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This page is dedicated to the understanding and explanation of self-abuse (or self-mutilation)

Additional Resources and Places help follow below the articles.

When Pain Is All You Have
Some people in great emotional pain turn to cutting, burning, and other types of self-abuse. How can you recognize this cry for help?

By Dana Sullivan WebMD Medical News
Medically reviewed by Dr. Craig H. Kliger
(C)2000 Healtheon/WebMD. All rights reserved.

Aug. 28, 2000 -- Lauren McEntire was 17 the first time she intentionally cut herself. She was sitting in a darkened movie theater next to a boy who was her best friend. On the other side of him sat his new girlfriend. "I was jealous. I was scared he wouldn't be my friend anymore," she says, two years later from her home in Austin, Texas. "But I didn't know how to tell him how I felt."

Instead, fidgeting nervously in the quiet theater, she yanked the tab off her soda can. Without much thought, she pressed its sharp edge deep into the flesh of her thumb. The pain and blood that followed made her feel, for the first time, as if she were in control. But with the blood came something  more: anger. "A lifetime's worth exploded in that one minute," says McEntire. Within a month, she was a full-fledged self-injurer, graduating to a single-edged razor blade and using it to carve deep grooves into the skin of her arms and legs.

Long misunderstood by outsiders, self-injury (also known as self-mutilation and self-abuse) is finally being taken seriously, and a growing crop of books, television programs, and even a recent made-for-TV movie are spotlighting this surprisingly common phenomenon. The audience is certainly out there: Although few firm statistics are available, those who have treated self-injurers estimate that about 2 million people in the United States engage in some form of this behavior. Cutting is the most common expression of this disorder, but burning, self-hitting, hair-pulling, bone-breaking, and not allowing wounds to heal are other variations.

While more than 70% of self-injurers are women, mostly between the ages of 11 and 26, they come from all races and social classes, says Steven Levenkron, MS, a psychotherapist in New York and author of Cutting. What self-injurers have in common, says Levenkron, is that they are often children of divorce, and as many as 90% grew up in homes where communication between parents and child was lacking and where messy problems were ignored, avoided, and ultimately left in silence.

Cuts Run Deep: Understanding Why
About 50% of self-injurers have a history of sexual or physical abuse, says Wendy Lader, PhD, a psychologist who co-founded and is co-director of SAFE (Self-Abuse Finally Ends) Alternatives, the nation's only in-patient center for self-injurers, in Berwyn, Ill.

Heather Collins, a 26-year-old from Oregon, says the physical pain she inflicted with her own hand for nearly a decade -- using razor blades to cut herself and smoldering cigarettes to burn her flesh -- helped her forget the emotional pain of a childhood marred by sexual abuse. "After I [cut or burned myself,] I felt better," says Collins. This kind of nonverbal expression of anger and frustration is common, says Levenkron. "Many cutters simply lack the language skills to express their emotions." Instead, they feel only self-loathing, alienation, and an intense desire to do themselves harm.

Self-injurers turn to cutting as a way to avoid feelings of worthlessness, numbness, and detachment. They come to appreciate the raw pain of injury; finally, they can feel something. "Self-injurers would rather feel the physical pain than the emotional pain," says Lader.

At the heart of self-injury is control, says Lader. As with eating disorders, self-abuse is a way to take charge of your body. That's one reason many people who self-injure -- an estimated one-half to two-thirds, according to Lader -- also suffer from conditions like anorexia or bulimia. "Self-injury has a hostage-taking effect," says Lader. "It's a way to control parents and friends whose attention you want, or who are worried about you." Whereas the cutter may have previously felt invisible and insignificant, she (or he) is now getting noticed like never before. Self-injury makes others pay attention.

Healing the Wounds
Just as those with eating disorders tend to shroud their activities in secrecy -- anorexics who wear baggy clothes, bulimics who purge in private --self-injurers often injure places that can be easily hidden by clothing, such as the arms, upper chest, and upper thighs.

Yet, Levenkron says, "Self-injurers are not suicidal. They're pretty careful. They don't intend to destroy themselves, so they quickly figure out how deep, how long, they can safely cut." The wounds are usually quite short (only an inch or so, usually on the non-dominant forearm) and very controlled. Nevertheless, tragedies -- including serious medical complications or death -- can and do occur.

Until recently, self-mutilators like Lauren and Heather were bounced from emergency rooms to mental hospitals with little hope for complete recovery. Mental health professionals simply didn't know what to do with them. Even today, says Levenkron, emergency room doctors sometimes dismiss them, suggesting that they'd rather treat "real" patients, or they simply treat the surface wound and send them on their way. But thanks to increased media attention (the teen drama Beverly Hills 90210 featured a self-mutilation story line), the disorder is finally coming out of the shadows. Now a combination of techniques, including psychotherapy, antidepressant medication, and stress-tolerance and stress-management therapies, are being tried and found to help.

Helping Those Who Are Hurting
At Lader's program, she and her colleagues take a "tough love" approach with their patients, refusing to treat them like potential suicide cases, and ignoring the scars (they don't want the focus to be a show-and-tell of the patients' wounds). Instead, they use talk therapy to help them learn to take responsibility for, and control of, their actions.

The program is a last stop of sorts: SAFE patients have been hospitalized an average of 21 times before they get to Lader; one recent patient had been in and out of hospitals 200 times for treatment of self-inflicted wounds. Despite the odds, Lader says the intensive program has a 75% success rate two years after treatment. "Cutting is a way to be temporarily distracted from real feelings," says Lader, "and we help [cutters] learn to put a thought between the impulse and the action, to learn to deal with their feelings without 'self-medicating.' " The program seeks to uncover the motives behind the self-injury; one technique the program uses is having patients reach for a pen instead of a blade and write about their feelings.

As treatment for self-injurers becomes easier to find, friends and family can play a more active role. If you suspect someone you know is a self-injurer -- say you notice a series of similar scars in various stages of healing -- don't just ignore it. "Be direct but empathic," says Lader. "React in a caring way by saying something like, 'I've noticed scratches (or scars) on your body. Did you make them? I'm worried about you and want to help you get help.' " Don't minimize their seriousness, thinking the whole thing is just a harmless fad and that the wounds will heal with time. "Self-injury was my way of telling people that something was wrong," says McEntire, herself a "graduate" of the SAFE program, "but now I use my voice."

Dana Sullivan is a freelance writer based in Reno, Nev.

Article found here: and is posted for informational purposes for Drink Deeply & Dream site and forum members who may have a need.

When One Pain Replaces Another

How can I stop abusing my body?

By Ronald Pies, MD
WebMD Answers to Questions Archive
I find cutting myself on my wrists relieves some of the pain I feel. I have tried other ways -- taking an old towel and wringing it, punching a pillow -- but still I go back to cutting. Can I ever stop?

If you get the proper professional care and treatment, there's a good chance you can stop cutting yourself. Self-cutting and other forms of self-injurious behavior have many causes. No single kind of treatment works for everyone.

Some people injure themselves to release tension or anger. Others do it to control racing thoughts or to "feel more alive." Some find injuring themselves takes their mind off an underlying depression or anxiety. Some say it's the only way they can get people to pay attention to how much emotional pain they are in. Still others hurt themselves because they hear voices commanding them to.

Survivors of Abuse

Many people who injure themselves have a history of being abused early in life. For some of these people, this behavior is a way of transforming an emotional pain they can't control into a physical pain they can, to some degree.

Dealing with self-injury and bleeding may be less scary than facing the deeper sources of emotional pain. Done over many years, self-injurious behavior can become a kind of addiction in which the fleeting relief from emotional pain reinforces the habit of cutting, burning, or other self-injury.

Getting Help

Marsha Linehan, MD, has developed some therapeutic techniques to deal with self-injury and other self-defeating behaviors. The various techniques can broadly be described as accepting reality, letting go of emotional suffering, distraction, self-soothing, improving the moment, reducing vulnerability to negative emotions, and becoming more effective in dealing with others. These are all areas you can work on in a type of psychotherapy called dialectical behavioral therapy.

In some cases, medications can also reduce self-injurious behavior. Prozac-type antidepressants seem to be especially helpful, according to work published by Cornelius and colleagues in the April 1991 Journal of Clinical Psychopharmacology.

You might contact Self-Abuse Finally Ends [SAFE] at 800-DON'T-CUT for more information. But there is no substitute for being seen and treated by a professional. 

Article originally found here:{5FE84E90-BC77-4056-A91C-9531713CA348} and reprinted for informational purposes only.

Self-Injury No Longer Rare Among Teens

Cutting and Other Dangerous Acts Becoming New Cries for Help

By Jennifer Warner
WebMD Medical News Reviewed By Brunilda Nazario, MD
on Thursday, November 21, 2002

Nov. 21, 2002 -- For desperate teenagers overwhelmed with emotions that they cannot express, deliberate self-injury is becoming an increasingly popular and dangerous form of self-expression.

A British study of nearly 6,000 students shows that over their lifetime, 13% of 15- and 16-year-olds have carried out an act of deliberate self-harm. Within the past year, an act of deliberate self-harm occurred in about 400 of the students. Only 50 students went to the hospital, which suggests that the problem may be even more widespread. American experts say those numbers aren't surprising, but until now there has been relatively little research on the issue.

The study, which appears in the Nov. 23 issue of the British Medical Journal, was based on a survey conducted in England from fall 2000 to spring 2001.

Wendy Lader, PhD, co-author of the book Bodily Harm, says an estimated 1% of the U.S. population as a whole resorts to physical self-injury to cope with extreme emotional distress, but that rate is much higher among adolescents and females.

Lader says the phenomenon of self-harm has been around forever, but not at the level it is now. She says that not only are people talking about it more but it's also becoming more common as teens search for a new way to rebel and express themselves.

"It's harder for kids to get noticed as individuals, and they don't have the words for it," says Lader, who is also clinical director of the SAFE (Self-Abuse Finally Ends) Alternatives program at Linden Oaks at Edward Hospital in Naperville, Ill. "So they show it -- even if it's just to themselves because it makes it real for them. It's almost like their body becomes a bulletin board on which to notch their pain."

For some, hurting themselves is a form of suicidal behavior. In fact, nearly half of the students surveyed who engaged in the behavior said they had wanted to die. But for others, Lader says self-injury is a survival method.

"It's a coping strategy to deal with intolerable pain, but it works for them so it's a way of surviving," says Lader. But she says there is always the risk that once the method stops working for them, they could commit suicide -- either accidentally or purposefully.

Researchers say girls seem to be especially prone to self-injurious behavior, and the study found acts of self-harm were four times more common among girls than boys.

Lader says that when girls have a strong emotional response, they tend to act inward rather than outward because it's not "feminine" to be that angry.

"Girls will act on themselves and tend to say that they would rather hurt themselves than anyone else -- not realizing that no one needs to get hurt," says Lader. Coupled with the fact that girls tend to be very body conscious and more dissatisfied with their bodies, she says it's not a stretch for some girls to take their anger out on their body.

David Fassler, MD, a child and adolescent psychiatrist in private practice in Burlington, Vt., says the study's findings are important because they show that there is a significant number of adolescents both in this country and elsewhere in world who have either suicidal or other self-destructive thoughts, plans, and impulses who actually engage in these acts.

"These are kids that are calling out for help, and we need to do a better job at recognizing the warning signs and getting these kids the help that they need," says Fassler, who is also a spokesman for the American Academy of Child and Adolescent Psychiatry.

Warning signs of self-injurious behavior may include the following:

* A history of emotional problems, abuse, or exposure to violence (even if the child was not physically abused)
* Drug or alcohol abuse
* Anxiety
* Impulsive behavior
* Low self-esteem 

Fassler says emotional events such as a breakup with a girlfriend or boyfriend or being kicked out of class or a sports team may also act as a trigger for this type of activity. He says many of the adolescents that resort to harming themselves suffer from undiagnosed depression or other mental disorders that require evaluation and treatment by a trained professional.

As the study authors conclude, "In many cases, self harming behaviour represents a transient period of distress; in others it is an important indicator of mental health problems and risk of suicide.

"Our findings support the need for development and evaluation of school based programmes for the promotion of mental health," write study author Keith Hawton, professor of psychiatry at the Centre for Suicide Research at Warneford Hospital in Oxford, England, and colleagues. 

Article originally found here: and reprinted for informational purposes only

Self Injury
by Colleen Thompson

Many people with eating disorders also engage in the act of self-injury. Just like the eating disorders are used to help the individual cope, the act of injuring oneself is also used to help cope with, block out, and release built up feelings and emotions. Self-injury is probably the most widely misunderstood forms of self harm and there are many myths associated with it, which can make it difficult for people to reach out and ask for help.

Self-injury (self-harm, self-mutilation) can be defined as the attempt to deliberately cause harm to one's own body and the injury is usually severe enough to cause tissue damage. This is not a conscious attempt at suicide, though some people may see it that way.

It has been reported that many people who self-injure have a history of sexual or physical abuse, but that is not always the case. Some may come from broken homes, alcoholic homes, have emotionally absent parents, etc. There are many factors that could cause someone to self-injure as a way to cope.

There are three types of self-injury. The rarest and most extreme form is Major self-mutilation. This form usually results in permanent disfigurement, i.e. castration or limb amputation. Another form is Stereo typic self-mutilation which usually consists of head banging, eyeball pressing and biting. The third and most common form is Superficial self-mutilation which usually involves cutting, burning, hair-pulling, bone breaking, hitting, interference with wound healing and basically any method used to harm oneself.

Most people who self-injure tend to be perfectionists, are unable to handle intense feelings, are unable to express their emotions verbally, have dislike for themselves and their bodies, and can experience severe mood swings. They may turn to self-injury as a way to express their feelings and emotions, or as a way to punish themselves.

You may be wondering why someone would intentionally harm themselves. Self-injury can help someone relieve intense feelings such as anger, sadness, loneliness, shame, guilt and emotional pain. Many people who cut themselves, do this in an attempt to try and release all the emotions they are feeling internally. Others may feel so numb, that seeing their own blood when they cut themselves, helps them to feel alive because they usually feel so dead inside. Some people find that dealing with physical pain is easier than dealing with emotional pain. Self-injury is also used as a way to punish oneself. If they were abused, they may feel ashamed, guilty and blame themselves for the abuse, which in turn causes them to feel the need to punish themselves by inflicting pain to their bodies. Some people have such hatred for themselves and their bodies that they will carve demeaning names on their bodies as a way to remind themselves of how terrible they are. Whatever form of self-injury is used, the person is usually left with a peaceful and calm feeling afterwards. Since those feelings are only temporary, the person will probably continue to self-injure until they deal with the underlying issues and finds healthier ways to cope.

If you feel the urge to injure yourself, below is a list of suggestions that might help you to overcome that urge. Please be advised that not all of these suggestions will be helpful to everyone. What is helpful to one person, may not be helpful to someone else. These suggestions have been provided by individuals who self injured and what they found helpful to them. If you feel that a certain suggestion may in fact cause you to want to self injure even more, do NOT use that suggestion. Find ones that are helpful for you. Again, these are only suggestions and may not be helpful to everyone.

It is very difficult for people to admit to someone that they harm themselves because there is usually so much shame and guilt that goes along with it. It's important to try and remind yourself that there is no shame in what you are doing and that it's okay to reach out and ask for help. In order to help yourself overcome this, you need to want to stop the behavior and you need to find a therapist that you like and trust to help you deal with the underlying issues causing you to do this to yourself. Sometimes treatment may also involve the use of medications such as Xanax and Klonopin. Hypnosis and relaxation techniques can also be helpful, and in extreme cases, hospitalization might be required for a short period of time. If there are support groups in your area, you may want to think about joining them for extra support.

Many people who self-injure keep it a secret because they feel like they are crazy, insane and evil. They fear if they tell anyone, they might be locked away forever. The truth is, people who intentionally harm themselves are in fact very normal and sane people, who are in a lot of emotional pain. They self-injure as a way to cope, because they were probably never taught how to deal with intense feelings and emotions in healthy ways. Unfortunately, when people hear about this form of self-harm, they do tend to place labels on these people as being psychotic and crazy, which is why so many people do not come forward and ask for help. Until society dispels all the myths surrounding self-injury and start to educate themselves on this subject, sufferers will continue to keep quiet and this form of abuse will continue to be a secret for a long time to come.


Please know you are not alone and this does not need to remain a secret. 
Please take the time to talk to your family, teachers, or other adults so the hurt can end.

Additional resources are available. (Contact me if you know of other places for support)

For Parents of Self-injury teens:

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