Understanding Self Injury
by Stuart Sorensen RMN

The whole idea of self-injury (SI) is, for many people, very difficult to understand. It's a subject which causes most people to react with very strong emotions and can cause feelings of guilt, anger, depression and for many self-injurers, relief. That's the bit most people who don't harm themselves find the hardest to understand.

Many self-injurers find that acts such as cutting, overdosing, burning themselves etc. actually make them feel better - at least in the short term. This is especially true for people with Borderline Personality Disorder (BPD). It's as though there's a pressure cooker inside their heads and physical pain or the drama associated with emergency medical care is the only way they know to relieve the distress they feel.

The trouble is that there's always a price to be paid for self-injury. That price may be physical (scarring, liver damage etc.), social (leading to relationship problems) or psychological (a source of guilt, depression, self-reproach, frustration or anger). The short-term relief is real and it works for a while but self-injury often causes more problems than it solves in the longer term.

This little handout is designed to help self-injurers find alternatives to SI, some of which cause 'safe' pain and some which avoid pain or self-injury altogether. The best way to find out which methods work best for you is to try them out - maybe keep a diary of what worked and what didn't or what reactions you got from others and how that made you feel. Remember that the way you feel about what you do is at least as important as the action itself.

If your self-injuring is mainly to get a dramatic response from others (what some people might call attention seeking) it's likely that you have a deep emotional need to feel validated. Validation means being valued and treated with respect for your feelings and opinions. You may need to know that others care about you and value your existence. A good way to put this to the test is to do something potentially lethal such as take an overdose and see what response you get. If people worry, make a fuss, rush you to hospital or spend long periods of time 'supervising' you that demonstrates the value they place upon you.

It's not necessarily the attention itself that attracts you to self-injury so much as the validation that the attention demonstrates. People who react dramatically to your threats and suicidal gestures seem to be showing you how much they care and so you continue to feel validated so long as they keep rushing to your aid.

Unfortunately this is a very high risk strategy. And sooner or later it stops working and people begin to think less and less of you - you get to feel less validated instead of more. It's also worth knowing that people who self-injure have been known to die 'by accident' when events don't turn out the way they'd planned.

Most people who repeatedly injure themselves or make threats of suicide eventually end up alienating the people they love the most - the ones who have to respond when the blood hits the carpet or the pills get misused. Family, friends, partners eventually realise that they can't cope with this behaviour and simply leave. Self-injury is a way of calling out to others which actually drives most people further and further away.

That's the bad news - now here's the good:

There are other ways to get the same amount of validation without resorting to self-injury. If you need to know that you're wanted and cared for the best way is to get interested in other people. Most people will care about you roughly as much as you care about them. If you make a point of getting interested in someone else's well-being they will more than likely return the compliment. That's how friendships are formed - they get worked at.

Another way, when in crisis, is to tell the other person how you feel. Often you'll get a much better result by sitting and talking honestly instead of expecting them to 'guess' how you feel because of what you do. You may be surprised to know that it isn't always obvious how self-injurers feel.

Many people are confused, frightened and bewildered when faced with suicidal or parasuicidal behaviour. They get 'sucked in' by the gravity and drama of the situation but they certainly don't enjoy it - and after a while they simply get out of the relationship. By expecting people to 'guess' how they feel; by 'acting out' in such a dramatic way self-harmers actually drive away the very people they're trying to reach out to.

Other ways to remind yourself that you're valued by others is to make a list - yes I know it sounds pointless - of all the things you have to be grateful for in relationships. You may have to think long and hard, particularly if you're in 'negative thinking mode' but persevere. Remind yourself of all the times in the past when people have been there for you (even if you set the situation up with SI) and write them down. Some people find that simply reminding themselves of good relationships in this way is enough for them to feel validated once again.

Join a group of other self-injurers or maybe a special interest society. It doesn't really matter what the group's about so long as you can meet people and play an active part in it. This helps in two ways:

1 You get to form new relationships with people who may well come to care for you.
2 You develop an interest to take your mind off your own troubles.

For some people, of course, the drama isn't what it's all about. These people need to feel the pain of self-injury in order to feel better emotionally. If you're one of these people you may like to try some other ways of causing yourself pain without actually doing any long term damage. For example:

1 Hold some ice cubes in your closed mouth for as long as you can stand.
2 Wrap a rubber band (loosely) around your wrist and 'snap' it against your skin.
3 Squeeze your ear lobe between your finger and thumb.
4 Squeeze the inside of your nose between the two nostrils with your finger and thumb.
5 Hold your arms in front of you for as long as you can bear.
6 Have a cold bath (Not a hot bath as scalding can kill).
7 Squeeze your nipples between your finger and thumb.

If you really feel you must self-injure it's in your best interests to be honest with the people around you. They're more likely to stick around if you explain the reasons why. If you ask them to make assumptions or pretend to be suicidal when all you want is an end to the emotional pain you feel family, friends and emergency staff may well grow tired of playing what they may well come to se as a game. As a rule people are much more sympathetic if they get the chance to understand why you're choosing to self injure.

Everyone knows what emotional pain feels like and most people will relate to that (even if they don't understand about self-injury itself) if you explain it to them. Most people will also soon come to know the difference between suicidal intention and parasuicidal gestures. If they think you've lied to them they may well just turn their backs on you - precisely what you were trying to avoid in the first place.

If all you can manage is honesty - with yourself and with others - that's a good start. If you must self-injure do it as safely as possible and don't pretend it's more than it is to get validation - it'll only backfire on you. 

If you have a problem with self-injury your local library will have lots of useful information about methods of coping as well as local groups and helping organisations. Please have a look at what's available - it may just save your life.

Permission by Stuart Sorensen RMN