You bleed just to know you're alive

However, this is far from an accurate portrayal of people who self injure. It's a behaviour that usually goes unnoticed. Apart from, perhaps, a habit of wearing long sleeves no matter what the weather, And it's a behaviour that's all too common among young people, male and female. Statistics vary, but range from 14 to 750 per 100,000 people in the general population. The ratio of women to men is estimated at anything from 2:1 to 20:1. Self injury can cover a variety of behaviours, all carried out with the aim of producing damage or injury to the self, and, in some cases, pain¹. Lois Arnold's 1995 survey of 76 women found the following frequency of behaviours:

• Cutting - 90% of sample. (78% to arms and hands, 31% to legs)
• Inflicting blows - 30%
• Burning/scalding - 30%
• Picking/scratching - 12%
• Pulling out hair - 7%
• Biting - 5%
• Swallowing (objects or harmful substances) - 4%
• Inserting objects (into bodily orifices) - 3%
• Scrubbing/scouring body - 3%

While this is not a complete list - there are probably as many ways that a person can hurt themselves as there are people who self injure - it covers the main methods. Most self injurers will have one 'preferred' means of choice, with alternatives for back ups.

Anna², a former self injurer, tells how she began self harming:

I can remember very clearly the first time I self injured. It was in the February of my first year of a degree in French and Russian at Uni. I'd been feeling as if I didn't deserve to be there, and was a total fraud. Back in October, I'd taken refuge in the only thing I knew how to do - dieting. My six months of rigid control, 200 calorie a day starvation had just cracked. I'd experienced my first 'binge'. Desperate, I attempted to make myself vomit.. and failed. This was it, my life had completely collapsed. I took the only implement to hand, a small kitchen knife, and cut myself horizontally along my wrist.

I didn't die... in fact the blade did little more than scratch the surface... but I discovered that the scratching gave me a calmness, quietened the turmoil within. This then became my regular pattern: starve for as long as possible, binge eat, try and fail to vomit, so cut my arms instead. Within a week or so, I'd graduated from the kitchen knife to razor blades, and had realised that it was the bleeding that was important.

Watching the blood trickle down my arm, I could feel all the tension leaving me. Like the steam escape valve on a pressure cooker, letting the blood out would calm me, and help me get grounded once more. Then of course, there was the practical matter of cuts to blot (I used to use great wadges of tissues), sleeves to be pulled down, and 'normal' life to be resumed.

Two or three weeks down the line, I discovered that I didn't need the pre-cutting binge ... in fact, that cutting alone could often prevent a binge. The choice was simple - cut my arms, or stuff my body with food, and get fat. So, the binges decreased in frequency, and the cutting increased. I really could not understand the people around me who were concerned by this - they seemed to much prefer that I would binge instead of cut, whereas for me, it was totally the other way around. Cut and scar this body I hate? Sure, no problem.

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.

Most people who self injure do their best to cut on places that can't be seen, and to keep their injuries from others. Any injuries that you do see may represent only a fraction of the total.

Self injury also is not suicide, or an attempt at suicide. In fact, it's very often the exact opposite - a way of staying alive whilst in extreme distress and pain. A former self injurer, Emily said: 'These scars represent the ultimate in self restraint. They are the least amount of damage I could do to myself'.

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 harm is exactly that - the damage, 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

Above all, self injury is a way of coping. Coping with feelings and emotions that otherwise might seem unbearable.

Emily³ puts it this way:

Some people when they get stressed would go down the pub and get completely rat-arsed. Other people I know chain smoke. Or over eat. Me, I'd nip into the loos, and cut my arms a few times. And come out a few minutes later feeling so much calmer, and more able to cope. Which is more than you can say for anyone trying to take lecture notes when pissed.

Seeing it in those terms makes it somehow less scary. More understandable. All of which are good things, especially when trying to overcome self injury, or when helping a friend.

If you self injure

The main thing to hold on to is that self injury can be overcome, and replaced by 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 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. Show them this article if need be. 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 article for both contacts). Talking to people who've been there can again lessen the shame around self harm.
• Learn enough basic first aid to take care of your injuries. Boots sell steri-strips antiseptic, and bandages; and if you use a blade or sharp edge to cut with, make sure that it's clean.
• 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.
• 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. 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.
• 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 harming, there are some general things that are worth remembering. The first, and most important of which, is to take care of you, and your own feelings and reactions too.

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. 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.
• 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.
• Make it clear that self-injury is okay to talk about, and can be understood.
• Don't put pressure on them to stop, or take away their means of self harming. This will often only add to the guilt and pressure that a self injurer feels about their behaviour.
• Encourage them to get help - a counsellor is practically essential, and there are also helplines listed below.

Sources of help:

Obviously a brief article 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.

Nottingham Women's Crisis Centre Helpline available on Friday and Saturday night, 9pm-midnight on 0115 958 3399.

The Bristol Crisis Service for Women (BCSW) national Helpline available on Friday and Saturday evenings from 9pm to 12.30am on 0117 925 1119

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

Websites:

More information about self injury can be found at the following websites:

Self Injury Mainly UK based resources, information sheets from NSHN and BCSW, and some rather sick humour too.

Secret Shame. Although not updated for over a year now, this is still the top site on the subject. It's a great source of research-based information, as well as containing contacts for US and Canadian resources.

Bodies Under Seige (bus) Email list: send email to [email protected] with the message "subscribe bus".