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This list of stresses is not exhaustive but it illustrates the kind of psychological-
emotional conditions that set the stage for the development of self-injury reactions.
Soon we’ll see how that might happen.
Self-Injury varies in severity and serves very different purposes
It should be made clear, however, that not all people who Self-Injure start with a
terrible traumatic crisis. Some may have simply had friends or relatives who injured
themselves and learned the behavior that way. Others who self-injure may have
developed an unhealthy habit that helps them calm down: something like having a
drink, eating, or smoking cigarettes or dope. In these kinds of cases, the injuries
were not life threatening, maybe just a compulsion like pulling out hair, picking at
sores, or sticking or hitting themselves. This self-abuse may be a distraction, a way
to release tension, to regain some sense of control over a situation, or to show
others that they really are hurting. Note: People who injure themselves do not
necessarily have a mental health problem, especially if the physical damage
is mild to moderate. For example, in a sample of about 2000 ordinary military
recruits (60% males) about 4% had a history of self-harm. That 4% scored higher
on anxiety, depression, borderline, schizotypal, dependent, intense emotions, and
fear of interpersonal rejection (Klonsky, Oltmanns & Turkheimer, 2003), but not high
enough to keep them out of military service.
On the other hand, it is fairly common for Self-Injury to be combined with
various psychiatric diagnoses. Therefore, to understand this behavior in some people
it is important to realize comorbid disorders may be involved, including: Depressive
Disorder, Borderline Personality Disorder, Bipolar Disorder, Post-Traumatic Stress
Disorder, Obsessive-Compulsive Disorder, Attention Deficit Disorder, Dissociative
have a center core of intense emotions, impulsiveness, and irrationality. In addition,
a different kind of self-injury occurs in the repetitive head-banging of autism and
retardation. The most horrific mutilation, such as cutting off a limb, an ear, or self-
castration, is usually in a very severe psychotic condition. So, self-injury may range
from a mild habitual coping technique to death or an extreme response to
overwhelming stress.
Major Depression and Borderline Personality Disorders
Certain diagnoses have been studied because they are associated with frequent
self-injury and suicidal behavior, namely, Major Depression and Borderline
Personality Disorder. One study (Brown, Comtois & Linehan, 2002) distinguished
between suicidal self-injury and nonsuicidal self-injury in 75 Borderline women (over
50% were also diagnosed as having depression or anxiety). The patients were about
30 and had self-injured an average of 6 times in the last year, so they were quite
injury prone. The women who inflicted nonsuicidal injuries gave these reasons: (a) to
produce some feeling (relief, a sense of control, an emotional high), (b) to express
their anger, (c) to punish themselves, and (d) to divert their attention from painful
situations or thoughts. The main reason for self-injury given by the suicidal patients
was “was to make things better for others.” That is interesting but you can be sure it
is more complicated than that. They all wanted to reduce internal stress.
