“Is it weird that I cut myself on purpose?”

A 14-year-old girl from a local middle school asked me this question at work last week. In my years as a Teen Xpress counselor, I have been asked about self-injurious behaviors many times.

They ask:

“What is it about?”

“Isn’t it just a way to get attention?”

“Why would someone do that?”

“Are they trying to kill themselves?”

It’s not only teens that ask about self-injury. I’ve also been approached by parents, teachers, friends and co-workers. The very act of hurting oneself on purpose seems to hit people with a mix of bewilderment, disgust and fear all at once. It’s understandable. Purposely causing pain just does not make sense to most people. It is normal to feel confused about something like this.

How prevalent is self-injury?

Accurate statistics are hard to get, but according to HealthyPlace.com, 1 in 5 females and 1 in 7 males engage in self-injurious behaviors. Those statistics are pretty consistent with what I’ve seen in over ten years of experience working with children and adolescents. People that have endured abuse, trauma, or experienced mental health issues such as depression or anxiety are more likely to engage in these behaviors.

What exactly does “self-injurious behaviors” mean?

According to the Mayo Clinic, “self-injury,” also called “self-harm,” is the act of deliberately harming your own body, such as cutting or burning yourself.   Simply put, self-injury is hurting oneself on purpose, whether it is cutting, scratching, punching or burning, and usually not with the intention of serious harm. Self-harm can include pulling out one’s own hair (trichotillomania) or picking at one’s skin (excoriation). There are many different forms of this behavior and many ways it manifests itself.

Why does it happen?

Some people feel significant amounts of emotional pain, for various reasons. Emotional pain could be due to depression, due to past traumatic events, extreme stress or pressure, just to name a few. Sometimes the act or the behavior of hurting themselves may give the person a feeling of control when they otherwise may feel out of control. Unfortunately, many people do not have or do not feel that they have ways to express or release their pain. Many people lack a sufficient emotional support system or knowledge of healthy coping skills, and simply do not seem to know what to do. Many times I have heard people say, “Sometimes, it’s just easier to hurt on the outside than on the inside.” There are times when people feel so much pain internally that they will actually cause harm to themselves as a way to escape, alleviate, or distract themselves from the dark emotions that plague them.

These behaviors are often hidden- cuts and burns are often made on parts of the body that people don’t often see. Common unseen areas that are injured are thighs, chest or breasts, stomach, genitals, or even the bottoms of feet. Not everyone makes an effort to disguise it- hair pulling and plucking is often harder to hide. Some cutting, burning and picking is done on arms and legs, in plain view.

What do we do when someone we know is injuring themselves on purpose?

First of all, hearing about or seeing someone’s cuts or injuries can be alarming. If you find yourself in this situation, as scary as it might be, remember that this is someone who is in pain and treat them with kindness and compassion.  There is a good chance that this person may feel ashamed or embarrassed. Do not show shock or disgust regarding what you see. As challenging as it may be, it is important that you stay calm and act normal, but not so much that you seem uncaring.

Most of the time, self injury is not a suicide attempt. If the injuries are serious, showing signs of infection, or appear to be life-threatening, seek medical care immediately. If the person injuring themselves tells you that the injuries are an attempt at suicide or that they are suicidal, seek help immediately.  How do you know if the injury is a suicide attempt or not? You need to ask them.

Let that person know that you care about them and would like to help them. Ask them to talk to you about what is going on. Ask them if they are feeling like they want to kill themselves. Contrary to popular belief, asking someone if they are suicidal does not cause them to become suicidal if they weren’t already. If they answer yes, keep them with you, limit their access to objects that could be used to hurt themselves, and get help immediately. Contact 911 and let them know what is going on. Continue to support and be there for that person until help arrives.

If they tell you that they are not suicidal and you feel that you can believe them, continue to support them, but watch what you say. Typically, people do not like to be told what to do. Telling them they need to stop what they are doing is likely to frustrate them or cause them to lose interest in talking to you. You will quickly become “someone who just doesn’t understand.” However, showing care and compassion is helpful. Let them know that you love them or care about them. Share with them that this behavior can be very dangerous, even if they are not suicidal, because they could accidentally hurt themselves or expose themselves to infections, even blood-borne viruses, depending on what they are doing to hurt themselves. Encourage them to continue to talk with others about this and help them get help. If you are a teen or young person, and the person hurting themselves is also a teen or young person, make sure that you tell an adult that you trust- your parents, their parents, a teacher or a counselor.

Counseling or therapy is a treatment that has been shown to be effective in treating self-injurious behaviors.  A counselor can work with that person on replacing their behaviors with healthier, safer alternatives, as well as giving that person a place to talk about their feelings. A visit or a few visits with a medical provider is a good idea. A counselor or a medical professional can diagnose and provide different treatments for clinical issues like depression and anxiety.

Could this all just be to get attention?

Self-injury has sometimes been glorified in the media and almost seen as trendy. Some teens may see it as normal or a rite of passage. Some see it as a way to fit in to an “emo” type of counter culture. Unfortunately, the internet has all kinds of disturbing sites that are dedicated to heralding this type of behavior, much like sites that glorify disordered eating habits. Could this all be an act, or a dramatization? It is possible, but it doesn’t matter. I treat every teen that engages in this behavior the same. It is not worth dismissing behaviors like this with thoughts of, “She’ll grow out of it” or “He just has an anger issue.” You never know what someone is going through unless you show you care and ask. Someone could look like a happy, healthy, “normal” person, but that does always mean that they are doing okay. It is always safer to take a situation like this seriously.

Caring means getting involved and asking the hard questions. It means finding people and professionals to reach out to and helping people get the help that they need.

It’s the right thing to do and the right way to do it.

Susie Raskin is a counselor, Arnold Palmer Hospital for Children, Orlando, FL. She blogs at Illuminate.