Hardly any other behavior elicits such a wide range of reactions as self-injury. From fascination to fear, from dismissal to disgust, from avoidance to anger, almost everybody experiences a strong emotion when it comes to people inflicting injuries on themselves. There are a variety of assumptions and myths involved but not many people know the facts behind self-injury.

Self-injury is any form of intentional harm that a person does to his or her body tissue. This includes, among other things, cutting, burning, biting, or embedding objects in your skin. Socially acceptable ways of changing your body, such as piercings or tattoos, are not considered self-injury. Even though self-injury is most often seen in adolescents, younger children and adults also engage in this behavior.

For an outsider, it is hard to understand why a person would do that to himself. People who self-injure have often been labeled as attention seeking or manipulative. While hurting themselves is a way of communicating distress, people rarely self-injure to “shock others” or to get attention.

Younger people, particularly, don’t always understand why they engage in this behavior. They don’t have more appropriate ways to communicate their feelings and their distress. Most of them have experienced severe trauma earlier in life, often in the form of physical or sexual abuse. Hurting themselves might be the only coping mechanism that has worked for them so far, at least temporarily.

For some people, inflicting physical pain is a way to avoid other overwhelming and painful feelings, such as sadness or fear. For others, self-injury is the only way they can feel anything at all because they have become emotionally numb in order to survive the trauma they experienced. In both cases, they often hide their wounds and are deeply ashamed of their behavior. Many even make up stories to explain wounds and scars if the injuries are detected. They don’t ask for help because they fear being judged, being labeled as “crazy” or being committed to a mental institute.

People who hurt themselves in this way are usually not suicidal. As a recent article in “Counseling Today” stated: “Suicide is to end life. Self-injury is to control something in order to keep living and move forward.” Many who self-injure report that it is the only thing that keeps them from committing suicide.

However, self-injury is by no means harmless. It is common to develop a tolerance over time. Then the person needs to cut deeper or in more sensitive places in order to obtain the same effect. Infections occur quite frequently and can be life-threatening. Accidental death by cutting too deeply and losing too much blood is also a risk of self-injury.

If you are a person who is hurting yourself, please consider getting help. Even if people have made fun of you or judged you before, there are others who understand and will support you. Talk to a teacher, a friend, a family member, or a counselor. Mental health professionals are not required to report self-injuries, unless the person is suicidal. They will help you to identify your feelings and teach you how to deal with them so you don’t have to hurt yourself anymore.

Even if you are not ready yet to talk to anybody there are things you can do to minimize the danger. Get rid of the things you commonly use to hurt yourself. Make a list of activities that make you happy and that you can use when you feel lonely or sad, such as listening to music, reading, hiking, or playing with your pet. Seek out the company of positive people and avoid being alone until the urge to hurt yourself passes.

If you know a person who self-injures, there are things you can do to help. The most important one is to stay calm. Wounds and scars can be scary and shocking. But if you display disgust or repulsion, the person won’t trust you to handle their situation and they won’t continue to seek out your support. Let the person know that you don’t judge them but that you are willing to listen and to help. If possible, ask concrete but respectful questions about frequency and severity of the injuries.

If the person is willing to do so, have them evaluated by a physician. Encourage them to seek professional help so they can learn healthier coping skills. Self-injury is scary for everybody involved. The more respect and support we can provide, the easier it will be for the person concerned to ask for help.

Thanks to Kirsten Bolt, LMFT, who recently provided an excellent training on this subject.