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PTSD, Cutting, and Other Forms of Self-Injury
By Matthew Tull, PhD, About.com Guide
Updated: May 27, 2009

Carbide Cutting Tool
PTSD and self-injury (also called deliberate self-harm), such as cutting and burning, frequently co-occur. Deliberate self-harm has been defined as the deliberate and direct destruction or alteration of body tissue without conscious suicidal intent, but resulting in injury severe enough for tissue damage to occur. Basically, deliberate self-harm means doing something to cause immediate physical harm to yourself but not for the purpose of ending your life. Self-harm behaviors may include:

•Cutting
•Burning
•Needle-sticking
•Banging your head
•Carving on your skin
•Severe scratching
•Punching yourself
•Biting yourself
Cutting, skin carving, severe scratching, head banging, and punching oneself have been found to be some of the most common methods of self-harm.

Deliberate Self-Harm, Trauma, and PTSD
The experience of a traumatic event has been linked to deliberate self-harm behavior. In particular, people who have a history of sexual abuse and/or physical abuse have been found to be more likely to engage in deliberate self-harm. Women who have been raped may also be more likely to begin engaging in deliberate self-harm behavior. People with PTSD have also been found to be more likely to engage in this behavior.

Why Do People Use This Behavior?
There is evidence that people engage in deliberate self-harm as a way of attempting to express and manage their emotions, such as anxiety, sadness, shame, and/or anger. Deliberate self-harm may also provide a temporary escape from or be a way of avoiding emotional pain.

People with PTSD in particular may use deliberate self-harm as a way of getting back in touch with the present moment (also called "grounding"). Some people with PTSD may experience dissociation or flashbacks. Hurting oneself such as through cutting or burning may "shock" the body back into the present moment, ending the flashback or dissociation, much like the way smelling salts work.

Consequences
Deliberate self-harm is a serious behavior. Although some people report that it causes relief from painful emotions, this relief is temporary. Afterwards, people may feel more painful emotions, such as shame, guilt, sadness, and/or anger. The behavior may also leave scars which people may feel shame about and attempt to hide, and the behavior may become more severe over time.

Resources
If you engage in deliberate self-harm or you know someone who does, it is important that you seek out help. The S.A.F.E. Alternatives website provides resources on and referrals for people struggling with deliberate self-harm behavior.

Source:

Chapman, A. L., & Dixon-Gordon, K. L. (in press). Emotional antecedents and consequences of deliberate self-harm and suicide attempts. Suicide & Life Threatening Behavior.

Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.

Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10, 192-205.

Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the Deliberate Self-Harm Inventory. Journal of Psychopathology and Behavioral Assessment, 23, 253-263.

Greenspan, G.S., & Samuel, S.E. (1989). Self-cutting after rape. The American Journal of Psychiatry, 146, 789-790.

Harned, M.S., Najavits, L.M., & Weiss, R.D. (2006). Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence. The American Journal on Addictions, 15, 392-295.

Lyons, J.A. (1991). Self-mutilation by a man with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 179, 505-507.

Pattison, E.M., & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.

Pitman, R.K. (1990). Self-mutilation in combat-related PTSD. American Journal of Psychiatry, 147, 123-124.

Whitlock, J., & Knox, K.L. (2007). The relationship betwen self-injurious behavior and suicide in a young adult population. Archives of Pediatrics and Adolescent Medicine, 161, 634-640.