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7 Misconceptions About Self-Injury You Need to Stop Believing

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Editor's Note

If you struggle with self-harm or experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741. For a list of ways to cope with self-harm urges, visit this resource.

Self-injury, also known as self-harm or non-suicidal self-injury (NSSI), is a complex behavior that can be difficult to understand for people who haven’t experienced it. It is counter-intuitive to consider that anyone would want to cause themselves pain or injury. Even so, many people struggle with this behavior and there are some misconceptions I would like to clear up.

1. Self-injury isn’t a suicide attempt.

Most often, self-injury is a coping mechanism to mediate distressing thoughts, feelings or conflicts. Personally, I turn to self-injury to actually prevent myself from acting on the persistent suicidal thoughts that plague me in the worst of my depressive episodes, or I may turn to it when I’m in a hypomanic state and I can’t slow my racing thoughts. Accidental suicide is a risk factor, however, for individuals who self-injure. Serious complications and death could result from infections, bloodborne illnesses, traumatic injuries, and so on. Further raising the risk, many people do not seek medical care even when it is needed often out of fear of misunderstandings, negative stigma and even mistreatment by medical professionals. Sometimes, people who self-injure are reluctant to seek help for the behavior because they fear it will be seen as a suicide attempt and they might have restrictive measures taken against them.

2. Self-injury isn’t always related to borderline personality disorder (BPD).

This misconception comes up a lot with people who have an above average awareness of psychological conditions, but may not know the nuanced differences and symptom overlap of many other conditions. This can even be misinterpreted by clinicians who are operating under outdated understandings of both NSSI and BPD. While self-injury is one possible diagnostic criterion for BPD, it is not enough alone to warrant a diagnosis of BPD. The DSM-5 lists criterion number 5 for borderline personality disorder as “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.” This is only one of nine criteria of which at least five must be met to warrant a diagnosis of BPD. Although self-injury may be found at higher rates amongst people diagnosed with BPD, each is not exclusively indicative of the other. Other conditions that have higher rates of self-injury include eating disorders, substance use disorders, mood disorders and others. Some folks who have BPD self-injure and some do not. Some folks who self-injure do not have BPD. I’m sure some of you math-minded folks could make a Venn diagram of this, but I’ll just leave it at NSSI ≠ BPD.

3. Self-injury isn’t “just a teenage thing.”

Self-injury does occur at higher rates in adolescent populations. According to a meta-analysis of 52 studies by Jennifer Muehlenkamp, Ph.D., about 17 percent of adolescents had engaged in NSSI at least once. Comparatively, the American Psychological Association reports the adult lifetime rate of NSSI at about 5 percent. The problem is that when people dismissively call self-injury a “teenage fad,” “just a phase” or “just a teenage thing,” it perpetuates the guilt and shame many adults carry when they are struggling to overcome self-injury. It also disregards the true struggle that both adults and adolescents experience when trying to recover. As an adult who self-injures and has done so for nearly 20 years, I can attest to the large amount of guilt and shame I already place on myself that is compounded when I hear it referred to as a “teenage thing.”

4. Self-injury isn’t motivated by any one reason.

Logically, a behavior that is intentionally repeated must be providing the person with some benefit, whether it is giving them a positive reinforcement or is removing or lessening a negative sensation, feeling or conflict. But not all people who self-injure do it for the same reason and some people will have different reasons at different times and situations. Here’s just a short list of reasons I’ve heard from people, including some of my own. This list is not meant to be all-inclusive, so please add additional reasons in the comments section:

To calm myself.

To punish myself.

To avoid suicide, or quiet suicidal thoughts.

To feel something (as opposed to numbness).

To make emotional pain physical and visible.

To express anger or hate toward myself.

To provide care to the wound.

To release emotional pressure or tension.

To fit in with others who self-injure.

To do something extreme and exhilarating.

To show I’m strong.

To get back at someone.

To keep someone from abandoning me.

To be self-sufficient.

To seek care or help from others.

To feed the “craving.”

To see injuries to my body.

5. Self-injury isn’t just cutting.

While cutting may be one of the most common behaviors associated with NSSI, it can manifest in many other ways as well. Some types may not even be reported as self-injury, but the reason for the behavior is still to intentionally cause harm.

6. Self-injury isn’t attention-seeking.

A lot of people go to great lengths to keep self-injury a secret because of the negative stigma and fear of restrictive measures that might be taken against them if they are “found out.” While some people might injure in order to gain attention, most likely it is because they are, in fact, in need of attention because they are dealing with distress that is beyond what they think they can handle. So, even if you think someone is doing it for attention, it does not mean that they do not deserve attention. That said, if I choose to disclose to you that I self-injure, that does not mean I’ve invited you to look at my scars or wounds. If you ask to see them and I refuse, please don’t push it. Ask what I need and if there’s any way you can help. If I’m not in immediate danger, that is enough.

7. Self-injury doesn’t need to be hidden (or shown).

Some people hide scars or injuries. Some people do not. Some people cover them with makeup or tattoos. None of these people are wrong, and frankly, their choice is none of your business. If I choose to wear short sleeves, I should be able to do so without being told my scars are ugly or they should be covered up. If I choose to wear sleeves even though it’s too hot, I don’t need to be told over and over again to take off my sweater. Everyone deals with self-injury marks in the way that is best for them in their current situation and that is OK.

Here’s the thing — I understand that self-injury is hard to understand for a lot of people. I concede that it is not the best coping mechanism out there. But for me, it’s been a reliable one when others have failed me. As of today, I still have not completely replaced it with healthier alternatives, but recovery is a process.

If you’re having trouble understanding why or how someone might do this, take a step back and remember that there are a lot of people who struggle with this and what we really need is support and care, not judgment or scorn. Please also try to wrangle in your curiosity — someone might share their story with you when they feel safe in doing so, but it is not appropriate to ask or comment about it in passing or in front of others. Be kind. Be patient. Be an ally.

Photo by Annie Spratt on Unsplash

Originally published: January 29, 2019
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