self injuring sister

Dear Maigler,
Recently I went on a family vacation and I noticed that my younger sister has cuts and scars all over her legs. I had noticed marks on her arm before but she said our cat did it, and now I feel like an idiot for believing her. Does this mean she is suicidal or totally nuts, why would anyone do this to themselves?

Self-injurers Sister

Dear Sister,
Self injury is an unhealthy coping skill that becomes an addiction just like gambling, eating disorders, drugs etc... Is your sister in danger of killing herself? Possibly but without knowing more I would list her at the same level of risk as if you had found her dealing with one of these other issues. Most of the self injurers I have worked with are depressed but they generally do not want to die, they just want the pain to go away and self injury works for them in helping to manage their emotional pain.

My first recommendation is to talk to your sister about what you've noticed and how seeing that makes you feel. Ask her what it does for her and if she would like help in stopping. Offer to go with her to talk to your parents if they do not know about the problem, and if they do, offer to encourage them to get her into treatment.

Regardless of what she says (even if she begs you not to) you MUST tell your parents who should then get her in for an evaluation. Many psychiatric hospitals will do a free evaluation and if the person is not suicidal they will usually just help set up an appointment with a therapist in their insurance network. It may be a tense and boring several hours while you sit in a waiting room, and leave with a phone number but better safe than sorry. Call any hospital switch board and ask to talk to the intake social worker for psychiatric issues and you will get to someone who can guide you to your next step.

If you want to know more about self injury there are a number of great books out there. My favorite is called Bodily Harm by Karen Conterio and Wendy Lader http://product.half.ebay.com/Bodily-Harm_W0QQtgZinfoQQprZ839016 You can find it on half.com for 75 cents but it is worth it's weight in gold.

There is a misconception that self injurers like pain. This has not been my experience working with them. For most the act of cutting or burning does not actually hurt and for many seeing the blood or the scars helps them to have a visual representation of the emotional pain they are feeling. Most simply describe feeling overwhelmed and filled with pressure and the act of injury allows them to feel release, and many times this the only way they know to find peace.

The problem with self injury is that it works. Many of my clients will say “it's my body and I'm not hurting anyone else so everyone should just leave me alone.” Even if self injury wasn't dangerous, even if injurers didn't build up a tolerance and often need to use more extreme and intense means to get the same feeling, it still wouldn't be okay.

All addictions destroy relationships. I ask my clients how it would feel for them to watch their Mother, Father, or future children self injure?

“Would that be okay with you if they did it? I mean why not it works, and it is their body?”
For some reason I rarely find a self injurer who is willing to allow someone they love to inflict pain upon themselves and think it okay. BEWARE SPECIAL RULES! My self injury and eating disordered clients tend to play by a different set of rules than they hold for the rest of humanity. I tell them that when you do that you are cheating. As long as you were born on this Earth and not on planet Krypton you get the same rules as everyone else.

When I finally get self injurers to really commit to treatment it is because they have realized that as long as they self injure, even if hide it perfectly, they will never have a balanced and honest relationship while they are injuring. They will always be hiding and never sharing their true feelings. Any time they get an intense feeling of anger, sadness, shock,... anything but happiness, they will turn to their coping skill and not to their partner to deal with it. Most injurers have a history of emotional trauma, many were physically and/or sexually abused. They want connection but they fear it and they feel they are unworthy of it.

Reach out to your sister, say something. Every person who ignores the issue is reinforcing in the injurer's mind the idea that they and their problems do not matter. Self injury makes a lot of sense, it isn't crazy, but it isn't healthy and she could be choosing something better.