Tuesday, February 28, 2012

March 1st is International Self Injury Awareness Day

What do these high profile individuals have in common? Singer, Fiona Apple; Comedian, Russell Brand; Actress, Drew Barrymore; Actor, Johnny Depp; Actor, Colin Farrell; Actress, Megan Fox; Actress, Angelina Jolie; Singer, Demi Lovato and Princess Diana....

Before finding emotional health, they struggled with self-injury.

Self-Injury is a deliberate, non-suicidal behavior that inflicts physical harm on one's body to relieve emotional distress. Self-injury has a paradoxical effect in that the pain self-inflicted actually sets off an endorphin rush, relieving the self-harmer from deep distress. It's important to note that self-injury does not involve a conscious intent to commit suicide - and as such, the clinical term for this behavior is called Non-Suicidal Self Injury (NSSI), NSSI can take many forms from cutting, picking, burning, bruising, puncturing, embedding, scratching or hitting one's self, just to name a few.

In its simplest form, NSSI is a physical solution to an emotional wound. Generally, it is a deliberate, private act that is habitual in occurrence, not attention-seeking behavior, nor meant to be manipulative. Self-injurers are often secretive about their behaviors, rarely letting others know, and often cover up their wounds with clothing, bandages, or jewelry.

Symbolically speaking, deliberately injuring one's self can be viewed as a method to communicate what cannot be spoken. With self-harm, the skin is the canvas and the cut, burn or bruise is the paint that illustrates the picture. Most individuals who self-injure are struggling with emotional expression. This clinical experience is known as Alexithymia - the inability to recognize emotions and their subtleties and to understand or describe thoughts and feelings. Many other self-harmers are struggling with internal conflicts, may have anxiety, depression, may have experienced physical or sexual abuse, or other more serious psychological concerns.

Statistically speaking, approximately 4% of the population in the United States uses NSSI as a way of coping. Individuals who self-injure are represented in all SES brackets in the United States with the behavior usually starting in adolescence. Girls and women tend to self-injure more than boys and men, but this may be represented by the fact that females tend to turn to professional help more than males.

Those Who Self-Injure Are Often Trying To:

* Distract themselves from emotional pain

* End feelings of numbness

* Offset feelings of low self-esteem

* Control helplessness or powerlessness

* Calm overwhelming or unmanageable feelings

* Maintaining control in chaotic situations

* Self-punish, self-shame or self-hate

* Express negative thoughts or feelings that cannot be put into words

* Self-nurture or self-care

10 Tips for Reducing Self-Injury

1) Create an Emergency Kit. Place positive things in your kit like photos of people you love, notes to yourself or from friends or family, a journal for writing, markers or art supplies for artistic expression, an inspirational poem, beloved stuffed animal, upbeat music, favorite scents, things like that.

2) Use positive imagery. Visualize yourself moving through your painful moment without self-harming. Research shows that using positive visualization can keep you in-the-moment which is a key tool for recovery.

3) Hold your ground. Sensory Grounding experiences like holding something soft, listening to soothing music, drawing or writing, for example, can interrupt the trance-like state that often comes with self-harm, shifting you towards more positive behaviors.

4) Reboot your mind. Reframe your thoughts toward helpful statements, also known as Cognitive Grounding Skills, like "Who am I really mad at?""What is setting me off?" or "I am safe and I am in control." These can re-orient you to the here-and-now.

5) Know your triggers. Become aware of what issues bend or break you. Try to dilute your exposure to them, call upon others to help you move through them and remind yourself that you can emerge from them successfully.

6) Take a detour. Reroute self-harm by using less severe forms of sensations. Holding an ice cube, tearing or shredding paper or a sheet, snapping a rubber band against your skin, sucking a lemon peel are ways to dilute the need to experience pain.

7) Move your body. Consider the adrenaline rush of running, dancing, holding a yoga pose, jumping rope to offset urges to self-harm. The rush of adrenaline has been known to produce the similar chemical surge that comes from self-injury.

8) Forgive yourself. As you try to interrupt your self-harming behaviors, know that it may not come as easily some days as others. Should you find that you've lapsed into self-harming, remind yourself that change is a process. Learn to forgive and be kind to yourself as you start anew.

9) Be supportive.
If you know someone who may be self-injuring, offer support and try not to shame or criticize the NSSI behavior. Self-injury behaviors can be successfully treated, so help your friend or family member by encouraging them to seek help.

10) Consider calling a therapist. Remember that having an urge to self harm is not the same as actually self harming. If you can distract yourself from self-injury, you are well on your way to recovery. However, if the urges win out, not allowing you to reduce your self-harm behaviors, consider working with a professional.


Froeschle, J. & Moyer, M. (2004). Just cut it out: Legal and ethical challenges in counseling students who self-mutilate. Professional School Counseling. 7(4), 231-235.

Kress White, V.E. (2003). Self-injurious behaviors: Assessment and diagnosis. Journal of Counseling & Development. 81(4), 490-496.

Lee, Y. et al. (2010). Direct and indirect effects of the temperament and character on Alexithymia: A pathway analysis with mood and anxiety. Comprehensive Psychiatry, 51 (2), 201-206.

Levenkron, S. (1999). Cutting: Understanding and overcoming self-mutilation. New York: W.W. Norton & Company.


Wanda's Wings said...

You are so right. It is indeed a private way to relieve pain. I am thankful that it can improve with treatment of the underlying reason. Your blog is so informative and helpful.

one brave duck said...

thank you for writing about this. i have been self-harming since i was 13, i'm 46 now. i stopped for a decade in my thirties but started up again in my forties. i stopped again about a year ago, with the insight that it was early trauma that was causing me to want to self harm. i have worked hard on healing that trauma (sexual abuse) in therapy, and the urge to self-harm has lessened.

one thing that has really helped is writing on my arm where i usually cut. i write things like "you are safe now" or "he can't hurt you" and they comfort me greatly. before i can cut, i have to read these affirming messages. it takes away the urge to hurt myself.

thank you again, c.

Liz said...

Thank you. I have been self injuring for over a year now and it's a constant struggle not to. It's literally taken over my life, everything. I'm in counseling now though. Thank you for your post.

Purple said...

# 8 is the hardest part of of SI for me to deal with. The immense guilt I feel for not being able to stop myself is huge for me to work through.

I started seeing a therapist in January after realizing that I couldn't stop on my own. I tried so hard but it was just so much stronger than I was sometimes. I was super scared to go but it feels like such a huge weight has been lifted off my shoulders now.

Oh the emergency kit, put funny movies in there too. Like you know those stupid silly movies that you can't help but laugh at. Sometimes is all I need to snap me out of a really crappy and dark place. :)

As always, great post! I always learn something new every time I come here.

Jen said...

Thank you for this one. I actually started self-harming AFTER I started therapy to work through the aftermath of csa and tons of very unpleasant emotions surfaced.

It actually scares me that I have that destructive energy in me. Just hope that it will lessen once I work through the trauma.

I appreciate you creating awareness about this topic and help people understand more about this subject.

STAG said...

Do you suppose that smoking, drinking and fast driving may have components of self injury in them?

Cassie said...

This is a great explanation for something I've pondered on considerably. Thank you! Some of my children have done this to themselves. No one right now, thankfully. I don't ever remember people doing this up until this current generation. Am I right?

Anonymous said...

Of course there is also the self-injury that comes about from abuse of substance -- alcohol or drugs. The end result can be the same and the motivations are similar.

Dreaming again said...

I'm always alarmed when I see someone telling someone to use a rubber-band and snap it when they feel like cutting .. it's just substituting one form of physical pain for another .. doesn't leave the chance of infection, but it doesn't resolve the problem (but it does get the health care provider off the hook for a bit)

I did not cut .. I'm not going to put on a public forum what I did, because I'm not going to give anyone any ideas, but when I learned it was self harm, I was quite alarmed (as Wanda can attest to!) but it was ..

It's been a long journey .. but there is hope .. and healing ..