Self-Injury: Understanding Teenagers Who Mutilate Themselves
Karen Carr, Ph.D.

Terrie is a 16-year-old student in a suburban high school in the U.S. It’s been a hard year for her. She broke up with her boyfriend over the summer and she had a major fight with her best friend a few weeks ago. She feels intense pain and anger inside and nothing seems to relieve it. She assumes that no one really understands or cares.

Terrie knows some other girls who say that cutting yourself can make you feel better. That always seemed weird to her but she is desperate and decides to try it one night after arguing with her parents. She takes a razor blade and makes several cuts on the inside of her forearm. It doesn’t really hurt that much and there’s a comfort in feeling the warmth of her blood run down her arm.

David is a 15-year-old missionary kid who just started boarding school this year. Although he was looking forward to doing just as his two older siblings had before him, he is now struggling with his new environment and being away from home. His school feels overly structured, excessively strict and oppressive to him. Most of the time he feels numb inside but he’s never been one to talk much about the way he feels. Sometimes when he’s really frustrated with his teachers or dorm parents, he punches the door in his room or bangs his head against the wall. Somehow that gives him a sense of relief. He feels less tension and the physical pain is a comforting reminder that he is capable of feeling something—even if it hurts.

Both of these teenagers are harming themselves as a way of coping with pain. They are not alone. An estimated eight million Americans are currently self-mutilating, among them many teenagers cut themselves. Others burn themselves with cigarettes or matches. Still others repeatedly reopen old wounds by picking at a scab, or pulling out their hair, biting their fingernails to the quick, or even breaking their own bones. Most of these actions result in minor injuries that can be covered or hidden (with the exception of the broken bones). They are usually not life threatening, but without proper care they can lead to infection or permanent scarring.

"Most people who injure themselves do so for a combination of reasons."

Self-injury is the intentional harm of one’s own body without any conscious intention to commit suicide. This is an important distinction because self-injury may be confused with a suicidal attempt or gesture, but the underlying motivation of self-injury can be quite different from someone who is attempting suicide. Although some people who inflict injury on themselves do commit suicide, we shouldn’t jump to the conclusion that self-injury means that someone is necessarily suicidal.

Why Teenagers Injure Themselves

Like most adjustment problems, self-injury is rarely caused by one simple thing. Instead, most people who injure themselves do so for a combination of reasons. Here are some of the most common.

Relief from painful or upsetting feelings: People who injure themselves often have trouble identifying, expressing, and releasing their emotions—especially their painful ones. If a teenage boy is feeling isolated, alienated, depressed, frustrated, disorganized, tense, fragmented, or empty he may hurt himself to gain a little immediate relief. The physical pain produces a flooding of endorphins and provides a tangible wound that can be nurtured and healed unlike the hidden inner emotional pain. In this way, self-injury serves as a kind of coping mechanism that temporarily brings relief and lowers stress when one doesn’t know how else to handle a problem.

Physical Expression of Pain: We all feel some inner pain or unhappiness at times that we can’t quite describe or put our finger on. For unhappy teenagers, this can be especially troubling. They are upset but they don’t know why. Hurting oneself turns the invisible pain into a tangible, external reality. As odd as this may sound, in the hurting teenager’s way of thinking, it seems better than an unnamed inner pain.

Revenge: Many teenagers go through a period of being quite angry with a parent or other person. If they cannot express that anger directly, they may seek out a hidden, alternate way. Some adolescents, for example, use drugs or drink alcohol or fail at school in order to unconsciously get back at their parents. Self-injury sometimes serves this same purpose. It can be a disguised way of expressing anger or resentment.

Self-punishment: People who have been abused or mistreated or made to feel very badly about themselves may engage in self-mutilation because they think they deserve it. They feel so guilty or worthless that they punish themselves for their perceived badness.

Re-enacting Previous Abuse to Gain Control: People who have been injured or abused by another person sometimes replicate the abuse in order to gain a sense of control or to bring relief of their tension and pain. Their unconscious logic goes like this: “If I hurt myself, I am in charge of my pain. I can control it and keep it manageable. If I don’t, someone else may hurt me and I will have no control at all over that.”

Self-Protection: Other adolescents fear sexual victimization. They produce scars because they believe that will make them unattractive and scare away anyone who may approach them with a bad intent.

Relief from Numbness: Few things are worse than feeling inwardly numb or emotionally dead. Although this is difficult for many parents to understand, many teenagers feel inwardly numb—almost like they aren’t really alive. They are kind of floating emotionally or feeling dazed rather than alive and alert. This is a terrible feeling so they look for a way to prove to themselves that they are alive. Few things prove this better than seeing ones own blood running or feeling physical pain. It is a terrible paradox, but many people hurt themselves to prove that they are alive and real.

How Can I help?

The key to helping someone who is self-mutilating is to remember that people don’t do this just by chance. There is always some underlying cause or reason. The most important thing to do is find out why the person is hurting themselves, not just try to get them to stop. We need to be good listeners and draw the person out. Only then can the real problem be resolved.

Since most people who self-injure do so in order to gain some sense of control, it doesn’t help to take a controlling, dominant stance or try to force him or her to change. It will need to be the person’s choice to stop and they will have great difficulty doing this until they have faced their emotional pain and learn better ways of coping with emotional stress. Anything that you can do to help the person identify their painful feelings, talk about them, and discover effective problem-solving strategies, will divert the focus away from self-injury and onto the real source of the problem.

"Never hesitate to consult with a mental health professional when you become aware that someone is engaged in self-injury. "

Providing a model of self-awareness and honesty and being able to talk about our own conflicts, grief, or other forms of emotional pain can encourage a teenager to do the same. So does pouring our hearts out to the Lord and allowing Him to heal us in our own brokenness. Instead of acting as if we have it all together we need to be real and open with our children.

Once it comes out that a person is self-injuring, it will be important to provide ongoing support and care for him or her even after it seems that the self-injuring has stopped. Relapse prevention principles are useful here. It is important to help the person anticipate when he might be tempted to hurt himself again—under what circumstances and in what way. Then this person can be helped to develop a strategy for what he or she will do in that situation. It’s also important to try to reduce their shame in case they do hurt themselves again, since shame makes it difficult to let anyone know that they still have a problem.

Never hesitate to consult with a mental health professional when you become aware that someone is engaged in self-injury. Self-injury might be due to other types of problems such as sexual abuse, depression, suicidal thoughts, eating disorders, or substance abuse.

As with any kind of behavior with addictive components, it can be a long road to recovery with relapses and pitfalls along the way. Christian families and caregivers will want to use all of their spiritual resources of prayer to help their children or others learn to face their inner hurts and find deep and lasting solutions. The child may or may not be ready to participate in prayer with you and should be given the choice but in either case, we should be seriously seeking God’s guidance, support and intervention.

References and Reading Resources:
The Scarred Soul: Understanding and Ending Self-Inflicted Violence by Tracy Alderman.
A Bright Red Scream: Self-mutilation and the Language of Pain by Marilee Strong.
Bodies Under Siege by Armando Favazza.

Websites:
www.webring.org/cgi-bin/webring?ring=bus;list
www.palace.net/~llama/selfinjury



Karen Carr, Ph.D, is Clinical Director of MMCT (Mobile Member Care Team) residing in Accra, Ghana. She is an experienced licensed clinical psychologist and has conducted training in crisis response, interpersonal skills, and member care with various missions in ten countries, including several in Africa. www.mmct.org

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