Self-Injury and Trauma

Today is self-injury awareness day.  Last year I wrote about why this issue is important to discuss openly:

Self-injury is defined as any deliberate behavior that causes physical harm but is not done with conscious suicidal intent  that a person engages in to manage or decrease emotional distress.  Self-injury is something that is often misunderstood, even by helping professionals. Because it evokes such strong feelings (fear, powerlessness, disgust) in others they may label the self-injurer negatively and shy away from providing needed help. For example, many who self-injure are labeled as “borderline” or “manipulative”. This is why increasing  awareness is so  important.

This morning I was sharing some resources via Twitter, including this post about common self-injury myths, and it got me thinking about another common misconception. Self-injury does not exist in a vacuum, but many still act as if it does. Focusing on the behavior alone misses the mark, in my experience. Self-injury is very commonly associated with trauma: physical, emotional or sexual abuse. It may be an expression of trauma-related feelings that the survivor cannot express. It may be a way to cope with those feelings, flashbacks, negative feelings about the body, or other trauma content. This may be true even if the person self-injuring has no conscious awareness of the connection. Sometimes that is a clue that the behavior originates from a dissociated part of the self.

Self-injury is serious. Of course it is important to intervene to reduce harmful behavior. But much like what I just wrote about eating disorders, we miss the point if we stay focused on the level of the behavior. Listening to the message of self-injury is crucial. Helping the survivor find their voice more directly is key. What does it mean and what function does it serve, these are the questions I want to ask. Once you answer these questions for yourself, you have more information about how to proceed.

People who self-injure may not have developed healthy ways to feel and express emotion or to tolerate distress. Another reason that it is so important that trauma therapy focus on the development of basic skills like identifying and managing emotions. I work with clients in my practice to develop a list of alternatives to self-injury, all the while acknowledging the substitutes may not (especially at first) work as effectively as self-injury did. Resolving the underlying trauma while developing better present day coping skills, this is the key to lasting change.

Kathleen Young, Psy.D.

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7 Responses to Self-Injury and Trauma

  1. Misunderstoodeyes says:

    I enjoy reading your posts about eating disorders & self harm. With posts & links like these more people will be able to understand self harm & some of the reasons why we react or don’t act on our emotions.

  2. Kathy says:

    This really made a lot of things clear to me. Thanks.

  3. Pingback: Best Tweets for Trauma and PTSD Survivors (week ending 03/04/11) « Third of a Lifetime

  4. Paul says:

    This is really good advice. Intervention is important. Most who self-injure, hide it and when it’s known, minimize it. Often therapists don’t have the entire picture, so it often feels to the patient that they are not being helped or heard or seen. Sometimes, I think, this is fear on behalf of the patient, and what needs to happen is trust between those who are helping and those who need help. Only with trust, can you then address the behaviors (important), but what’s driving them (more important). Thank you!

    • Thanks for making this very important point Paul!

      Since self injury is so misunderstood and stigmatized it makes sense that it may not be shared quickly or easily. Trust is indeed needed. In part I think this is fostered by the therapist conveying that she/he understands that there is meaning and even an attempt at coping contained within this behavior and that the therapist gets the difference between self injury and suicidality.

  5. It feels so good, but its most definitely a destructive emotional outlet which needs to be replaced. It is a sad and vicious wheel that I am spinning in, one that I hope to get out of soon…. Thanks for the post!!

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