Betty W. Phillips, Ph.D., Psychology
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Help for Self-Injury

Help for Self-Injury

A Chatham County resident wrote expressing concern and confusion about the puzzling behavior exhibited when young people hurt themselves intentionally. The most common behavior is cutting the skin with a sharp object, but may also include burning the skin, hitting oneself, skin-picking or a combination of these behaviors. How can these young people be helped? Is this behavior contagious or manipulative?

The general public became aware of this behavior when Princess Diana admitted to cutting herself on her arms and legs. A majority of people who self-injure are females between the ages of 13 and 30. While some young people experiment with this behavior after hearing about it from the media or their friends, their attempts are usually confined to marking themselves on their bodies in less painful ways. Individuals who deliberately cause pain to themselves in a repetitive manner are psychologically disturbed and are not just imitating the latest fad. They are usually embarrassed by their behavior and do not flaunt their markings. They often lie about their injuries and wear clothes designed to conceal the scabs or scars.

Self injury, while counter-intuitive, is not "crazy" or suicidal (i.e., not psychotic and not an attempt to cause death.) There is no controversy about the basic motivation for this behavior which occurs when an individual feels overwhelming stress and finds the pain of self-injury to be a release from otherwise unbearable psychological pain. Individuals whose self-injure have not learned appropriate ways of expressing emotion or coping with psychological and family problems. They are often chronically depressed, anxious, hypersensitive individuals who suppress their feelings, have low self-esteem, poor coping skills, feel unempowered and avoid their problems but then behave in impulsive ways to relieve stress. In other words, people who self-injure have psychological problems that are overwhelming to them and have very poor coping skills and outlets for their problems. Research has shown that self-injury behavior does lead to a reduction in psychophysiological arousal and level of stress hormones for these individuals. The pain of self harm is less intense and more bearable than the internal distress caused by psychological problems. Once the self-injury has occurred, the individual often feels guilt and shame and tries to hide the evidence. While the behavior is not suicidal, a person who self- injures may also experience suicidal crises due to the same constellation of problems.

Self-injury by itself is not manipulative or intended to annoy or frustrate caretakers. At times the self-injury behavior does express self-punishment or inner directed anger. The self-injury may be a way to communicate with others what they are not able to say with words. A secondary motivation may be a cry for help.

The best way to help young people who self-injure is to work with a therapist experienced in dealing with this problem. They cannot just be told to stop self-injury because this behavior is out of their control. Well-meaning parents, nurses or doctors who lecture or criticize will only drive the problem underground and make it worse due to increased shame and guilt. Hospitalization is not necessary and often is counterproductive. There is no medication which will stop this problem by itself. A therapist will work on a short range plan to help the young person with distraction and substitution methods and a long range plan to help develop more effective ways of understanding and coping with life problems. Self-help information is available on the Web, for example A form of group therapy called Dialectical Behavior Therapy is available locally for individuals with self-harm behavior and other forms of emotional dysregulation.