Self-Harm in Adults: Self-Injury Not Limited to Teens

When people think of self-harm, they often picture a teenage girl cutting herself, but self-harm in adults is more common than people realize. Adult self-injury (also known as self-harm or self-mutilation) is not limited to a particular age nor a gender.

"Stereotypically people think that self-injury happens only among teenagers and young women, but it also happens with older, middle-aged females and males," says Harrell Woodson, PhD, director of the Menninger Hope Program, which treats adults with mental illness. The Program is participating in a clinic-wide initiative to learn more about self-injury and to develop new protocols to treat it, since it is a frequent health issue among Menninger patients.¹

Adult self-injury is commonly comprised of cutting or burning the skin, or banging one's head repeatedly against a wall. Dr. Woodson notes adult self-mutilation is often more difficult to treat than that of younger people, as adults may have been self-harming since childhood. The ingrained behavior, then, may be one of the only ways the adult knows how to deal with stress; one of the major causes of self-injury.

Adult Self-injury and Mental Illness

Adult self-mutilation may be a sign of a psychiatric disorder such as depression, bipolar disorder or borderline personality disorder. It's not known how many adults self-mutilate and it's likely that adult self-harm is underreported due to the shame and guilt associated with the behavior. People are very likely to hide adult self-injury and many do not seek help.

Left untreated, self-harm in adults, and the accompanying psychiatric disorders, can be dangerous. While the majority of people who self-mutilate are not suicidal (read about self-harm and suicide), it's easy to accidentally induce a life-threatening wound during acts of self-injury. Adults that self-mutilate may be at higher risk of this than their younger counterparts.²

"Self-injurious behavior can cause irreparable physical damage and can even lead to death, from cutting too deeply, getting an infection or going into shock," Dr. Woodson says.

Why Do Adults Self-Injure?

There are many reasons an adult may self-injure:

• Adult self-injury may be an attempt to keep loved ones concerned and connected. This is often seen in borderline personality disorder.
• As in teens, self-mutilation in adults may be the result of a severe trauma such as sexual abuse or childhood neglect.
• Self-harm in adults may be used to distract from other painful life events. It may also be a release of the emotional pain associated with stressors like marriage problems, work or parenting issues.
• Adult self-injury may also be as a result of on-going symptoms of psychosis which causes adults to have a break from reality. "They are being commanded to hurt themselves," Dr. Woodson says. "They may hear a voice bargaining with them, telling them that if they don't bang their head 13 times, something bad will happen."

Treatment of Adult Self-Injury

Because adult self-injury behaviors can be very ingrained, it can be challenging to find other coping techniques. For adults, self-injury may be one of the few parts of their lives in which they feel complete control. This may mean they are reluctant to change their behavior and can make self-injury treatment more difficult.

The desire for behavior change needs to come from the patient rather than as a demand from the mental health professional or family members, Dr. Woodson says. Motivational interviewing techniques put the majority of the responsibility for behavior change in the hands of the patient.

"With motivational interviewing, you capitalize on the patient's ambivalence—in terms of the pros and cons of continuing that behavior, in a non-confrontational way," Dr. Woodson continues. "Traditionally, admonishing people about the consequences of self-injurious behavior doesn't work very well."

Triggers of adult self-mutilation must be identified and new coping strategies put in place. One self-harm alternative recommended by professionals is to put a rubber band around the wrist that can be snapped when the urge to self-injure becomes too strong.

Treatment of self-harm in adults may also include medication, particularly when the self-harm co-occurs with a psychiatric illness. Group therapy is also common. Patients in group therapy discuss what they could do differently in response to particular stressors, situations, thoughts and feelings rather than harming themselves. Groups are an effective form of treatment for self-injury, Dr. Woodson says, because patients learn new insights and adaptive behaviors from their peers as well as receiving support and encouragement.

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