, and veins, that isn’t really the point of shooting up or getting wasted. It’s a byproduct. So again, it’s not self-injury.
Substance abusers don’t really respond very well to rage-based treatments the way self-injurers do. Same thing with hair-pulling and skin-picking.
Those two (“trichotillomania” and “excoriation,” respectively) are better understood as compulsive habits, and therefore respond better to anxiety-focused treatments.
If you are looking for help for yourself or someone you love, make sure your therapist understands how to distinguish between different kinds of self-destructive behaviors.
The wrong therapy can take a toll on your emotional health as well as your wallet.
Feel free to contact us if you want some help determining which category yours might be, and we can help you find the treatment that’s right for you.
-Angela Kahn is the Founder and Director of KISI.