I had been seeing Mark for just a couple of weeks. He always wore long sleeve shirts, even in the middle of summer. That should have been my first clue. But Mark had a lot of tattoos on his body, so I wrongly assumed that he had “sleeves” of tattoos that he was simply covering during our sessions.
Little did I know that what was actually concealed underneath the sleeves of his shirts were a vast series of scars, scabs and fresh wounds.
Mark denied engaging in self-injury when we first met. During the intake, he mentioned thinking about self harm on several occasions, but never acting on it. As our trust and relationship was growing, he decided it would be safe to share his “legacy”, for that is what he called the scars that marked his body.
Mark would never injure himself where the scars would be visible to a passerby, or acquaintance. So no scars on his wrists or face, just his shoulders, chest and stomach. Mark said that whenever he felt “dead inside” he would cut, scratch, or burn himself, until it bled or he could not stand the pain.
As I discuss in my book, 100 Questions and Answers about Anorexia Nervosa, while Mark’s behaviors may strike some as being highly unusual and may indeed be quite troubling, self-injury is becoming increasingly common among eating disorder patients. Approximately 25% of people with an eating disorder engage in self-injurious behaviors. The risk increases with the presence of co-occurring mood disorders and certain personality disorders.
Self-injury (also called self-mutilation, self-harm, or self-abuse) is defined in the Journal of Clinical Psychiatry as behavior involving the deliberate infliction of physical harm to one’s own body without any intent to die as a consequence of that behavior. In other words, self-injury is not necessarily an attempt at suicide, although that possibility should always be considered (Shepphird, 2009).
Examples of common modes of self-injury include hair-pulling, skin-cutting, head-banging, skin-picking or scratching, biting, hitting, or burning. Tattoos, bracelets and clothing are often used to conceal the practice or history of self-injury, as I discovered was true in mark’s case.
What motivates a person to self-injure? Patients have reported engaging in self-injury for reasons that include:
1. Coping with very uncomfortable emotions. People who self-injure report extreme feelings of tension, anxiety, stress, or emotional pain just before harming themselves. Patients sometimes see self-injury as a way of distracting themselves from that pain or “releasing it” in an attempt to self-soothe; many report that self-injury makes them “numb” to their emotions, bringing them a sensation of peace or temporary relief (Shepphird, 2009).
2. Conversely, some patients who self-injure report feeling “dead inside” and “numb” to emotional states. In these cases, self-injury becomes a means of reminding themselves that they are “alive on the inside” (Shepphird, 2009).
3. Self-harm can also be a form of self-punishment for behaviors that bring shame or guilt. Yet self-injury is often a vicious cycle, given that the perceived relief is only temporary and does not represent a means for dealing with the underlying issues. In fact, the shame that people feel after harming themselves may lead to additional attempts at self-harm (Shepphird, 2009).
The cycle of self-injurious behavior may yield an increased sense of desperation, potentially involving attempts at suicide. Therefore, self-injurious behavior should always be taken seriously. It can be a delicate topic in therapy, as you would imagine, because some patients may scoff at the suggestion that they are engaging in potentially suicidal behavior. Many who self-injure do not express the intent to die, and for them, self-injury may instead be a way of living, as difficult as that may seem to understand.
At the very least, self-injury represents a threat to an individual’s overall well-being and quality of life. The reality is that self-injury can cause more harm than intended and can result in serious medical complications, or even death.
There are many fine resources available for further information about self injury. Among them are:
http://www.selfinjury.com and their companion phone number (800) Dont-Cut
http://www.selfinjury.org
http://helpguide.org/mental/self_injury.htm
http://www.focusas.com/SelfInjury.html
and books such as:
Secret scars: Uncovering and Understand the Addiction of Self-Injury, by V.J. Turner
Treating Self-Injury: A Practical Guide by by Barent W. Walsh
Helping Teens Who Cut: Understanding and Ending Self-Injury by Michael Hollander
and you can find a more comprehensive listing of resources by clicking here.
**Source: Shepphird, S.F. (2009). 100 Questions and Answers about Anorexia Nervosa.Sudbury MA: Jones & Bartlett Publishers.
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