Caring for People who Cut Themselves (Help for Self-Injury)

self-injury scars from cutting

Years ago I was responsible for training volunteer telephone counselors for an international Christian ministry. We were getting 150 calls a day from adults and teenagers who were in crisis, hurting in some other way, or needing prayer. Some of the young people who called were struggling with cutting themselves. This frightened some of our volunteers. So I taught the lay counselors a class on self-injury, based on my experience with these clients in psychotherapy and the research I did. This articles is based on the notes for the class I taught in 2005.

People who injure themselves are in pain. And they feel alone. Like this reader of our “Soul Shepherding Devotional” who wrote to me:

“This is just a prayer request. I feel dead inside. The only time I feel alive is when I cut my arm.  I have been doing this for a little over two years now. I have recently been talking to a Christian therapist.

“The longest time I can stop cutting is two months. Then I go right back to it. I don’t know how to stop. This seems to be the only way I can cope with my pain. No other outlet seems to work.

“But a little while ago I was reading one of your devotions it was called ‘God cares about little birds and little people too!’ I really enjoyed reading it! It reminded me, that I will not be in this dark place in my life forever… And I thought while I was reading it, what a wonderful picture this paints, in my mind of a Christian family peacefully discussing God’s love and protection for us. And to be completely honest I wished I could have that peace in my family and in my soul that has been lacking for so long.

“In closing, please pray that my pain doesn’t overtake my heart. And that I can be set free from this prison of self-hatred. Thank you for the encouragement that you bought to me today though your devotion.”

What is Self-Injury?

Self-injury is one of those taboo subjects that we tend not to want to talk about.  Those who do it feel ashamed.  Busy emergency room doctors and staff may get exasperated with those who need treatment for intentional wounds.  Family, friends, and even counselors may feel squeamish about the cutting and blood, bruising, or pain. And they may be afraid that the cutter will attempt suicide.

Self-injury is self-inflicted physical harm that is serious enough to cause bodily damage or to leave marks that last at least two hours.  It’s deliberate attempt to cause physical pain to yourself.  It’s not a suicidal act.  It’s done as a way of coping with unpleasant or overwhelming emotions, thoughts, or situations.  Some people obsess about this (can’t stop thinking about it) and do it compulsively (like an addiction).

Examples of Self-Injury

Over the years I’ve talked with people self-injure. They cut themselves with knives, bang their head against the wall, slap their own face, compulsively scratch at pimples and scabs until they bleed, or pull their hair until they’ve left a bald spot.

1% of Americans (about 2 million people) injure themselves on purpose.  These figures include all ethnic and socioeconomic groups and 40% of these are men.  And it’s not just young people either.

By far the most common way that people harm themselves is by cutting. Here are some statistics on the most common ways that people hurt themselves.

  • Cutting 68%
  • Skin picking or scratching 14%
  • Burning 5%
  • Hitting 4%
  • Wound interference (picking off a scab) 2%
  • Biting (e.g., extreme nail biting) 2%
  • Head banging 1%

Why Injure Yourself on Purpose?

Many people have trouble understanding and accepting that people would deliberately injure themselves.  Even the people who self-injure often say, “I don’t know why I’m doing this.”

Why cut yourself, draw blood and leave a scar?  Why cause yourself pain? People who self-injure may be frozen by past trauma of sexual, physical, or emotional abuse. Or they have denied and detached from other emotional wounds. Then in crisis or another stressful situation they deal with their emotional pain by physically harming themselves.

Princess Diana confessed that she reacted to the strain of her marriage by throwing herself down the staircase and cutting herself with razors, pens, knives, and lemon slicers.  “You have so much pain insider yourself,” she said in an interview with the BBC, “you try and hurt yourself on the outside because you need help.”

People who self-injure haven’t learned healthy ways of coping with painful feelings.  They’re afraid to feel their emotions and talk to someone they trust in order to seek understanding and comfort. So they harm themselves.

Self-harming is a defense mechanism against pain, done in order to…

Feel alive

They’re detached or cut off from their feelings.  They may be depressed or feel empty.  They may be “dissociated.”  When they cut they experience an euphoric adrenaline rush about doing it and endorphins are released in the brain as a reaction to the physical injury.

Control feelings or relieve pain

Their emotional pain is unbearable and they feel it in their bodies as intense arousal.  Their sadness, fear, guilt, or anger feel overwhelming and out of control.  They feel panicky, jittery, and trapped. These emotions, sometimes along with frightening flashbacks or self-hating thoughts, just won’t go away until they injure themselves.  Then the extreme tension and arousal in their bodies and souls returns to a more bearable level.

Convert emotional pain into physical pain

Their emotions feel overwhelming or out of control and so convert them into physical pain.  The physical pain feels more manageable: they can see the wounds on their bodies, they can see the bleeding stop, and they can see their body heal. Some people like the attention they get attention for wounding themselves and others are embarrassed by it. Still others love and hate the attention.

Punish self

They may feel guilty about hurting people or mistakes they’ve made. They may feel bad about themselves or how empty their life feels. They take their anger out on themselves.

Compassion for those who Cut

The best way to understand what cutters and others who self-harm are going through is to listen to what they have to say about their experience. (I found these quotes on the Internet.)

I want to feel alive (instead of feeling empty, detached, or unreal)

“My blood voices my pain, like a bright red scream.” (This is the title of a book on self-injury).

“You have it wrong: I’m not trying to kill myself.  It’s what I do to stay alive.” (Client to a residential counseling center worker.)

“To feel real when I feel numb.”  (38 year-old woman, injuring herself since she was 14)

“With the blood flowing down my arms, I was real.” (31-year old health care worker)

I have to make the pain go away, to get in control of it

“I cut myself with razors because the pain in my chest is unbearable. Almost anything can set me off. Most of all, the desire to injure myself comes when I feel like I have failed at something or when I feel as though someone close to me is going to leave me. The need for intimacy in my life is great and although I try to keep everyone at arm’s length, when I do let someone in I feel as though I will be hurt. Cutting relieves the pain that nothing else can take away.” (32 year-old woman, works as an MSW, injuring herself since she was 15)

“Injury gives me focus…..i cannot seem to focus and stop the spinning or emotions/ideas and thoughts (mostly thoughts that i don’t want)……si gives me a temporary peace, and it works for any situation.” (26 year old man with one year of self-injurious behavior)

“I like the thought that it is ME causing the pain for once, not someone else.”  (14 year-old girl)

“I injure myself usually when i feel like things aren’t in my control. like when i get into a fight with my boyfriend or i feel like noone cares about me, or if i wasn’t invited somewhere with my friends that everyone else was invited. i get this feeling where i have so much energy that i could punch through a wall, and my heart is beating so fast i feel like i could have a heart attack and my breathing feels like its being cut short.”

I want to put the pain in my body (a form of control called “conversion”)

“Because sometimes it hurts so bad on the inside, it’s nice to have something tangent to relate to. There is a weird sort of comfort in having an injury on the outside. It is also a whole lot easier to deal with than crud from the past and present. Before [I feel] out of control — it’s like a obsession I can’t get rid of. During [I feel] a sense of satisfaction, control, victory. After [I feel] like dirt.” (37 year old woman, graduate student, injuring self since age 14)

I have to punish myself

“I’m too needy.  Too emotional.  I can’t handle the pain so I cut.”

“I use it as a way of punishing myself for whatever is bad about me.”

Why it Can be so Hard to Stop Hurting Yourself

As a coping mechanism, self-injury temporarily works to relieve emotional pain and unwanted feelings.  And it is accompanied by an adrenaline rush.  For these reasons it can become addictive.

“I am usually VERY upset during the process and venting of my emotions accompanies the cutting. Most of the time, I do not quit until I am exhausted both emotionally, and physically.”  (33 year-old woman with a Ph.D.)

“I know it’s time to stop when I can realistically see how much I’m going to hate myself for doing this the next day. I also stop when I have so many cuts that I can’t possibly continue cutting unless I go over all the marks again.”  (13 year-old girl)

“The idea of stopping for good terrifies me. I don’t know what I would do without that release. I’m afraid I’ll go back to abusing alcohol (too messy) food (too shame-filled) or pot (too numbing) so until I can deal with why I am hell bent on my own destruction – the cutting is best coping mechanism I have.”

“Sometimes after so many cuts I use sandpaper to scrub away the evidence.”  (24 year-old woman with 8 years of self-injury since being raped.)

“Sometimes I call hotlines for self-mutilation or suicide, but they can be really mean.” (17 year-old girl, injuring herself since age 12)

How to Help Someone who is Self-Harming

One young woman who stopped cutting herself said: “I find that calling someone and being able to have the freedom to vent helps. Sometimes I will write my feelings down on paper, speaking as I choose without pressure.”

People who injure themselves need care, though they may be scared to ask for it and resist it. They need a “Christ’s Ambassador” to show God’s love (2 Corinthians 5:20). If you’re responding to someone who has been cutting stay calm!

Don’t panic.  The cutting in itself is not a suicide attempt. (Although people who self-injure may attempt suicide.)

Don’t react with shock or repulsion.  That closes up people emotionally and shames them.

Don’t judge or pressure to stop.  Never moralize, judge or criticize in your role as a New Hope Counselor!  And don’t pressure people to do the right thing (unless it’s the best way to save a life or protect a child or elder from abuse) because it’s likely to activate their resistance.  (A doctor wouldn’t hesitate to preserve the life of an overweight, sedentary heart-attack patient and yet might become impatient with someone who self-injures.)

The most important thing you can do is to listen calmly. Be available when the person who self-harms is ready to talk. At opportune times gently ask open-ended questions like,

  • “How are things going for you?:
  • “What are you feeling?”

Or make compassionate statements that communicate your concern like:

  • “It seems that you’ve been stressed lately.”
  • “I’m concerned that maybe you feel discouraged.”

Speak the Truth in Love

Paul teaches us in Ephesians 4:15 that to help someone mature in Christ we need to “speak the truth in love.”

At first many self-injurers won’t see the need to change their behavior. They like how cutting makes them feel, at least compared to how overwhelmed they felt before the episode of cutting. To be motivated to get help they need to see the negative consequences of their self-harming.

For instance, a man who got help said: “I haven’t injured myself for almost 8 years now but when I get the urge these days I look at the state of my arm and all the awkward moments I’ve had trying to account for the scars when people ask what happened to my arm…”

Here are some questions that promote listening and caring and can help those who harm themselves to re-consider their behavior:

  • “How do you feel after you cut?”
  • “What do you think about the way your arms (or legs, face, stomach) look?”
  • “What problems has your cutting caused for you?”

If the person is motivated to change then you can begin to explore alternative ways of dealing with emotional pain besides self-injury. It’s best to be careful about giving advice. Ask questions like:

  • “What’s another way of dealing with your pain?”
  • “Have you ever felt this way and not cut yourself?  What did you do instead?”

Feel – Think – Do

One person who overcame self-mutilation said: “I stop and think and tell myself to talk about my feelings instead of cutting.”

I teach people to use “the Feel-Think-Do Triangle?”  It teaches a great rule:  “Before you speak or act feel and think first.”

Self-injurers feel overwhelmed or detached and so they cut.  Instead, as this person learned, it’s best first to stop and think, to “process” feelings, to think about the negative consequences of cutting, to accept your emotional needs as valid, to think about a positive coping resource.

When you ask questions, listen, and offer empathy to someone who self-harms your implicitly teaching them to think and feel before they react to their pain by injuring.

Find a Substitute Behavior

The Bible teaches: “Overcome evil with good” (Romans 12:21). This is an example of a fundamental psychological principle: the way to overcome a negative attachment is by replacing it with a positive attachment. Those who self-injure are emotionally connected to this and need to find a new and helpful emotional connection with God, which usually begins with a caring relationship with someone who serves as “Christ’s ambassador” (2 Corinthians 5:21).

An 18-year old girl who was the valedictorian of her high school gave a simple example of this: “It may sound silly but I find that playing with and talking to my dog helps me not to cut!”

A young man explained what enabled him to stop injuring himself: “I do practical things like eat healthy and get needed rest. Sometimes I write poems, stories, or sketch because they take a lot of concentration and also express the emotions. Sometimes I will do a lot of physical exercise that is really intense.”

Someone else who self-harms found help by, “Taking a brisk walk. Shower, eat, scream; hey, I have a ton of lists… “

And sometimes antidepressant medication is needed.

How Tanya Got Help

Listen to the story of Tanya (not her real name), a teenage volunteer for the New Hope Crisis Counseling Center:

In the 7th grade I started burning myself for no reason.  Then I realized that I was depressed.  I started scratching myself with my fingernails on my arms and legs.  It was sometimes bad enough to make me bleed and always noticeable for a week afterward.  I would do this instead of crying.

I developed a boyfriend and things he said and did hurt me so much that I was constantly sad.  I spent most of my time in tears.  I became so sick of crying.  And I hated that when I was depressed I had no control over my emotions or anything.  And I felt like the smile I wore was fake.  Hurting myself on my body was better than hurting on the inside.  It made me feel like I was in control of my emotions.  I transferred my inside pain to outside pain, something I had total control over.  Only later did I realize that this only made things worse!

I broke up with my boyfriend and asked God to help me.  And when I volunteered for the New Hope Teenline program helped me to understand my feelings and to talk about them with people I trusted, something I hadn’t done as a girl.  It used to be that when I was depressed I relied only on myself to get through it, but then I learned to ask God to help me and to trust people who cared for me.

Thankfully, I haven’t cut or hurt myself for three years.  I can honestly say that I’m no longer tempted to either.

Real Hope

The hope for people who cut themselves is Jesus, bleeding on the cross and dying for our sins. He rose from the dead to forgive our sins and welcome us into the Kingdom of God — not only when we die, but also today.

Those who self-injure are seeking comfort from their own wounds rather than the wounds of Jesus. They’re trying to convert their emotional pain into physical pain that will heal rather than bringing their pain to Jesus and looking to him for comfort, help, and healing.

They need help learning how to engage themselves in an authentic, living connection to Christ, trusting him in their hearts, experiencing his unconditional love and healing mercy, relying on his power for living a life of love for God, others, and self.

Learning to trust Christ in this way requires being honest in relationships with others in the Body of Christ, especially a Christian counselor or support group.

For More Information on Self-Injury

Here are a couple of resources that I found to be helpful:

S.A.F.E.: Self-Abuse Finally Ends: an approach to professional treatment used by psychotherapists and treatment centers, 1-800-DONT CUT.

Critical Mental Health Resources for College Students: 75% of college students with possible mental health issues don’t seek the help they need. Here are some resources.