From Hellish Cycles To Stability: A Mental Health Story

Taken from  SC  Times  which is found  HERE.

St. Cloud resident Marsha Hagfors can quote a frightening statistic: From 2005 to 2012, she had 38 inpatient treatments for her mental health.

And that’s counting only those at St. Cloud Hospital.

She was isolated and alone, facing the ups and downs, the push and pull that her combination of illnesses was putting her through.

Three years later, she’s stable, living independently in her apartment, maintaining a job at Independent Lifestyles in Sauk Rapids and paying her own bills.

She’s connected to other people with mental illness, helping them through their struggle with lessons she’s learned.

“This may sound weird but, I’m … blessed to have had that experience,” she says. “Because I feel like I’m a stronger person and I can better understand people that do struggle with mental illness because I’ve lived every dark corner there is.”

And she hasn’t had any hospitalizations since 2012.

Hagfors’ story is an example of the sometimes revolving door of the mental health care system.

“When people ask me, I’m like, I’ve been through hell and back. That’s exactly how I feel. But I’m so grateful to be here,” she said.

Now, at age 32, Hagfors is doing what she can to make that system better.

She tells her story in hopes that others do the same.

“One in four people will have mental illness,” she said, in their lifetime. That’s a lot of people.

Hagfors’ story centers on a sexual assault in college in 2005 in her early 20s. It started her on a downward spiral that would lead to three suicide attempts and numerous occasions of dangerous behavior such as cutting and erratic driving.

Eventually, she was diagnosed with borderline personality disorder, bipolar disorder, post-traumatic stress disorder and depression.

“People think of you for (your diagnosis). You shouldn’t live your diagnosis. That’s what I’m trying to get out to people,” she said.

But it didn’t start there. Hagfors had a hard time making and keeping friends as a child. Borderline personality disorder isn’t something that just happens. It develops over time via the environment, usually in childhood.

“I was very emotional growing up. Like every little thing bothered me,” she said. “In school, I’d maybe have one friend. I tried to be in things like band. But I would come home from school and just cry all night long.”

Because of stress, Hagfors has been grinding her teeth since she was a year old.

She was really good at basketball, but anxiety won.

When other teenagers were partying with their friends, Hagfors was home with her parents.

“I turned into myself and didn’t talk about it because it wasn’t OK,” she said. “I did have a problem and I wish I could have gotten help sooner.”

After high school, she went to St. Cloud State University. At first, she lived on campus. But when her parents dropped her off that first day, signs weren’t looking good.

“Literally felt I would die because I was not ready,” she said. “I cried every single day for the first month.”

Her mom helped her through, listening to her over the phone.

“She was my rock during that time,” Hagfors said. “I think at that time she knew something was wrong.”

She’d go to class, go back to her dorm and stay there. She didn’t have any friends.

“Always inside me, I had the inner drive,” she said. But mental symptoms got in the way.

The assault triggered her borderline personality disorder.

“I just completely fell apart,” she said. “It all just kind of spiraled down from there.”

Her symptoms started with depression and anxiety.

Hagfors cut herself as a release because she didn’t have coping skills.

“That’s just what I went to all the time. It was awful,” she said.

And so began her revolving door.

The next few years were a blur. She can’t remember much.

Hagfors was self-medicating with prescription and over-the-counter drugs, landing her in the ER with a dose of charcoal, used to treat drug overdoses.

Police would perform welfare checks and take her to be institutionalized.

“I’d generally go in, be there for like a week, and then get out for a couple days, and then I’d go back,” she said. “That was like my cycle for two years.”

She was able to talk her way out of the institutions, and she wanted to get out because she felt shame being there so often.

“With the borderline, it’s very easy to be manipulative,” she said.

She was seeing a therapist once a month during that period, but he was a man, something that was hard for her to cope with following the college trauma. So she’d skip a lot of appointments.

During that period Hagfors had jobs on and off, in retail or doing office work, but sometimes only for as short as a week. For a while she’d do really well. Then she’d have a lot of symptoms. She’d miss work, then lose her job. Of course, that led to major instability.

“I moved a lot. And I lived in foster care for a year. I lived in three different group homes,” she said. Living in her own apartment didn’t work.

She attempted suicide three times. During that third attempt in 2008, she landed in an intensive care unit.

“That time was the life-changing event. OK, I really need to figure this out,” she said. “It scared me. Life is way more precious than this.”

The near-death experience was her catalyst for recovery. A month later Hagfors got her own place and started turning her life around.

Along the way, she learned coping strategies and outlets to express her emotion. She found purpose, in creating art and in helping people. Now, she hopes to break down stigma around mental illness.

She found community-based services that helped her live independently, people who help with basic living and social skills and recovery. They could help her manage medications and even helped her figure out a job wasn’t right for her.

Today, she has to listen to herself and take it easy on the bad days. For instance, she knows autumn can be triggering, and at one point, hearing an ambulance could make her feel sick.

The real key to her recovery was finding and believing in herself.

“If you don’t find something meaningful, it’s hard to go on.” Hagfors said.

Right now, she finds purpose in her job at Independent Lifestyles as a peer mentor, working with people with disabilities and mental illness.

“My consumers can tell me anything, and it won’t faze me because I’ve probably done it,” she said. “I can relate to them and I’m not saying any situation is the same or this is how I feel about it. Just genuinely listening, being like, I understand and not saying ‘that’s stupid.’ I’ve lived these situations and I can relate to them.”

She passes on wisdom she’s gained and tells her clients one simple fact: She believes in them. And whatever they do, let it out; they can talk to her. Leaving whatever it is inside is dangerous, she said.

When Hagfors thinks back over the last 10 years, she can identify the obstacles that, in her opinion, kept her sick.

That includes a lack of consistency in mental health providers. It’s particularly important for someone with borderline personality disorder, where trust doesn’t come easily.

“It’s nice to have consistency because you can gain trust with that person,” she said. “Once you have that trust and you feel safe, it’s easier to talk to somebody and get the help you need.”

Having the same provider for a longer period can also help with medication management. There’s a lot of trial and error in medicines that treat mental illness. It takes time to find the right drug, the right dose, the right timing and the right combination.

Changes in insurance and who would or wouldn’t accept public and private insurance meant it was hard to have that consistency. At one point, her therapist no longer accepted Medical Assistance.

“I was just devastated because I’m like ‘Look, I just started trusting this person and now I have to change again,’ ” Hagfors said.

In some ways, it seemed the system was set up to keep wounding her.

“(I) felt sometimes, ‘OK, I’m doing everything I can but I’m still having all these issues.’ (It) kind of felt they were making me stay in the situation,” she said.

She was either institutionalized, with intense supervision and structure, or out on her own, with neither. There was no middle ground.

“It seemed like I’d get out of hospital and wouldn’t have any services to get and I’d just end up right back in there,” she said. “I went from being institutionalized where you’re taking care of me every two seconds, to ‘Oh I’m on my own, what do I do?’ I’m freaked out. ‘Oh my gosh, I have to create drama to get my needs met.’ ”

Sometimes, the inflexibility of the health care system complicated matters, she said.

“I think most people look at your diagnosis and say, ‘Oh you have this, you must be like this.’ But everyone is different,” she said. Bipolar isn’t bipolar isn’t bipolar.

Then there’s the way conditions can interact. For instance, Hagfors’s bipolar medications can make the borderline worse and the conditions can trigger each other.

As she looks forward to the rest of her life, Hagfors hopes to continue helping people with mental health issues and educating the community about mental illness stigma.

She’s off to a good start: “Know me by my name, not my diagnosis.”

Bipolar disorder: Formerly called manic depression, bipolar disorder causes extreme mood swings from emotional highs of mania to lows of depression. Mood shifts may occur only a few times a year or as often as several times a week.

Borderline personality disorder: It effects the way a patient thinks and feels about themselves and others, causing problems functioning in everyday life. It includes a pattern of unstable intense relationships, distorted self-image, extreme emotions and impulsiveness. Patients have an intense fear of abandonment or instability and may have difficulty tolerating being alone. But inappropriate anger, impulsiveness and frequent mood swings push others away.

Post-traumatic stress disorder: A mental health disorder triggered by a terrifying event — one that’s experienced or witnessed. Symptoms can include flashbacks, nightmares, severe anxiety and uncontrollable thoughts.

Depression: A mood disorder that causes persistent feeling of sadness and loss of interest, and can lead to a variety of emotional and physical problems. Patients may have trouble with day-to-day activities and may feel sometimes that life isn’t worth living.

Source: Mayo Clinic.

Self- Harm & Trauma

What is self-harm?

Taken from  the U.S. Department Of Veterans Affairs  which is found  HERE.

Self-harm refers to a person harming his/her own body on purpose. Other terms for self-harm are “self-abuse” or “cutting.” Overall, a person who self-harms does not mean to kill himself or herself.

Self-harm tends to begin in teen or early adult years. Some people may engage in self-harm a few times and then stop. Others engage in it more often and have trouble stopping the behavior. Self-harm is related to trauma in that those who self-harm are likely to have been abused in childhood.

How common is self-harm?

The rates of self-harm vary widely, depending on how researchers pose their questions about it. It is estimated that in the general public, 2% to 6% engage in self-harm at some point in their lives. Among students, the rates are higher, ranging from 13% to 35%.

Rates of self-harm are also higher among those in treatment for mental health problems. Those in treatment who have a diagnosis of PTSD are more likely to engage in self-harm than those without PTSD.

What are self-harmers like?

Self-harmers, as compared to others, have more frequent and more negative feelings such as fear or worry, depression, and aggressive impulses. Links have also been found between self-harm and feeling numb or feeling as if you’re outside your body. Often those who self-harm have low self-esteem, and they do not tend to express their feelings. The research is not clear on whether self-harm is more common in women or men.

Those who self-harm appear to have higher rates of PTSD and other mental health problems. Self-harm is most often related to going through trauma in childhood rather than as an adult. Those who self-harm have high rates of:

  • Childhood sexual abuse
  • Childhood physical abuse
  • Emotional neglect
  • Bonds with caregivers that are not stable or secure
  • Long separations from caregivers

Those who self-harm very often have a history of childhood sexual abuse. For example, in one group of self-harmers, 93% said they had been sexually abused in childhood. Some research has looked at whether certain aspects of childhood sexual abuse increase the risk that survivors will engage in self-harm as adults. The findings show that more severe, more frequent, or longer-lasting sexual abuse is linked to an increased risk of engaging in self-harm in one’s adult years.

Why do people engage in self-harm?

While many ideas have been offered, the answer to this question may vary from person to person. The reasons that are most often given are “To distract yourself from painful feelings” and “To punish yourself.” Research on the reasons for self-harm suggests that people engage in self harm to:

  • Decrease symptoms of feeling numb or as if you are outside your body or yourself
  • Reduce stress and tension
  • Block upsetting memories and flashbacks
  • Show a need for help
  • Ensure that you will be safe and protected
  • Express and release distress
  • Reduce anger
  • Punish self
  • Hurt self instead of others

How is self-harm treated?

Self-harm is a problem that many people are embarrassed or ashamed to discuss. Often, they try to hide their self-harm behaviors. They may hold back from getting mental health or even medical treatment.

Self-harm is often seen with other mental health problems like PTSD or substance abuse. For this reason, it does not tend to be treated separately from the other mental health problems. Some research suggests, though, that adding in a round of therapy focused just on the self-harming behavior may result in less self-harming.

There have not yet been strong studies on using medicine to treat self-harm behaviors. For this reason, experts have not reached agreement on whether medicines should be used to treat self-harm behaviors.


This fact sheet is based on a more detailed version, located in the “Professional” section of our website:Self-Harm and Trauma: Research Findings


Antidepressants & Self Harm

Taken from  the  Los Angeles Times   which can be found    HERE.

About a decade after the Food and Drug Administration first warned that antidepressant medications increase the risk of suicidal thoughts and behaviors in children, new research has found that kids and young adults starting on high doses of antidepressants are at especially high risk, especially in the first three months of treatment.

Among patients 24 and younger, those who started treatment for depression or anxiety with a higher-than-usual dose of selective serotonin reuptake inhibitor (SSRI) were more than twice as likely to harm themselves intentionally than those whose treatment began at the customary dose and increased slowly, the study found.

For every 150 such patients treated with high initial doses of SSRIs — antidepressants marketed under such commercial names as Zoloft, Paxil, Prozac, Celexa and Lexapro — the study suggests one additional suicide would be attempted. By contrast, young patients starting SSRI therapy at doses considered customary were at only slightly elevated risk of self-harm, about 12% above the level of their depressed peers not taking medication.

The latest research on depression treatment, conducted by epidemiologists at Harvard University and the University of North Carolina, was published Tuesday in JAMA Internal Medicine.

The researchers found no increased risk of suicidal behavior among adults older than 24 who started medical treatment for depression or anxiety at larger initial doses.

About 18% of young people diagnosed with depression were prescribed an initial antidepressant dose that was higher than that recommended by clinical guidelines: For the antidepressant fluoxetine (better known by its commercial name, Prozac), for instance, a standard dose would be 10 milligrams daily for the first week, increasing to 20 milligrams for the next three weeks, and only then considering any increased dose.

Given that antidepressants appear to be less effective in young people than in older patients, and that higher doses do not appear to bring more or faster relief, the author of an invited commentary in JAMA Internal Medicine suggested that prescribing physicians should abide by the well-worn maxim “start low, go slow,” and monitor patients closely during their first several months of treatment.

The study used medical records to track 162,625 U.S. residents, ages 10 to 64, who were diagnosed with depression and prescribed SSRI between 1998 and 2010. It found that more than half of antidepressants in that period were prescribed by primary care doctors, and about an additional quarter by practitioners not specialized in mental health. Even in children, fewer than 30% of antidepressant prescriptions were issued by psychiatrists.

The authors acknowledged that they could not discern why younger patients on high initial doses of antidepressant were more likely to try to harm themselves. Although it could have been the dose at which these young patients began their therapy, it is equally plausible that younger patients who are correctly perceived to be in a mental health crisis are more likely to be treated more aggressively, but not more likely to get better with SSRIs.

It might also be that those started on high-dose SSRIs are more likely to discontinue their therapy and to suffer from “discontinuation syndrome,” which can bring physical symptoms of anxiety and is sometimes linked to unpredictable behavior.

Mike Ehrmantrout: Men Self-Harm Too. Here’s My Story Of Self-Harm


A secret is usually not healthy. But keeping a secret about your self-harm can be downright deadly. Today’s the day I tell my story of self-harm.

A Safety Pin Isn’t Always Safe

When I was 9 years old, I accompanied my single mom to the supermarket. After doing our shopping, we started toward the car with our groceries. My mom opened the trunk and we put the sacks inside. When she closed the trunk, all hell broke loose.

Somehow, I’d gotten my right thumb caught in the trunk lid as it slammed down. The pain was unbearable and, of course, I began to scream bloody murder as my mom frantically tried to find the key. When she finally opened the trunk, obviously my thumb was somewhat mutilated. It might have even been severed, but there was an air pocket between the edge of the trunk lid and the car body that somehow kept my thumb from being cut off.

Click   HERE  to complete this article.

Self-Injury/Cutting: Part 2


Taken from the  Mayo Clinic  which is located   HERE.


Your first appointment may be with your family doctor, another primary care doctor, a school nurse or a counselor. But because self-injury often requires specialized mental health care, you may be referred to a mental health provider for evaluation and treatment.

What you can do
To help prepare for your appointment:

  • Make a list of symptoms you’ve had, including any that may seem unrelated to the reason for the appointment.
  • Note your key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins, herbs or supplements that you’re taking.
  • Take a family member or friend along, if possible, for support and to help you remember information.
  • Be ready to provide accurate, thorough and honest information about your situation and your self-injuring behavior.

Prepare a list of questions to make the most of your time with your doctor. Some basic questions to ask your doctor include:

  • What treatments are available? Which do you recommend for me?
  • What side effects are possible with that treatment?
  • What are the alternatives to the primary approach that you’re suggesting?
  • Are there medications that might help? Is there a generic alternative to the medicine you’re prescribing?
  • What should I do if I have an urge to self-injure between therapy sessions?
  • What else can I do to help myself?
  • How can I (or those around me) recognize that things may be getting worse?
  • Can you suggest any resources that would help me learn more about my condition and its treatment?

Don’t hesitate to ask questions any time you don’t understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions about your self-injuring and emotional state, such as:

  • When did you first begin harming yourself?
  • What methods do you use to harm yourself?
  • How often do you cut or injure yourself in other ways?
  • What feelings and thoughts do you have before, during and after self-injury?
  • What seems to trigger your self-injury?
  • What makes you feel better or worse?
  • Do you have social networks or relationships?
  • What emotional issues are you facing?
  • How do you feel about your future?
  • Have you had previous treatment for self-injury?
  • Do you have suicidal thoughts when you’re feeling down?
  • Do you drink alcohol, smoke cigarettes or use street drugs?


Although some people may ask for help, sometimes self-injury is discovered by family members or friends. Or a doctor doing a routine medical exam may notice signs, such as scars or fresh injuries.

There’s no specific diagnostic test for self-injury. Diagnosis is based on a physical and mental evaluation. A diagnosis may require evaluation by a mental health provider with experience in treating self-injury. A mental health provider may also evaluate you for other mental illnesses that may be linked to self-injury, such as depression or personality disorders. If that’s the case, evaluation may include additional tools, such as questionnaires or psychological tests.


There’s no one best way to treat self-injuring behavior, but the first step is to tell someone so you can get help. Treatment is based on your specific issues and any related mental health conditions you might have, such as depression.

Treating self-injury behavior can take time, hard work and your own desire to recover. Because self-injury can become a major part of your life and it’s often accompanied by mental disorders, you may need treatment from a mental health professional experienced in self-injury issues.

There are several treatment options for self-injuring behavior.

Known as talk therapy or counseling, psychotherapy can help you identify and manage underlying issues that trigger self-injuring behavior. Therapy can also help you learn skills to better manage distress, help regulate your impulsiveness and other emotions, boost your self-image, better your relationships, and improve your problem-solving skills.

Several types of individual psychotherapy may be helpful, such as:

  • Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
  • Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others.
  • Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination guided by a therapist.
  • Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression, and improve your general well-being.

In addition to individual therapy sessions, family therapy or group therapy also may be recommended.

There are no medications that specifically treat self-injuring behavior. However, your doctor may recommend treatment with antidepressants or other psychiatric medications to help treat depression, anxiety or other mental disorders commonly associated with self-injury. Treatment for these disorders may help you feel less compelled to hurt yourself.

Psychiatric hospitalization
If you injure yourself severely or repeatedly, your doctor may recommend that you be admitted to a hospital for psychiatric care. Hospitalization, often short term, can provide a safe environment and more intensive treatment until you get through a crisis. Day treatment programs also may be an option.


You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan, including keeping psychotherapy appointments and taking prescribed medications as directed.
  • Keep your doctor or mental health care provider’s phone number handy, and tell him or her about all incidents related to self-injury.
  • Appoint a trusted family member or friend as the person you’ll immediately contact if you have an urge to self-injure or if self-injuring behavior recurs.
  • Take appropriate care of your wounds if you do injure yourself or seek medical treatment if needed — call your relative or friend for help and support.
  • Don’t share instruments used for self-injury, which raises the risk of infectious disease.
  • Ask your doctor for advice if you have sleep problems, which can significantly affect your behavior.
  • Learn how to include physical activity and relaxation exercises as a regular part of your daily routine.


If you or a loved one needs help in coping, consider the tips below. If there’s a focus on thoughts of suicide, you or your loved one can call the National Suicide Prevention Lifeline 24-hour crisis line at 800-273-8255 (800-273-TALK).

Coping tips if you self-injure

  • Recognize the situations or feelings that might trigger your desire to self-injure. Make a plan for other ways to soothe, distract or get support for yourself so you’re ready the next time you feel that urge.
  • Connect with others who can support you so that you don’t feel alone. For example, reach out to a family member or friend, contact a support group or get in touch with your doctor.
  • Learn to express your emotions in positive ways. For example, to help balance your emotions and improve your sense of well-being, become more physically active, practice relaxation techniques, or participate in dance, art or music.
  • Avoid alcohol and illegal drugs. They affect your ability to make good decisions and can put you at risk of self-injuring.
  • Avoid websites that support or glamorize self-injury. Instead, seek out sites that support your recovery efforts.

Coping tips if your loved one self-injures

  • Get informed. Learning more about self-injury can help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior.
  • Try not to judge or criticize. Criticism, yelling, threats or accusations may increase the risk of self-injuring behavior.
  • Let your loved one know you care no matter what. Remind the person that he or she is not alone and that you are available to talk. Recognize that you may not change the behavior, but you can help the person find resources, identify coping mechanisms and offer support during treatment.
  • Share coping strategy ideas. Your loved one may benefit from hearing strategies you use when feeling distressed. You can also serve as a role model by using appropriate coping strategies.
  • Find support. Consider talking to other people who’ve gone through the same thing you’re going through. Share your own experiences with trusted family members or friends and keep in close touch with the professional taking care of your loved one. Ask your friend or loved one’s doctor or therapist if there are any local support groups for parents, family members or friends of people who self-injure.
  • Take care of yourself, too. Take some time to do the things you enjoy doing, and get adequate rest and physical activity.


There is no sure way to prevent your loved one’s self-injuring behavior. But reducing the risk of self-injury may include strategies that involve both individuals and communities — for example, parents, schools, medical professionals, supervisors, co-workers and coaches:

  • Identify people most at risk and offer help. For instance, those at risk can be taught resilience and healthy coping skills that they can then draw on during periods of distress.
  • Encourage expansion of social networks. Many people who self-injure feel lonely and disconnected. Forming connections to people who don’t self-injure can improve relationship and communication skills.
  • Raise awareness. Adults, especially those who work with children, should be educated about the warning signs of self-injury and what to do when they suspect it. Documentaries, multimedia-based educational programs and group discussions are helpful strategies.
  • Promote programs that encourage peers to seek help. Peers tend to be loyal to friends even when they know a friend is in crisis. Programs that encourage youths to reach out to adults may chip away at social norms supporting secrecy.
  • Offer education about media influence. News media, music and other highly visible outlets that feature self-injury may nudge vulnerable children and young adults to experiment. Teaching children critical thinking skills about the influences around them might reduce the harmful impact.

Self-Injury/Cutting: Part 1

Taken from the Mayo Clinic  which is located   HERE.


Self-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It’s typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.

While self-injury may bring a momentary sense of calm and a release of tension, it’s usually followed by guilt and shame and the return of painful emotions. And with self-injury comes the possibility of more serious and even fatal self-aggressive actions.

Because self-injury is often done impulsively, it can be considered an impulse-control behavior problem. Self-injury may be linked to a variety of mental disorders, such as depression, eating disorders and borderline personality disorder.


Signs and symptoms may include:

  • Scars, such as from burns or cuts
  • Fresh cuts, scratches, bruises or other wounds
  • Broken bones
  • Keeping sharp objects on hand
  • Wearing long sleeves or long pants, even in hot weather
  • Claiming to have frequent accidents or mishaps
  • Spending a great deal of time alone
  • Pervasive difficulties in interpersonal relationships
  • Persistent questions about personal identity, such as “Who am I?” “What am I doing here?”
  • Behavioral and emotional instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness

Forms of self-injury
One of the most common forms of self-injury is cutting, which involves making cuts or severe scratches on different parts of your body with a sharp object. Other forms of self-harm include:

  • Burning (with lit matches, cigarettes or hot sharp objects like knives)
  • Carving words or symbols on the skin
  • Breaking bones
  • Hitting or punching
  • Piercing the skin with sharp objects
  • Head banging
  • Biting
  • Pulling out hair
  • Persistently picking at or interfering with wound healing

Most frequently, the arms, legs and front of the torso are the targets of self-injury because these areas can be easily reached and easily hidden under clothing. But any area of the body may be used for self-injury. People who self-injure may use more than one method to harm themselves.

Because self-injury is often an impulsive act, becoming upset can trigger an urge to self-injure. Many people self-injure only a few times and then stop. However, for others, self-injury can become a long-term, repetitive behavior.

Although rare, some young people may self-injure in public or in groups to bond or to show others that they have experienced pain.

When to see a doctor
Getting appropriate treatment can help you learn healthier ways to cope.

  • Reach out for help. If you’re injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Talk to someone you trust — such as a friend, loved one, health care provider, religious leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help.
  • Emergency help. If you’ve injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider.

When a friend or loved one self-injures
If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you’d be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some options for help.

  • Your child. You can start by consulting your pediatrician or family doctor who can provide an initial evaluation or a referral to a mental health specialist. Don’t yell at your child or make threats or accusations, but do express concern.
  • Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult.
  • Adult. Gently encourage the person to seek medical and psychological treatment.


There’s no one single or simple cause that leads someone to self-injure. In general, self-injury is usually the result of an inability to cope in healthy ways with psychological pain related to issues of personal identity and having difficulty “finding one’s place” in family and society. The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-injury is complex. For instance, there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.

Through self-injury, the person may be trying to:

  • Manage or reduce severe distress or anxiety and provide a sense of relief
  • Provide a distraction from painful emotions through physical pain
  • Feel a sense of control over his or her body, feelings or life situations
  • Feel something, anything, even if it’s physical pain, when feeling emotionally empty
  • Express internal feelings in an external way
  • Communicate depression or distressful feelings to the outside world
  • Be punished for perceived faults


Certain factors may increase the risk of self-injury, including:

  • Being female. Females are at greater risk of self-injuring than males are.
  • Age. Most people who self-injure are teenagers and young adults, although those in other age groups also self-injure. Self-injury often starts in the early teen years, when emotions are more volatile and teens face increasing peer pressure, loneliness, and conflicts with parents or other authority figures.
  • Having friends who self-injure. People who have friends who intentionally harm themselves are more likely to begin self-injuring.
  • Life issues. Some people who injure themselves were neglected, or sexually, physically or emotionally abused, or experienced other traumatic events. They may have grown up and still remain in an unstable family environment, or they may be young people questioning their personal identity or sexuality.
  • Mental health issues. People who self-injure are more likely to be impulsive, explosive and highly self-critical, and be poor problem-solvers. In addition, self-injury is commonly associated with certain mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
  • Excessive alcohol or drug use. People who harm themselves often do so while under the influence of alcohol or illegal drugs.


Self-injury can cause a variety of complications, including:

  • Worsening feelings of shame, guilt and low self-esteem
  • Infection, either from wounds or from sharing tools
  • Life-threatening problems, such as blood loss if major blood vessels or arteries are cut
  • Permanent scars or disfigurement
  • Severe, possibly fatal injury, especially if you harm yourself while under the influence of alcohol or illegal drugs
  • Worsening of underlying issues and disorders, if not adequately treated

Suicide risk
Although self-injury is not usually a suicide attempt, it can increase the risk of suicide because of the emotional problems that trigger self-injuring. And the pattern of damaging the body in times of distress can make suicide more likely.

If you, your friend or a loved one is having suicidal thoughts or is in emotional distress, get help right away. Take all talk of suicide seriously. Here are some options:

  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor.
  • Seek help from your doctor, a mental health provider or other health care professional.
  • Reach out to family members, friends, teachers or spiritual leaders for support.

If you think your friend or loved one is in immediate danger of attempting suicide or has made a suicide attempt, make sure someone stays with him or her. Call for emergency help or take the person to the hospital, if you can safely do so. If possible, take away any tools used for self-injury.