Self-injurious Behavior

Last month, Instagram’s VP, Adam Mosseri, promised to ban images of self-harm on the site after the social media network was blamed for the suicide of a British teen. Facebook has made a similar move to enforce policies against posts about self-harm and suicide.

Self-harm means hurting yourself on purpose. One common method is cutting self with knife/razor, others include burning, skin-picking, hair-pulling. The images that people post online include lacerations on arms/legs/abdomen, scars from healed lacerations, burn marks, etc. Self-injurious behavior can happen in people with diagnoses like depression, anxiety, eating disorders; but it can also happen in someone with no history of a psychiatric diagnosis. About 17% of teenagers have engaged in self-injurious behavior at least once.

Self-harm behaviors like cutting are not usually a suicidal behavior (at least, not an indicator of a current suicide attempt). Most patients tell me they cut themselves for variations on one of two reasons:

  • “I needed to turn my emotional pain into physical pain. It’s easier to deal with the physical pain.”
  • “I was numb and wanted to feel something.”

Sometimes the patients experience temporary relief of the pain or numbness with self-harm, but it never lasts long. It is common for my patients to discuss feelings of guilt or shame after an episode of self-harm (and then sometimes the shame leads to increased urge to hurt themselves, and the cycle goes on and on). Treatment for patients who self-harm includes therapy by a mental health professional, as well as treatment for any other comorbid diagnoses. Sometimes, the injuries themselves need medical attention, like stitches or treatment of infection.

Even though I said earlier that self-harm is not a suicidal behavior, it can predict future suicidal behavior. A study in the April 2018 Pediatrics found that youths treated for deliberate but non-suicidal self-harm, such as cutting, were more than 25 times as likely than demographically matched peers to die from suicide within the following year. Interestingly, although depression and anxiety diagnoses were common in both adolescents and young adults who self-harm, adolescents with self-harm were far more likely to have been recently diagnosed with attention deficit hyperactivity disorder and other disruptive behaviors, while young adults more commonly had substance use and personality disorder diagnoses.

Back to Instagram and Facebook. Both have promised to post more mental health resources on the sites and work with experts about how to properly proceed. Interestingly, not all mental health experts think that images of self-harm should be completely removed from the internet. Some experts say that creating a safe space online for people to talk about their experiences, including self-harm, is essential to help with feelings of isolation and loneliness. We also don’t want to increase the stigma of people struggling with mental health issues and we certainly don’t want to shame anyone who is brave enough to come forward with their story.

If you or someone you know is engaging in self-harm behavior, make sure to talk to your health care provider.  If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.