Parents, teachers, and other adults go to great lengths to protect teenagers from harm. Yet, within any group of adolescents, statistics indicate one of every five females and one of every seven males either are currently engaging or have engaged in self-injurious behaviour. Most began in junior high, and many also struggle with untreated mental illness. As disturbing as these statistics are, they probably under-represent the actual number of individuals struggling with self-injurious behaviour because most people who self-injure conceal their behaviour and never seek assistance.
What Is Self-Injury?
Self-injury is purposefully engaging in behaviors intended to self-harm. These behaviors are usually NOT suicide attempts though they may occasionally result in death. Some individuals engage in self-injury a few times and stop while others find it extremely difficult to stop. Self-injury is often a way of dealing with distressing emotional pain. As strange as it sounds, hurting yourself physically can create temporary positive sensations. Some people use self-injury to cope with problems and other utilize it to stop feeling lonely, sad, anxious, angry, or hopeless.
Self-injurious behaviors can include:
* Cutting (using a razor blade, knife, or other sharp object to cut or scratch the skin)
* Punching self or things
* Burning with cigarettes, matches, or candles
* Pulling out hair
* Poking objects through body openings
* Breaking bones or bruising body
Myths About Self-Injury
Truth: The seriousness of the wounds has little to do with how much emotional distress the individual injuring themselves may be in. It is important not to assume minor injuries mean minor emotional issues. All self-injurious behavior should be taken seriously and treated.
Truth: Individuals who self-injure are struggling with internal pain and may also be dealing with anxiety, depression or other mental health conditions. However, this does not make them more dangerous than other people. They should not be labeled or treated as though they are dangerous.
Truth: People who self-injure generally do so secretively and go to great lengths to hide what they are doing. They often experience high levels of shame and fear which make it difficult to admit they are struggling and to seek help.
Warning Signs of Self-Injury
Individuals engaging in self-injurious behavior often hide the physical signs of their injuries and cover their inner turmoil with a calm exterior. This makes self-injury difficult to detect. However, warning signs to watch for include:
- Unexplained wounds or scars
- Blood stained clothing, towels, tissues, or bedding
- Sharp objects in personal belongings
- Frequently explaining away injuries as being “accidents” or “clumsiness”
- Wearing long sleeves or long pants even in hot weather
- Excessive periods of time spent alone in bathrooms or bedrooms
- Isolation and irritability
If You Suspect Someone Is Self-Injuring
- Listen without being critical; remember to focus on them rather than your feelings.
- Try to understand their feelings.
- Help them find out the facts about self-injury.
- Remind them self-injury is not a shameful secret, but a problem to be addressed.
- Encourage them to seek professional help to learn new ways of addressing problems.
- Try to be their therapist or tell them what they need to do differently.
- Expect them to stop quickly or because you want them to.
- Get angry or upset with them about their self-injury.
- Physically struggle with them to stop the self-injury. This may result in unintended harm to either you or the other individual. Walk away or call the police for assistance.
- Make them promise not to do it again.
- Threaten to leave the relationship unless they stop.
Resources to Help
If you suspect someone you care about is engaging in self-injurious behavior, starting a conversation can be one of the most difficult but most caring things for you to do. It is better to err on the side of open communication than to say nothing and have them continue to suffer in silence. Below are resources to help address self-injurious behavior:
S.A.F.E. Alternatives Information line (800-366-8288) provides referrals and support for those engaging in or affected by self-injurious behavior
SelfInjury.com has numerous resources and assessment tools
Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron
Stopping the Pain: A Workbook for Teens Who Cut & Self-Injure by Lawrence E. Shapiro
Talking about self-injurious behavior is stressful and brings up a myriad of emotions. Don’t be discouraged if the situation gets worse as it begins to be addressed. While it is initially uncomfortable, dealing with the issues and learning new patterns of managing emotional distress can result in life-long positive outcomes well worth the initial discomfort.
Jean Holthaus, LMSW, LISW has been providing outpatient therapy services since 1995 when she earned her Masters of Social work degree from the University of Iowa and has worked for Pine Rest since 1997. She currently serves as manager of the Telehealth Clinic and the Hastings Clinic and is also a Pine Rest Outpatient Regional Director. She is trained in cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), interpersonal therapy, and narrative therapy. She is deeply invested in walking with individuals struggling to find meaning an purpose in the mist of the struggles of life. She is also passionate about providing educational services which equip individuals to proactively address mental health issues. Jean started her career as a teacher after earning her BA in Elementary Education from the University of Northern Iowa in 1985. She was an elementary and junior high teacher for 10 years prior to beginning her career as a therapist.
Jean’s professional experience includes working with children, adolescents, individuals, couples and families within a therapist setting. She has also worked as a dialysis social worker in a hospital setting. Jean enjoys working with adolescents and adults dealing with abuse, depression, marital issues, divorce, spiritual issues, changes of life, parenting, and family issues. She participates with Faith Community Outreach, an initiative within Pine Rest that seeks to connect area clergy, churches, and ministries to services from Pine Rest as well as develop new services specifically designed to benefit the faith community.