A loved one's urge to self-injure (i.e., cutting, scratching, burning, or carving skin; self-bruising; etc.), is often difficult for friends and family to understand. According to the Cornell Research Program on Self-Injurious Behavior (CRPSIB) 12% to 24% of teenagers and young adults have self-injured. About 25% of youth who have self-injured report injuring only once in their lives, while 6%-8% of adolescents and young adults report current, chronic self-injury. Most of these young people are likely to use multiple methods and to injure on several areas of their body (though it is common to have a preferred method and body location). Most often self-injury begins between the ages of 12 and 15, and can last for weeks, months, or years. For many, self-injury is cyclical- meaning that it is used for periods of time, stopped, and then resumed. Self-injury is not, however, a passing adolescent phase; rather, it is a sign that someone is struggling and is in need of support.

There are many reasons why people self-injure. The most common triggers for self-injury include feeling overwhelmed by a negative emotion (e.g., anger, fear, anxiety, and sadness), feeling emotionally numb, or difficulty coping with emotional pressure. Self-injury provides a way to manage intense, overwhelming feelings. Some people self-injure to punish themselves because they feel they've done something wrong (in reality, they may not have done anything wrong) - or for not living up to the perceived expectations of self or others. Self-injury is often used to relieve stress; as a way to experience some sense of feeling (rather than feeling empty or disconnected); to gain a sense of control over one's body and mind; to communicate one's needs/feelings to others (people who self-injure often have difficulty verbalizing emotions); as a way of distracting one's self from problems; as a method of reenacting a past trauma in an attempt to resolve it; and/or to protect others from one's emotional pain (e.g., they do not want to upset, disappoint, or burden loved ones - so they internalize their painful emotions and become overwhelmed). Self-injury is also used as a coping strategy to AVOID acting on suicidal thoughts/urges. Approximately 60% of those who self-injure report never having considered suicide. Even so, according to CRPSIB, non-suicidal self-injury is a symptom of distress that, "if unsuccessfully resolved, may lead to suicidal behavior." Regardless of the reason, self-injury is an unhealthy coping mechanism - one that may provide relief in the moment but does not solve the problem.

Self-injury often goes undetected by loved ones. Arms and forearms, opposite the dominant hand, are common areas for injury. However, signs of self-injury can and do appear anywhere on the body. According to the CRPSIB, other signs that a loved one might be self-injuring include: inappropriate dress for the season (e.g., consistently wearing long sleeves or pants in the summer); constant use of wrist bands/coverings; unwillingness to participate in events or activities which require less clothing (e.g., swimming or gym class); frequent bandages; odd or unexplainable paraphernalia (e.g., hidden razors, knives, etc.); spending long periods of time alone, particularly in the bathroom or bedroom; and heightened signs of depression or anxiety. It is important that questions about the marks be non-threatening and emotionally neutral. When talking with the loved one who self-injures, it is important to: demonstrate a "respectful curiosity" (e.g., "How does self-injury help you feel better?," "Is there anything that is stressing you out right now that I can help you with?"), listen, validate feelings, offer reassurance, and speak in calm and comforting tones.

There are some behaviors that can actually increase your loved one's self-injurious behavior. AVOID saying or doing the following: yelling, lectures, put downs, harsh and lengthy punishments, invasions of privacy (e.g., going through your child's bedroom without his/her presence), ultimatums, and threats. Some unhelpful things to say include: "I know how you feel" (This can make your loved one feel as if their problems are trivialized); "How can you be so crazy to do this to yourself?" or "You are doing this to make me feel guilty."

The Cornell Research Program on Self-Injurious Behavior (CRPSIB) in Adolescents and Young Adults has a website with many useful fact sheets for those who self-injure, as well as for the parents and friends of those who self-injure: www.crpsib.com. Self Injury Outreach and Support (SIOS) is another helpful resource: http://sioutreach.org. S.A.F.E. (Self Abuse Finally Ends; www.selfinjury.com) has set up a helpline that can be called when feeling the urge to self-injure: 1-800-DONT-CUT (1-800-366-8288). There are also online chat rooms for those struggling with the urge to self-harm (e.g., www.recoveryourlife.com/).

If you or someone you love is struggling with self-injurious behavior, contact NHPA to schedule an appointment.