Self-Inflicted Violence: Helping Those Who Hurt Themselves

by Tracy Alderman, Ph.D.

After having an awful day at work and an even worse time fighting the traffic to come home, Joan wanted nothing more than to sit down on her couch, turn on the television, order out for pizza and relax for the rest of the evening. But when Joan walked into the kitchen, what she saw indicated that this would not be the evening of her dreams. Standing in front of the sink was her fourteen year old daughter, Maggie. Maggie's arms were covered with blood, long slashes on her forearms dripping fresh blood into the running water of the kitchen sink. A single edged razor blade sat on the counter along with several once-white towels, now stained crimson by Maggie's own blood. Joan dropped her briefcase and stood before her daughter in silent shock, unable to believe what she saw.

It is likely that many of you have had a similar experience and reaction to learning of the self-injurious activities of a loved one. This article is intended to provide some support, advice, and education to those of you who have friends and family who engage in activities of self-inflicted violence.

Self-Inflicted Violence: The Basics
Self-Inflicted Violence (SIV) is best described as the intentional harm of one's own body without conscious suicidal intent. Most types of SIV involve cutting of one's own flesh (usually the arms, hands, or legs), burning one's self, interfering with the healing of wounds, excessive nail biting, pulling out one's own hair, hitting or bruising one's self, and intentionally breaking one's own bones. SIV is more common than you might think with roughly 1% of the general population engaging in these behaviours (and this is likely to be greatly underestimated). The explanations for why people intentionally injure themselves are numerous and diverse. However, most of these explanations indicate that SIV is used as a method of coping and tends to make life more tolerable (at least temporarily).

How Can I Help Those Who Are Hurting Themselves?
Unfortunately, there is no magic cure for self-inflicted violence. However, there are some things which you can do (and some things you shouldn't do) which can help those individuals who are hurting themselves. Keep in mind though, that unless someone wants your help, there is nothing in the world that you can do to assist that individual.

Talk About Self-Inflicted Violence
SIV exists whether you talk about it or not. As you know, ignoring anything does not make it disappear. The same is true with self-inflicted violence: it will not go away because you are pretending it doesn't exist.

Talking about self-inflicted violence is essential. Only through open discussions of SIV will you be able to help those who are hurting themselves. By addressing the issues of self-injury you are removing the secrecy which surrounds these actions. You are reducing the shame attached to self-inflicted violence. You are encouraging connection between you and your self-injuring friends. You are helping to create change just by the mere fact that you are willing to discuss SIV with the person who performs those behaviours.

You may not know what to say to the individual who is performing acts of SIV. Fortunately, you don't have to know what to say. Even by acknowledging that you want to talk, but you're not sure how to proceed, you are opening the channels of communication.

Be Supportive
Talking is one way to provide support, however, there are numerous other ways to show your support to another. One of the most helpful ways by which to determine how you could offer support is to directly ask how you might be helpful. In doing so, you might find that your idea of what is helpful is vastly different from how others view what is helpful. Knowing what kind of assistance to offer and when to offer it is necessary in order to be helpful.

Although it may be difficult for you, it is really important that in being supportive you keep your negative reactions to yourself. Because judgments and negative responses contrast with support, you will need to put these feelings aside for the time being. You can only be supportive when you act in supportive ways. This is not to say that you should not or will not have judgments or negative reactions to SIV. However, conceal these beliefs and feelings while you are performing helpful behaviours. Later, when you are not assisting your friend, go ahead and release these thoughts and emotions.

Be Available
Most individuals who injure themselves, will not do so in the presence of others. Therefore, the more you are with those individuals who hurt themselves, the less opportunity they will have to inflict self-harm. By offering your company and your support, you are actively decreasing the likelihood of SIV.

Many people who hurt themselves have difficulty recognizing or stating their own needs. Therefore, it is helpful for you to offer the ways in which you are willing to help. This will allow your friends to know when and in what ways they are able to rely on you.

You will need to set and maintain clear and consistent limits with your self-injuring friends. Thus, if you are not willing to take crisis calls after nine in the evening, than indicate this to your friends. If you can only offer support over the telephone, rather than in person, be clear about that. When individuals need support around issues of SIV, they need to know who is available to help them and in what manner they can offer help. While what you do for your friends is important, establishing and maintaining appropriate boundaries is equally necessary for the relationship (and your own sanity).

Don't Discourage Self-Injury
Although this may seem difficult and irrational, it is important for you to not discourage your friends or family from engaging in acts of self-inflicted violence. Rules, shoulds, shouldn'ts, dos and don'ts all limit us and place restrictions on our freedom. When we maintain the right to choose, our choices are much more powerful and effective.

Telling an individual to not injure herself is both aversive and condescending. Because SIV is used as a method of coping and is often used as an attempt to relieve emotional distress when other methods have failed, it is essential for the person to have this option. Most individuals would choose to not hurt themselves if they could. Although SIV produces feelings of shame, secrecy, guilt and isolation, it continues to be utilized as a method of coping. That individuals will engage in self-injurious behaviours despite the many negative effects is a clear indication of the necessity of this action to their survival.

Although it may be incredibly difficult to witness a loved one's fresh wounds, it is really important that you offer support, and not limits, to that individual.

Recognize the Severity of the Person's Distress
Most people don't self-injure because they're curious and wonder what it would be like to hurt themselves. Instead, most SIV is the result of high levels of emotional distress with few available means to cope. Although it may be difficult for you to recognize and tolerate, it is important that you realize the extreme level of emotional pain individuals experience surrounding SIV activities.

Open wounds are a fairly direct expression of emotional pain. One of the reasons why individuals injure themselves is so that they transform internal pain into something more tangible, external and treatable. The wound becomes a symbol of both intense suffering and of survival. It is important to acknowledge the messages sent by these scars and injuries.

Your ability to understand the severity of your friend's distress and empathize appropriately will enhance your communication and connection. Don't be afraid to raise the subject of emotional pain. Allow your friends to speak about their inner turmoil rather than express this turmoil through self-damaging methods.

Get Help For Your Own Reactions
Most of us have had the experience at some point in our lives of feeling distressed by our reactions to someone else's behaviour. Al Anon and similar self-help groups were created to help the friends and families of individuals dealing with problems of addiction and similar behaviours. At this point in time no such organizations exist for those coping with a loved one's SIV behaviours. However, the basic premise upon which these groups were designed clearly applies to the issue of self-inflicted violence. Sometimes the behaviour of others affects us in such a profound manner that we need help in dealing with our reactions. Entering psychotherapy to deal with your responses to SIV is one such way to handle the reactions which you may find to be overwhelming or disturbing.

You may find it strange to seek help for someone else's problem. However, the behaviours of others can have profound effects on us. This effect is further strengthened by the mysteriousness, secrecy, and misconceptions about self-inflicted violence. Thus, entering psychotherapy (with a knowledgeable clinician) can educate you about SIV as well as assist you in understanding and altering your own reactions. When you learn that a friend or family member is injuring herself, you are likely to have an intense emotional reaction and psychotherapy will help you deal with these reactions.

Sometimes asking for help is really difficult. The individuals who have come to you telling you of their SIV and asking for your help are highly aware of this. Follow in their path. If you need (or want) help, get it. Seek a trained professional. Ask some friends for support. Speak with a religious counsel if that's helpful. Whatever you need to do in order to take care of yourself, do it. You have to take care of yourself before you can assist another. When trying to help friends and family members who are injuring themselves, this point is critical. We cannot be of much use to anyone else if we, ourselves are in a state of need.