Self-Injury

By Dr. Courtney Mizuhara-Cheng, D.O., and Minh Nguyen, Candidate for Doctorate of Osteopathy 2016

Many people have different ways of coping under stress.  In this scenerio, a student doctor describes an interaction she witnessed with slight alterations to protect the identity of the individuals involved.  

“Would you mind taking your sweater off so I can look at your arm?”  My young patient accompanied by her mother presented with right arm pain. I had noticed an interesting dynamic between the mother-daughter duo.  “She’s a whiner. Been complaining about that stupid arm for months. I want you to tell her today that it’s normal and she’s being a baby, and so I can get on with my day,” said the mother.  As I had learned in medical school, I always started with the normal side, her non-hurting arm, to compare. There they were; lines: old and new and scabby and pink and perfectly parallel to each other, lines that had been created with the help of a razor blade. I was taken aback, but then it dawned on me that I should have suspected something. It was a scorching hot day in Southern California, and my 13 year-old was wearing a sweater.  “What are those? WHAT DID YOU DO? They weren’t there two days ago! WHAT DID YOU DO?” cried the mother with tears streamig down her face. In the midst of shock and confusion, the mother left the room, slamming the door behind her.  Silence filled the room, as my patient looked at her hands.

What is Self-Injury?

Self-injury is any deliberate, non-suicidal behavior that inflicts physical injury your own body. Contrary to the common stigma, self-injury is a coping mechanism that may enable a person to deal with intense emotional distress, creating a calming sensation. Self-injury may be used to "awaken" a person from the numbness or dissociation related to the hidden emotional pain. It is not a cry for attention and it is far from uncommon. Those that practice this coping mechanism tend to do it in private and hide their injuries from the public, such as wearing baggy clothes, sweaters, etc. While self-injury may bring a brief moment of calm and release, it is not a cure. It is usually followed by guilt and shame and the return of the emotions people try to run from in the first place.

Who Self-Injures?

Self-injury affects peopple from all walks of life, irrespective of age, gender, sexual orientation, ethnicity or personal strength.

What are some ways of self-harm?

Some forms of self-injury get talked about more often than others, but you may have found your own unique ways to hurt yourself. It is still self-injury.

• Cutting
• Burning
• Breaking bones
• Head banging
• Biting
• Pulling out hair
• Persistently picking at wound and interfering with healing

If you or someone you know has self-harming behaviors, a health care professional can help to provide alternative coping strategies and address the underlying emotional stressor.  By understanding the cause of the coping mechanism, the hope is that one can make positive changes in their lives, empowering themselves to move away from self-injury to healthier coping mechanisms.  

CONNECT WITH YOUR BODY

What causes a person to self-harm?
According to HelpGuide.org, here are some myths and facts about self-injury:

HARMONIZE WITH YOUR FEELINGS

What can I do to help?

Express your feeling by journaling or other artistic expressions (i.e., art, poetry, etc).  All yourself to be honest and avoid negative judgements about yourself to enter.
Treat your body and your mind. Put yourself and your well-being first. 
Regular physical activities release a great amount of endorphins, which can boost your mood and reduce stress.
Healthy meals with fresh fruits and vegetables can help.
A good night sleep will have a great positive effect on your day.
Spend time everyday doing something that you enjoy.

INTEGRATE YOUR PHYSICIAN

How is Self-Injury treated?  

Treatment for self-injurious behavior can be difficult as self-injury is often kept secret and hospital treatment frequently avoided.  Talking about self-injury can be really hard. Treatment relies on understanding the underlying emotional stressor.  Problem solving skills-training and cognitive behavior therapy is available within counseling and talking therapy.  If you are considering psychotherapy, different coping strategies to deal with emotional stress must be in place prior to therapy starting to avoid a potential increase in frequency and severity of self-injury.

Where do I find help? 

If you are doing self-injury, the first and most important thing you need to know is: it is okay to ask for help. Asking for help is not a weakness, and it is far from a shame. It is the first step of the most empowering journey you will ever take. To know and accept yourself, to want and embrace change is courageous and heroic. 

That said, reaching out can feel extremely difficult, if you are worried that people will judge you. Know that everyone needs support at one time or another, even the strongest and most successful. 
When you are ready, choose someone that you trust: a friend, a family member, a mentor, a counselor, a psychologist, or your doctor, etc. There are support groups, online or in person. You do not have to walk this journey alone. 

Where can I find more resources? 

www.helpguide.org, www.selfinjury.com, www.reachout.com
Remember, you are not alone.