Understanding Compulsive Self-Mutilation

Skin picking; nail biting; hair pulling… It’s not uncommon to occasionally fuss with our hair or pick at an annoying scab. For some people, however, that fussing turns into a compulsive behavior that is both destructive and embarrassing. From constantly biting one’s nails to cutting one’s skin when strong emotions hit, these repetitive behaviors often have a serious physical and emotional impact.

Types of Self-Mutilation

There are many different ways in which people mutilate themselves. Following are some of the most common:

Cutting: Although alarming to others, individuals who engage in this type of compulsive self-mutilation don’t do it with the intent to kill themselves. Rather, they almost always use it as a way to cope with intense negative feelings. The impulsive act of cutting gives the person a sense of control over his or her emotional pain. For many who engage in this type of behavior, the self-harm actually releases endorphins that provide a sense of pleasure.

While any area of the body is fair game, the arms and wrists are the most commonly cut areas. Sadly, cutting often leaves permanent, unsightly scars. Cutting occurs most frequently in adolescents, but for some individuals – particularly many diagnosed with Borderline Personality Disorder – it can continue into adulthood.

Hair pulling: Also known as trichotillomania, individuals with this impulse-control disorder have the uncontrollable urge to pull out hair from their head, eyebrows, eyelashes, or arms. The urge is often triggered by feelings of anxiety. The hair-pulling behavior relieves the tensions and provides a feeling of satisfaction – at least temporarily. It’s common in those with trichotillomania to also compulsively twirl their hair, inspect their hair’s root, and chew on their hair. Unfortunately, the behavior often results in visible patches and bald spots. Due to the embarrassment from these telltale signs of the disorder, individuals with trichotillomania often wear hats, scarves, or make-up.

Nail biting (Onychophagia): This is a common habit, affecting as many as 50% of children between the ages of 10 and 18 years of age [1]. Most people, however, stop biting their nails on their own by around the age 30. Chronic and serious nail biting can lead to scarring and infections. It can also create feelings of shame. For example, a nail biter might become too embarrassed to shake hands. If their condition is severe, they may wear gloves to hide the self-inflicted damage.

Skin picking (Dermatillomania): This condition is marked by repetitive skin picking that results in tissue damage. Picking can occur on any part of the body, but common target areas include the face, arms, lips, gums, scalp, chest, and fingers. Many individuals with dermatillomania pick with their fingers, however some use tools like fingernail clippers or tweezers. Skin picking can cause infections, interferes with the healing of wounds, and often leaves visible scars.

All of these compulsive behaviors can have a significant negative impact on a person’s emotional and physical well-being. Emotionally, self-mutilation produces feelings of shame and low self-esteem. A person may also feel guilty for compulsively engaging in behavior they understand is not normal. The injuries take a physical toll as well in the form of lesions, ulceration, infections, and scarring. Cutting, in particular, carries the risk of life-threatening complications if a major blood vessel is cut.


Researchers have yet to identify one clear source for self-mutilation behaviors. Some studies suggest that skin picking is related to substance abuse disorders; the person engages in it despite knowing its potential harm and often reports pleasure during the activity [2]. Others research suggests these conditions have more in common with obsessive-compulsive disorder (OCD) [3], falling within the obsessive-compulsive spectrum.

Self-Mutilation and Other Disorders

People who self-mutilate often have other psychiatric disorders as well, including substance abuse disorders, major depressive disorder, and anxiety disorders. Researchers estimate that between 6% and 19% of people who compulsively pick skin also meet the criteria for OCD [4].

Cutting behavior has been linked to several mental health conditions, including schizophrenia and borderline personality disorder. Borderline personality disorder is marked by unstable moods, feelings of emptiness, and a disturbed sense of self. This kind of self-harm is often used as a way to cope with the pain caused by serious trauma, such as physical or sexual abuse. This is why compulsive cutting is sometimes found in those with post-traumatic stress disorder (PTSD).

Self-Mutilation Health Risks

Self-mutilation is a relatively common disorder among people of many ages. Those who suffer from self-mutilation face many health risks as a result of their obsessive behaviors. The risks fall into both physiological and psychological categories.

Physical Health Risks

Self-mutilating individuals face a number of physical risks:

Wounds and scars — Probably the most common of all of the risks that come with this disorder are skin wounds and scars. From light to deep skin discoloration and scarring to the occasional need for skin grafting to repair wounded areas, individuals face a host of complications as a result of self-injury.

Infection — As with many open wounds, infection is a risk. Individuals who cut, burn or scratch themselves to the point of forming lesions often don’t take steps to prevent infection.

Accidental overdose — Sometimes individuals will take painkillers to dull the pain that is caused by self-injury or to harm their bodies still further. This can cause extreme sickness, seizures and even death.

Nerve and/or tendon damage — When a person cuts too deeply, he runs a risk of slicing into nerves or tendons. If a cut is deep enough to cause damage, there is a chance that even medical care may not even help to reverse it, leading to paralysis in the limbs, or the loss of a limb.

Broken bones — In rare instances, individuals will develop such a high tolerance for pain or will have such an overwhelming desire to hurt themselves so seriously that they will break their own bones. Some people do this because this form of self-mutilation causes the longest span of pain, as it takes the most time to recover from.

Physiological Health Risks

In addition to physical health risks, psychological ones exist for self-injurers as well. Strong emotions usually lead people to self-harm, which can also cause strong emotional responses, generating a vicious cycle. As a result, the following issues can develop or worsen:

  • Problems with self-esteem
  • Depression
  • Shame or guilt
  • Irritability
  • Using self-injury as a coping mechanism
  • An overwhelming desire to use self-mutilation to the point where one can no longer control it

Another sobering risk of self-mutilation is suicide. Many people who self-injure do not intend to complete suicide. Sometimes they hurt themselves more seriously than they intend, causing severe medical complications that lead to death. Others become so devastatingly tormented by their behavior that they see no way out other than to end their lives.

Treating Compulsive Self-Mutilation

One of the most effective types of treatment for compulsive self-mutilation disorders is cognitive behavioral therapy (CBT). The goal of CBT is to help the individual identify unhealthy and irrational thought patterns, and “re-wire” their thinking. By doing so, they can learn to replace the self-harm behavior with healthy ways to cope with anxiety, emotional pain, and other triggers. Researchers have found that CBT is far more effective than a medication-only approach. In one study, CBT had a more dramatic impact on reducing trichotillomania symptoms than antidepressants [5].

In severe cases, a therapist or psychiatrist may recommend medication in addition to therapy. The antidepressant fluoxetine, for example, may reduce compulsive skin picking [6] [7]. However, because of the risk of serious side effects, antidepressants are often used only in severe cases in which the behavior results in infection, ulceration, or disfigurement.

Since people who struggle with compulsive self-mutilation often suffer from other psychiatric disorders, such as PTSD or major depression, a successful treatment plan will also integrate therapies to address those conditions as well.

One of the challenges with compulsive self-mutilation is that the damage may also generate physical injury that requires medical treatment. Cutting, hair pulling, and skin picking can lead to infection and scarring that requires treatment by a dermatologist or other type of physician.

Self-help strategies are essential tools for managing and eliminating self-mutilating behaviors. These include:

  • Managing stress. Stress is a leading trigger for many people who pick and pull at their own bodies. Coping strategies will lower the body’s stress hormones and raise the body’s natural feel-good brain chemicals. Stress-relief strategies include yoga, meditation, and deep-breathing exercises. Making time for a relaxing hobby or volunteer work will also provide the physical and emotional relief needed to resist cutting, skin picking, and other behaviors.
  • Expressing emotions. Rather than unleashing negative emotions on the body, channel that energy into more constructive and expressive activities. Convey your emotions through activities like writing, singing, painting, or dancing. Talking with friends or a support group will also give you an outlet for negative feelings.
  • Keeping hands busy. When you feel stress, it may be helpful to use fidget toys or finger toys to keep your hands occupied with a non-destructive activity. A fidget toy can be any object you can fiddle around with, like a small squeeze ball or “stress ball”. Small craft projects, like knitting or crocheting, can also keep your hands busy during long periods of inactivity, such as watching television or riding in the car.

Self-mutilation behaviors, from nail biting to skin picking, are more than inconvenient habits. If your behavior is causing embarrassment, shame, or physical problems, seek help. A skilled mental health professional will give you the resources to reverse these conditions so you can live the healthier life you deserve.

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