Reprinted from "First Responders for Young People" issue of Visions Journal, 2006, 3(2), pp. 18-19
Self-injury refers to causing minor or moderate injuries to one’s own body. Common methods are cutting, burning, scratching or hitting oneself. Sometimes it is also called self-harm or self-mutilation.1 Self-injury is not a suicide attempt. It is a way of surviving by reducing emotional pain.2
I started self-injuring nine years ago, when I was 21. When I couldn’t focus on my university coursework, self-injuring helped me concentrate and continue studying.
Self-injuring became an outlet for painful feelings. At times, I felt like I had fallen into a void that held only the present unbearable moment. I couldn’t remember what it felt like to be cared about or to feel calm—though I often looked calm on the outside, despite my inner turmoil. I had no words to explain what was bothering me. Having a physical injury was a way of telling other people that I was hurting.
When I self-injured, I floated away from myself. This disconnection allowed me to injure my own body. After I self-injured, I still felt bad—but in a less intense way. The physical pain distracted me from my emotional pain. The need to get medical treatment was something concrete to focus on.
Because I have received effective therapy and have learned other coping skills, I now self-injure less often and less severely. However, coping without self-injury is an ongoing struggle.
I have had some difficult experiences receiving medical treatment for my self-inflicted injuries. A doctor at the emergency room told me that the other patients were there for reasons that weren’t their fault, but I was there because it was my own fault. He said that he would treat all the other patients in the treatment area first—I would have to wait until he was finished. He was very rough in cleaning my injury, causing more physical pain. I felt unsafe being treated by this doctor, so I left the hospital and found treatment elsewhere.
A doctor at a burn clinic told the medical students he was supervising that I was "obviously a very bitter young woman." Another doctor at the burn clinic ordered me to not self-injure again. When I came back with a new injury, he got angry with me for not following his order. At times, I was given inferior medical treatment—I think that, because I had so many scars, doctors reckoned that it no longer mattered how well my injuries healed.
I believe that the doctors' unhelpful responses came from their lack of understanding about self-injury. Unfortunately, their responses hurt me deeply, which ultimately contributed to more self-injury—and increased my fear and shame when seeking medical treatment.
Not all my experiences with medical staff have been negative. My family doctor has been a consistent source of support. If I need treatment for an injury now, I usually visit a walk-in clinic where the doctors treat me with respect. It was helpful for me when one of them encouraged me to come and talk to her before self-injuring. Clearly, the way medical staff treat people who self-injure can either help or hinder the recovery process.
Unhelpful Responses to Self-Injury
Telling the person to stop self-injuring. People need to learn other ways to cope before they are ready to stop.3
Calling self-injury (or the person) manipulative or attention-seeking.
Trying to deter the person from self-injuring again by making the medical treatment experience as bad as possible. Doing this may cause him or her to feel angry or ashamed. These feelings can contribute to more self-injury and to avoiding medical treatment in the future.4
Forcing a person to remove his or her clothes when it isn’t necessary for medical reasons. Many people who self-injure are survivors of sexual abuse and find it traumatic being forced to undress.
Punishing the person by giving stitches without anesthetic or treating his or her injuries in a way that causes unnecessary pain.5
Helpful Responses to Self-Injury
Educating yourself about self-injury.
Understanding that even if the person looks calm or capable, he or she may be feeling quite upset inside.6
Acknowledging the person’s distress, even if you don’t understand why he or she is distressed.
Offering the same quality of medical treatment for self-inflicted injuries as for accidental injuries.
Interacting with the person respectfully and avoiding judgments.
Being aware of your emotions when dealing with self-injury (fear, anger and shock) and not communicating them to the person who self-injures. Finding support for yourself if you need it.5
About the author
Lisa Marie is a mental health consumer recovering from borderline personality disorder and post-traumatic stress disorder. She is currently pursuing her psychology degree at Simon Fraser University and volunteers with Vancouver Coastal Health.
- Sutton, J. (2005, May 11). Terminology: Establishing the most appropriate term to describe the act of hurting oneself. Accessed August 24, 2006, at www.siari.co.uk/self-injury_terminology.htm.
- Martinson, D. (1998). Self-injury: A quick guide to the basics. Accessed August 24, 2006, at selfharm.net/guide.html.
- Jeffrey, D. & Warm, A. (2002). A study of service providers’ understanding of self-harm. Journal of Mental Health, 11(3), 295-303.
- Martinson, D. (1998). Emergency-room personnel and self-injury. Accessed August 24, 2006, at selfharm.net/erworker.html.
- Martinson, D. (1998-2001). Bill of rights for people who self-harm. Accessed August 24, 2006, at selfharm.net/brights.html.
- Bristol Crisis Service for Women. (1997). Helpful responses to self-injury. [Brochure]. Accessed August 24, 2006, at www.users.zetnet.co.uk/BCSW/pdfleafs/Helpful%20responses.pdf.