Since Princess Diana mentioned 'hurting herself' in that now infamous Panorama interview, self-injury has slowly become a topic of media interest. However, it is usually portrayed as 'sick' and 'disgusting', and the people are suggested to be 'mentally ill'. An article in the Sun newspaper on an anorexic Coronation Street¹ star described her 'hell' at being put in a hospital ward with 'women so sick they slashed themselves with razors'.

However, this is far from an accurate portrayal of people who self injure. The first thing to take into consideration is that self-injury itself is not usually the problem. It is a way for the person to deal with an underlying problem.

Many people are likely to know someone who does this, and who probably goes to great lengths to hide it. It seems to remain a taboo subject. Depending on the person, this could be due to embarrassment or fear of what people may think. Misconceptions and an inability to understand often leave friends and family of the person not knowing how to deal with the problem.

Self-injury tends to go unnoticed, and can include many different types of actions: cutting, burning, swallowing chemicals or banging your head and slamming your hand in a door. Simply, it's intentionally causing harm or pain to your body, and there are likely as many methods as people that use them. Most self injurers will have a 'preferred' method and use alternatives for back-ups.

Several studies have found that approximately 4% of the general population admitted having self-injured. Among those who are seeking mental health treatment, the rate rises to 21%. Despite the common perception that it is mostly a female problem, that doesn't seem to be born out when looked at scientifically. It is, however, more common in people who have symptoms of anxiety or depression, and also in people have been victims of abuse or trauma. Self-injury is also common in developmentally disabled individuals, but what happens in those cases is generally seen to be different than that which is described in this entry.

What it Isn't

Self-injury is not 'attention seeking'. As Louise Pembrooke, founder of the National Self Harm Network, puts it:

If it was attention I wanted, I'd take my clothes off and walk into the street.

Self-injury also is not suicide, or an attempt at suicide.

Self injurers are also extremely unlikely to be a danger to others, or to be 'mad' or 'crazy'. In fact, the whole point of self injury is exactly that - the damage and the feelings are taken out on one's own body, not onto others. This is probably the reason for the higher percentage of female self injurers over male - it's perhaps more socially acceptable for a guy to go out and get into fights, or to vent his anger externally.

What it Is

Self-injury is a way of coping with feelings and emotions that may seem unbearable, a way of letting them out and relieving distress or tension. It can be to punish yourself, deal with numbness, stop yourself feeling like you are about to explode, stop disassociation, make flashbacks stop or express emotion. There are many reasons, and none of them should be regarded as stupid. To widen the term, you could include overworking, deliberate lack of sleep, over- or under-eating and many other things. Self-injury in itself can be addictive, and is often seen as a way of taking control over something when you can't seem to control anything else.

If you Self Injure

The first thing is to remember you are not alone, and you can overcome what you are dealing with. You can replace it with other ways of coping with feelings that are less damaging to your physical and emotional self. Anna, who self injured from age 19 until she was age 30 says:

I see my scars as battle scars now. They represent the struggle I fought to stay alive - and I won!

There are things that you can do to help yourself.

• Find safe and supportive people to talk to who will listen to you without giving judgement. Try and help them understand- bearing in mind it is difficult for someone who has never self injured, and you may have to accept they might never totally grasp it. The less shame and secrecy around your self-injury, the better.

• Join some kind of support group. The UK Self-injury Page has a list of groups and contacts for Great Britain, or try an online group like the Bodies Under Siege email list (see resource box at the end of this entry for both contacts). Talking to people who've been there can again lessen the shame around self-injury and make you feel less alone.

• Learn enough basic first aid to take care of your injuries. Chemists sell steri-strips, antiseptic, and bandages; and you should never use a blade or sharp edge to cut with that isn't clean. While you may have reasons why you want to treat some injuries at home, remember sometimes you must seek medical attention if it is needed. In countries without a national health care system, many private health insurance plans won't cover medical expenses for anything relating to self-injury.

• Try and look at what the feelings are that make you want to self injure. You can then ask other people what sort of things they do instead. So if you cut when you feel angry, you could try ripping up phone books; if you want to cut to remind yourself that you're real and alive, try other means of getting sensation, such as holding an ice cube in your hands. If you cut when you feel scared, why not try curling up with a teddy and a blanket, or calling a safe friend? Even if these tactics only help delay the self-injury at first, that's a major achievement.

• Pills alone are not the answer- any kind of 'treatment' that just focuses on stopping the self-injury will most likely fail, unless it's backed up with giving you some positive alternative ways of coping too. Remember, some medications have side affects and not all work on everyone. Some have been known to make people feel worse, so be careful and if you think it's not working make sure people know. However, they can help some people in learn new coping mechanisms, perhaps more for those whose self-injury is related to anxiety or depression.

• Counselling might help, especially as a large number of people who self injure have a past history of abuse of some sort. It's worth shopping around and persevering to find a counsellor you can work with, and prepare for a long haul. Cognitive-behavioural therapy is a specific type of counselling that has shown to be helpful with self-injury, especially perhaps as it focuses on learning and practicing new coping mechanisms.

• Above all, be easy on yourself. You're not going to be able to stop all at once. Beating yourself up will only set up more guilt and shame and make another bout of self-injury more likely.

How to Help?

If you've got a friend you think might be self injuring, there are some general things that are worth remembering. The first, and most important, is to take care of you, and your own feelings and reactions too.

You should realise you will have a variety of feelings about what they do yourself. Remember- your first opinions may be wrong. How can you be sure you know everything about this person? If you are angry and think they are attention seeking, take a step back. How can you be sure of this, and is getting angry going to help? Whether or not it is attention seeking, self-injury is still not the best way to be noticed.

One thing to bear in mind is that anyone doing this probably has incredibly low self esteem, and believes themselves to be absolutely worthless. For them, the self-injury is only proof of this. If they've trusted you to talk to about this, your reaction is critical. Any signs of revulsion will most likely be taken as you rejecting them, even if it's more your own shock at realising what they do to themselves. Remember that they are likely very upset and try to understand their inability to stop what they are doing. Think: if they could just stop, wouldn't they have already? So be as supportive as you can be, while at the same time making sure that you get some support for yourself too if you need it! In the meantime, these are some practical things that might help.

• Try not to freak out. Remember, this is just their way of coping with distress.

• Try and be open in your attitude to it. It may be hard for you to understand, and you may never fully understand, but you need to try and help them feel safe and able to discuss it with you, and need to let them know that you will accept them and be there for them regardless of what they do. Therefore make it clear that self-injury is okay to talk about, and can be understood.

• Don't assume that the depth of the cut represents the depth of their pain - a shallow scratch can be just as indicative of great despair as a wound that needs stitching.

• Don't put pressure on them to stop, or take away their means of self injuring. This will often only add to the guilt and pressure that a self injurer feels about their behaviour.

• Above all, listen. Remember that they may not just want to hear your opinions on what they should do constantly as likely as not they may have heard it a hundred times before, but sometimes just being able to talk to someone who will listen and not give judgement is a therapy in itself.

• Encourage them to get help - a counsellor is practically essential, and there are also helplines listed below.

Sources of Help

Obviously a brief entry like this can only give a short outline of what is an extremely large and complex issue that carries different meanings for each individual. If you are in the UK, the organisations below can provide information, and someone to talk to:

The National Self Harm Network is a survivor-led organisation committed to campaigning for the rights and understanding of people who self-injure. The network is focused on its campaign to improve the treatments in Accident and Emergency (ER) departments, publishing leaflets for health staff, supporters and people who self-injure.

Contact: NSHN
PO Box 16190
London NW1 3WW

If you're not in the UK, check your phone book for agencies that can help you.