You may recall the famous interview given by the late Princess of Wales where she admitted not only bulemia nervosa, depression, and suicide attempts, but also that that she had indulged in self-injury. She had apparently cut herself with various objects, including a lemon slicer and a pen knife. While I'm sure some people were shocked to think of someone who was so disturbed they would actually harm themselves in that way, I understand perfectly, because I've been that disturbed.
Self-injury is actually a coping technique, although it is a maladaptive, dysfunctional, and potentially dangerous one. It takes many forms, and can include such things as being very "accident prone" (although, of course, not all people who are clumsy or careless are self-injuring), biting the fingers or nails excessively, burning with candles or matches or cigarettes, head banging, continual picking at healing wounds, scratching to the point of damaging the skin, and so forth. The most common "image" of self-injury is probably cutting (usually with a razor or other sharp instrument), but it's not the most common form of this behavior, just one of the most visible.
Because it is such a disturbing and apparently strange behavior, self-injury is highly misunderstood, sometimes even by health professionals. Most people can't understand why anyone would do it, and that's what this page is about.
Generally speaking, someone who practices self-injury is in a good deal of emotional pain and has no means of coping with that pain in a healthy way. Having some pain on the outside rather than just the inside seems to serve as a distraction, or perhaps it creates some sort of balance. It certainly acts as a temporary release valve. Possibly, this is due to the adrenaline and/or endorphines which are released as a response to the injury/pain.
There's also the issue that since internal, emotional pain is not visible to the outside world, in a twisted way it's good to have some sort of specific injury to be able to say, "This hurts," and point to something tangible. Doesn't matter that it was self-inflicted; it's there, it's real, and it's visible.
Many times, a self-injurer just feels so lost and so numb and so without ties to the world around them that the pain they inflict on themselves sort of pulls them back into this world. Like the song lyric says, "you bleed just to know you're alive".
I also suspect that for many, there is some sort of self-punishment involved. You hate yourself, you hate the fact that you exist in this world. I think on some very deep level, some self-injurers are expressing their hatred toward the body in which they exist, since that body may well have been the instrument of all manner of pain and anguish in their lives.
I also believe that one of the biggest drives is that self-injury can give the illusion of control. The pain inflicted is controlled, and the self-injurer is the one in control of it. This is not dissimilar to that which is described by those with eating disorders. It gives a feeling of control, in a world where you may really believe you are utterly powerless.
If you have this problem, take heart. This, like most things, can be overcome, but you'll have to work though what's really causing the pain and then learn new ways to cope.
If you know someone who has this problem, and want to help, here are some things you should know.
Self-injury is a coping technique. It's a way of numbing and altering emotional pain, not unlike alcoholism, drug abuse, sex addiction, eating disorders, and other forms of addictive, self-destructive behavior. These are, for many people, ways of dealing with their pain, because they don't have any more effective ways of dealing with it.
It's probably not a bad idea to acknowledge that the behavior probably helps the person, or at least, try not to act like it's the most horrible thing you can imagine. Don't inflict guilt or try to force them to stop with warnings about how dangerous the practice is. Think of it as someone who drinks too much to dull the pain. Self-injury has the same effect for a lot of complicated reasons (including issues of power and pain, issues of control, and the fact that self-injury releases endorphins and often adrenaline).
Gently encourage the person to get professional help. Until the root problem is dealt with, all kinds of maladaptive coping techniques like self-injury will pop up. Self-injury is a symptom of something more serious; it can benefit from professional attention.
However, although being supportive is important, don't feel that you need to give approval. You shouldn't approve of this kind of dysfunctional coping technique. Acknowledging that you understand that it helps is one thing. Saying the behavior is okay is another. You might try saying something like, "I understand that this helps you in some way, although I don't really know how. I know that you do it because you're in pain in other ways. But I'm concerned for you, because this isn't good for you, and it's not healthy for you. I want to help you. What can I do?"
Don't be surprised if you get a rude answer. People who are so distressed that they self-injure are often rather short tempered. Keep offering, keep acknowledging the behavior while indicating that you're worried about the injury done, and when appropriate, offer to help them find professional assistance. That's about the best you can do.
Oh, yes, and don't press your luck. If they say they don't want to discuss it, don't try to force the issue. Make sure the door is open for them to talk if they want to talk, though.
With time, patience, and dedication, anything can be overcome. I promise.