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Self-Injury: Notes for Concerned Others

Adapted from Secret Shame
© 1996-2002 Deb Martinson
by Robert Hsiung
November 9, 2002

Since you ask, most days I cannot remember.
I walk in my clothing, unmarked by that voyage.
Then the almost unnamable lust returns.
--Anne Sexton

If you cause physical harm to your body in order to deal with overwhelming feelings, know that you have nothing to be ashamed of. It's likely that you're keeping yourself alive and maintaining psychological integrity with the only tool you have right now. It's a crude and ultimately self-destructive tool, but it works; you get relief from the overwhelming pain/fear/anxiety in your life. The prospect of giving it up may be unthinkable, which makes sense; you may not realize that self-harm isn't the only or even best coping method around.

For many people who self-injure, though, there comes a breakthrough moment when they realize that change is possible, that they can escape, that things can be different. They begin to believe that other tools do exist and begin figuring out which of these non-self-destructive ways of coping work for them. This site exists to help you come closer to that moment.
--Deb Martinson

What counts as self-injury?
How common is self-injury?
How serious is self-injury?
Why do people self-injure?
Is self-injury manipulative?
Dos & don'ts

What counts as self-injury?

Immediate physical harm. Not just increasing the risk of future harm. Not socially sanctioned behavior (or sexual masochism).

Cutting72% of self-injurers responding to a survey Burning35 Hitting 30 Interfering with wound healing22 Pulling hair10 Breaking bones08 --Favazza AR & Conterio K, The plight of chronic self-mutilators, Community Mental Health Journal, 1988, 24: 22-30

How common is self-injury?

1% of Americans.

Favazza & Conterio "portrait": female, now in her mid-20s to early 30s, injuring herself since her teens, middle- or upper-middle-class, intelligent, well-educated, from a background of physical or sexual abuse or with an alcoholic parent, often with an eating disorder. And:

50previous acts of self-injury each 57%had taken a drug overdose 1/3expected themselves to be dead within 5 years 50%had been hospitalized 14%of those said it had helped 64%had been in therapy 73%of those said it had helped

How serious is self-injury?

Continuum of lethality. And of suicidality.

Why do people self-injure?

To express emotional pain (in a physical way).
To feel something (instead of empty or numb or dead).
To punish themselves.
To vent anger (by directing it at themselves). "Most women have not even been able to touch this anger except to drive it inward like a rusted nail." --Adrienne Rich
To influence others.
To exert control over their bodies.
To feel grounded in reality (instead of detached, depersonalized, or dissociated).

Is self-injury manipulative?

Does the person want to influence others? Maybe so, maybe no.

Dos & don'ts

Don't take it personally. It's not about you. (Probably not, anyway.)
Understand your feelings. Be honest with yourself. It's natural to feel repulsed, frightened, angry, helpless, overwhelmed, etc.
Take care of yourself. Set limits for yourself as well as for them. Earn their trust. Triage. Do: "Sometimes I need to recharge and that doesn't affect my caring about you." Get help.
Support the person without supporting the behavior.
- Don't avoid the subject. In fact, bring it up. Do: "I know that sometimes you hurt yourself, and I'd like to understand it. People do it for so many reasons. If you could help me understand why you do it, I'd be grateful." But don't push it.
- Be available.
- Set reasonable limits. Do: "I can't handle talking to you while you're cutting yourself. I care about you greatly, and it hurts too much to see you doing that." Don't: "I can't deal with you if you keep cutting yourself!"
- Show them that they don't need to self-injure to get you to care about them.
- Distract them. Take the initiative. Don't: "Is there anything I can do?" Do: "Can I take you to a movie?" Do: spontaneous acts of kindness.
- Offer physical safety. Do: "I'm worried about you. Would you come over for a while?"
- Be hopeful.
- Acknowledge their pain. It doesn't make it go away, but can make it more bearable.
Don't try to make them stop. Confiscating implements can just push them to be more creative. Punishment and guilt can feed the self-hatred that can lead to self-injury.
Don't push it.
Educate yourself.
- Web sites
  - Secret Shame
  - Parenting of Adolescents: Self-Injury Self-Mutilation Self-Abuse
  - Self-Mutilation (by and for adolescent girls)
  - Self-Injury Transcripts, Books, Links
- Online forums
  - Bodies Under Siege: Families and Friends
- Books
  Bodies Under Siege: Self Mutilation and Body Modification in Culture and Psychiatry
  by Armando R. Favazza
  More scholarly in tone. The Scarred Soul: Understanding & Ending Self-Inflicted Violence
  by Tracy Alderman
  Oriented toward self-help. A Bright Red Scream: Self-Mutilation and the Language of Pain
  by Marilee Strong
  Presents the voices of self-injurers talking about what they do and why; lets you inside their minds.
Take care of yourself.

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Revised: November 9, 2002
Adapted from Secret Shame
© 1996-2002 Deb Martinson. All rights reserved.
by Robert Hsiung, MD, dr-bob@uchicago.edu
URL: http://counseling.uchicago.edu/vpc/uchicago/self-injury.html