By Meghan Vivo
One of the biggest obstacles in treating people who self-injure is the toxic shame they feel as a result of their self-harming behaviors. The secrecy inherent in self-harm also creates obvious challenges for concerned friends and family, who may not know the depth of the person’s emotional pain until the problem has escalated.
“People who self-harm feel a lot of shame,” says Amanda Elkin, LPC-MSHP, CSAT-S, CMAT-S, a licensed professional counselor and program director at The Ranch rehabilitation center in Tennessee. “Many go to great lengths to hide their wounds and scars, fearing others will label them as ‘crazy,’ push them away, or otherwise respond with judgment, horror or disgust – all of which further isolates them from the support they need to get better.”
Understanding the feelings that fuel self-injury and learning constructive ways to help, without adding to the shame, allows loved ones to lend critical support in the person’s healing process.
Is There a ‘Typical’ Cutter?
Most people picture someone who self-harms as a teenage girl that cuts her forearms. But according to Elkin, that’s a stereotype. Although she does treat young girls who self-injure, “self-harm can look like a lot of different things,” she says. “We treat both males and females who self-harm in different ways and in different places.” For example, Elkin says recently she has noticed self-harm affecting younger populations. And her clients often self-injure on the inner thigh, hip, stomach or shoulder – not the forearm – because those are areas they can cover up even in summer clothes.
Although people frequently talk about cutting, it’s just one of many types of self-harm. “Loved ones and treatment professionals may not be able to tell the person is intentionally self-harming.” For example, Elkin has treated people who smashed their hand with a hammer, hit inanimate objects, burned themselves with cigarettes, or banged their head against a wall. A person can self-harm without ever leaving a mark or bruise, which can make intervention and treatment difficult.
Why Do People Hurt Themselves?
For some, self-harm is tied to body dysmorphia or an eating disorder; that is, they may self-injure on their stomach or thigh because they dislike that area of the body. Some are trying to cope with early life trauma or mistakenly believe they are at fault for abuses they’ve endured and are self-punishing. Some may be struggling with underlying depression, a personality disorder or another mental health issue. For many people, self-harm is a way to express difficult feelings. “Seeing blood means they’re still alive and whatever is causing them emotional pain hasn’t killed them yet,” Elkin says. Sometimes it’s a cry for help, but sometimes it’s not.
In studies, researchers have found that both self-injurers and non-injurers report feeling “pain offset relief” – even euphoria of sorts – from self-harm behavior. And in rat studies, over time the subjects began to associate a specific pain stimulus with pain relief and came back for more. Researchers concluded that people who self-injure aren’t unusual or different in their perception of pain, they’re tapping into a natural pain management system that lives in all of us.
However, people who self-harmed did show signs of negative self-image, describing themselves as defective, bad, or deserving of punishment or criticism. When provided with interventions that raised their sense of self-worth, the participants became less willing to endure pain. So, for many people, self-injury validates their image of themselves as being “bad” and becomes a way to cope with a poor self-image and other difficult feelings.
How to Help a Loved One Who Self-Harms
If you notice signs of self-harm, Elkin has a few tips for how to help without feeding the shame cycle:
Approach the person with an attitude and voice of love and concern. For example, “I’m worried about you. I’ve noticed we don’t spend time together lately/you’ve been withdrawn, and I’m really sad about that coming in the way of our relationship. Do you want to talk about it?”
Let them know you’re open and ready to talk about whatever, whenever, and that you’re willing to have those tough conversations. Don’t ignore the behavior, but don’t shame the person either. “It’s a difficult balance to strike – being able to share your concern without sending a message that the person is bad or doing something scary or wrong,” says Elkin.
See their pain. If you’re concerned about an adult friend or loved one, “be there to hold space and let them know you see them – not just the self-harm behavior, but who they are, including their pain and need for love and support,” says Elkin.
Keep morality, ethics and religion out of the conversation. It’s difficult to understand why someone so special in your eyes could possibly hurt themselves on purpose. In an attempt to make the behavior stop, loved ones may call upon family values or other methods of shaming the person into quitting. But self-harm is about emotional pain, not the quality of a person’s moral character or their beliefs.
“The person probably already knows what they’re doing goes against their own value system and feels conflicted about that,” says Elkin. “Telling someone self-harm is against the family’s religion or ethics only puts them further in the shame pit, which makes them less likely to stop the behavior or reach out for help.”
Recognize positive behaviors. Although it often comes more naturally to focus on the negative behaviors that concern you, “give attention in positive ways rather than allowing the self-harm behavior to become all-consuming,” suggests Elkin. “This way the person struggling with self-injury learns they can trust you with their pain.”
Get help. If you’re a parent concerned about your child, Elkin recommends seeking medical help, individual counseling services and family therapy so you can learn how to support your child in a healthy way. In treatment, people who self-injure learn tools to change their negative self-perceptions and improve their self-worth, which lessens the need for relief through self-injury. They also learn that self-injury is not shameful – it’s a way of dealing with pain and distress at a time when they don’t have other ways of coping. Talking about it clears the way for learning new coping skills and moving forward.