March 1st is Self-Injury Awareness Day.
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.
Deb Martinson has created a site, Secret Shame, full of a wealth of information about self-injury. She provides a comprehensive list of what self-injurers say this behavior does for them. In general, these reasons can be grouped into three categories:
Affect regulation — Trying to bring the body back to equilibrium in the face of turbulent or unsettling feelings. This includes reconnection with the body after a dissociative episode, calming of the body in times of high emotional and physiological arousal, validating the inner pain with an outer expression, and avoiding suicide because of unbearable feelings. In many ways, as Sutton says, self-harm is a “gift of survival.” It can be the most integrative and self-preserving choice from a very limited field of options.
Communication — Some people use self-harm as a way to express things they cannot speak. When the communication is directed at others, the SIB is often seen as manipulative. However, manipulation is usually an indirect attempt to get a need met; if a person learns that direct requests will be listened to and addressed the need for indirect attempts to influence behavior decreases. Thus, understanding what an act of self-harm is trying to communicate can be crucial to dealing with it in an effective and constructive way.
Control/punishment — This category includes trauma reenactment, bargaining and magical thinking (if I hurt myself, then the bad thing I am fearing will be prevented), protecting other people, and self-control. Self-control overlaps somewhat with affect regulation; in fact, most of the reasons for self-harm listed above have an element of affect control in them.
Self-injury is certainly an issue for many trauma survivors. I understand self-injury as serving a function, as a coping strategy. I have worked with many clients who have actually talked about using self-injury as a way to take care of themselves; a way to manage unbearable emotions or even a means to prevent attempting suicide. While there may be common causes and principles involved, it is of course important to understand what it means and how it works for each individual.
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.
If this is an issue for you, please seek help from someone who understands the issue and who can work with you to develop alternatives. It is possible.