The Scars of Self-Injury

Few of us can imagine inflicting the kind of physical pain and damage that self-injurers inflict on their own bodies. For many people, the concept of self-injury is as foreign as imagining picnicking on the moon. But in our counseling rooms, we see the reality of self-injury far too often. Cutting, burning, poking, slapping -- these violent behaviors can be regular occurrences in the lives of some of our clients. What would drive someone to hurt him- or herself? Isn't self-injury just a bid for attention? Is there a difference between self-injury and suicidal ideation? Loved ones of those who self-injure struggle with these questions. And while the specific instigating factors behind one's self-injurious behaviors are as varied as the individuals themselves, some commonalities can be noted. People who hurt themselves often engage in an addictive-like relationship with this behavior. They initially find some sort of emotional relief -- either in the form of distraction or a sense of release from psychic pain -- from the harming behavior. Later, either due to a lack of appropriate coping resources, or the relative speed with which self-harm usually provides relief, the person continues to use these actions to deal with more distressful life situations over time.

Most of us can recall a moment of self-loathing or a period of hopelessness in our histories. For those who self-harm, self-hatred, a sense of continuous personal failure and a fear of relinquishing the tool that has brought them relief are constant companions. And while the behavior can appear dramatic and attention-seeking, self-injury is rarely a casual choice by the individual. Due to the addictive nature of the dynamic, someone who hurts himself can quickly become reliant on this maladaptive coping skill. We can understand someone getting a sense of relaxation, increased well-being, a distancing from their problems, by drinking alcohol. Tobacco smokers often report feeling instantly calmed and/or energized, not just from that first puff, but even through the rituals of igniting their lighter or smelling the sulphur of a dying match. Similarly, self-injurers can experience a lowering of stress via the habit of self harm.

People who self-injure are at a higher risk of suicide, not only due to their struggles with depression and hopelessness, but because the risky behaviors associated with self-harm could inadvertently creat a risk to one's life, even if she isn't intending to end her life. Self-injurers have mistakenly nicked a major vein or artery, causing them to hemorrhage before help could be obtained. Some wounds can get so infected they can lead to sepsis, a potentially life-threatening blood infection.

The treatment for self-injury almost always involves a holistic approach, including individual therapy, medication, group therapy to teach skills like stress management, frustration tolerance, emotion regulation and appropriate self-care. Centering skills like mindfulness and meditation are other helpful tools that can help clients to learn to manage their painful life experiences without resorting to self-harm. Occassionally, hospitalization is necessary to ensure an individual's continued safety.

Self-injury is always a sign of deep distress and a loosening of one's ability to manage their pain in effective ways. But clinical and medical intervention can help these clients regain control of their lives, and offer a path of hope and recovery into a life marked by positive self regard, rather than haunting scars.