Being aware of self-injury
Dear Dr. Jeff: A friend of mine keeps cutting her arms. She says she's not suicidal, but that she can't stop herself from doing it. I'm getting pretty freaked out about it. What should I do? J.C.
Dear J.C.: Your concern about your friend is well placed. She is clearly struggling with some inner turmoil and needs help.
Cutting is one of the more common forms of intentional self-injury. It is estimated that over one percent of the population are self-injurers, primarily adolescents and young adults - predominantly young women. However, the true prevalence of this behavior is likely higher. Many people who injure themselves try to keep it secret, because they feel ashamed or guilty about their behavior. They try to hide scars with clothing, and if discovered, make up explanations for the injuries ("cat scratches" are among the most common).
Self-injurers are not trying to kill themselves. They inflict harm on themselves to bring relief from some kind of inner distress. Physical pain is used as a way to try to escape emotional pain. Many self-injurers report a great sense of calm and relief after hurting themselves.
Self-injurers tend to be perfectionists, unable to handle intense feelings, unable to express their emotions verbally, and can at times feel overwhelmed by dislike for themselves or their bodies. They may turn to self-injury as a way to relieve intense anger, sadness or emotional pain, to express their emotions and pain, to try to gain a sense of control of themselves and their lives, or to punish themselves.
Many authorities point out that self-injurers commonly struggle with low self-esteem and feelings of invalidation. They may have been taught from an early age that their thoughts and feelings about things were wrong, or bad. They may have learned that certain feelings themselves were wrong or bad, and not allowed. They may have been left feeling numb, unreal, so dead inside, that seeing their own blood when they cut themselves is their only way to feel real, to feel alive.
Many self-injurers come from broken homes, from alcoholic homes, or from families where parents were emotionally absent. One half to two-thirds of self-injurers also struggle with disordered eating.
Nearly 90 percent are survivors of sexual or physical abuse.
To return to your question, J.C.: your friend needs help for a number of reasons. She must be struggling with her own very significant issues and pain, and needs professional help and support. Suggest to her that the two of you make an appointment at the Counseling Center, or talk to someone at the Health Center or Res Life, if those seem less anxiety-provoking. Tell her how concerned you are, how much you care about her pain, how you want to help her get help.
Although your friend's cutting does not represent a desire to take her own life, it can nonetheless be very dangerous. A cut could go too deep, or involve an unseen artery, tendon or nerve. An untended wound could become infected.
There are a large number of helpful websites to consult about self-injury. Among them, S.A.F.E. Alternatives ("Self-Abuse Finally Ends") at www.selfinjury.com includes a good deal of information about various aspects of self-injury, including treatment options and referrals, and books, audio and video resources. Deb Martinson's "Secret Shame (Self-Injury Information and Support)" website (www.palace.net/~llama/self-injury) is equally comprehensive, but more personal. "Mirror-mirror," an eating disorders awareness website (www.mirror-mirror.org/selfinj.htm), explores linkages between disordered eating, abuse and self-injury.
Acts of self-injury often bring out uncomfortable and negative feelings in others, especially friends and care-givers. It is sometimes hard to remember that the self-injurer is only trying to cope with her or his own pain and inner turmoil, not to hurt or frustrate others. What the self-injurer needs most from us all, is care and support and help finding help.
Jeff Benson, M.D.