Saturday 21 April 2012

My friend cuts herself and I'm worried!


Q: My friend has scars on her arms - she says she “cuts” herself. I’m worried about her!

A: Finding out that someone you know and care about is intentionally hurting themselves can certainly make you feel uneasy. That fact that you even know she’s cutting is awesome because that means she had taken that very difficult first step of starting to open up to someone. Secondly, she must trust you or she would never have told you. Thirdly just being there for her and listening is helping more than you can imagine. I will try to briefly explain the general aspects of self injury or self harm.
The fact is that everyone learns to cope with their experiences in different ways. Most people are able to find constructive and meaningful ways to deal with their negative experiences. There are others who use tears, they might get angry, fall into depression and withdraw, or turn to drugs or alcohol in order to find relief from their overwhelming feelings.
For some however, particularly teens, experiences of intense and painful emotions can continuously build up inside of them, but they can see no way to escape these locked up feelings or releasing the emotional storm raging inside of them. For these people, the release of this pressure is done by cutting, burning or other self harming acts. This self injury is an act of temporary relief, kind of like opening a relief valve long enough to let the extra pressure that has built up inside of them to a bearable level again. It provides some immediate relief until the painful feelings swell up again along with the urge to reopen their relief valve.
The act of self-harm for the first time can vary for each person. This first act and later acts are usually “triggered” by other stressful events of daily living that raise that intense level of internal emotional pain and turmoil passed the point that they can bear or contain any longer. For others, they have passed a point of feeling anything at all and have become so numb to the world that they simply want to feel again, to feel alive, for even a short time. However it’s like putting a band-aid on a broken leg; it doesn’t fix the more important underlying problem which is the cause of the emotional pain and the lack of constructive coping mechanisms for dealing with the pain without self harming. So the solution then is to understand what caused the internal emotional pain in the first place and then help the person address it in constructive ways and start to heal and feel better.
Self injury is not a new phenomenon, but it is becoming more and more common. It is estimated that as many as 15% of teens currently self harm or have in the past, but it is difficult to assess because they tend to harm themselves alone and secretly, taking great care in hiding their injuries and scars through shame, embarrassment or fear by making up excuses and explanations.

What Are Some of the Types of Self-harm?
·         Biting at their skin
·         Burning or scalding the skin
·         Hitting yourself or banging their head
·         Punching things or throwing their body against walls and hard objects
·         Intentionally preventing wounds from healing
·         Swallowing poisonous substances
·         Putting themselves in danger or at risk - driving recklessly, binge drinking, taking too many drugs, and having unsafe sex.
  • Picking at their skin
  • Severely scratching their skin
  • Neglecting oneself
·         Cutting their skin with knives razor blades, glass pieces or other sharp objects
·         Sticking objects into their body or under your skin
  • Deliberately falling when doing something like extreme sports
  • Swallowing sharp and inappropriate objects
  • Pulling out their hair

What are Some Possible Underlying Causes of Self Harm?
·         Childhood abuse
·         Sexual assault
·         Bullying
·         Stress
·         Low self esteem
·         Family breakdown
·         Dysfunctional relationships
·         Mental health illness
·         Financial worries.

Self harm is a way some people try to cope with the pain that either seem too difficult to bear or are bad situations they think can't change. They may not know any other way to relieve the emotional pain or haven’t been taught ways to cope effectively and constructively. Perhaps they do have coping skills and support systems but the emotions may be too intense and they feel like they have lost control. For some, it’s a way of regaining that sense of control over the pain.
Some people who cut have had a traumatic experience, such as living through sexual or physical abuse or violence, or they may feel numb after a traumatic experience. It can also be a way of inflicting the previous pain they went through, expressing anger over it, or trying to get control of the situation in their mind.
Self-harm is usually conducted at times of anger, distress, fear, emotional worry, depression or low self-esteem in order to manage negative feelings that they can find no other way of dealing with in a rational or constructive way. Alternatively, self-harm can be used as a form of self-punishment for something that the self-harmer has done, thinks they have done, or that they have allowed to be done to them.

People who cut and self-injure do not do it for attention but is more like a silent cry for help – a need to express a pain that they know no other way of expressing. You can imagine that if someone goes to these extremes it is clear that they are in distress. They are not trying to draw attention to themselves and in fact the shame and fear can make it very difficult for them to talk about their feelings and ask for help.

Self harm is not about liking pain but is rather a way to cope with thoughts and feelings and an attempt to regain feeling of some control over themselves. It’s a way to feel something because of the emptiness and emotional numbness they are experiencing. Some people have said that they don’t feel any pain at all when they self harm, just a sense of relief. It is not until later that they feel the physical pain and begin to regret their actions.

Sometimes a person self harms to punish themselves due to feelings of guilt or shame. This is common where sexual abuse or sexual assault have occurred during childhood and almost everyone says that they were discouraged from expressing emotions, especially anger and sadness. However, it is important to know that there are many different triggers. Abuse, whether physical, sexual, or emotional is only one of them.

Another important point is that when someone self-injures they are not trying to kill themselves they are trying to cope with life. They want the internal pain to stop and hurting themselves is the only way they know to get relief. Self injury is a coping mechanism to prevent suicide, to feel better and help them continue to live.

It is true that people who self-injure have a much higher risk of suicide, because sometimes they feel they can’t escape the emotional problems and pain. That is why it is so important for self harmers to seek help. Some individuals that self harm may go on to complete a suicide attempt but suicidal feelings are not caused by the self harm. They are caused from the underlying reasons that became bottled up inside of them resulting in a coping mechanism of self harm. However, sometimes self harmers do die because they accidentally take an act of self-harm too far and they lose their lives before help can be found.

Another thing that is important to keep in mind is that you cannot determine how much a person is suffering by the severity of their wounds. Specifically, don’t assume that if the wounds and injuries are minor, there’s nothing to worry about. The severity of the wounds have very little to do with how much a person may be suffering inside.

Sadly, cutting behavior can spread, to the point where there are now teens discussing cutting on-line and forming cutting clubs at school. The danger of these groups is that they can attract vulnerable teenagers who may go on to develop severe problems with self-harm. The greatest danger is that the underlying cause of their pain is not being addressed.

Self-harm can also become a habit and a form of addiction because the more a person does it, the more they feel the need to do it. Once started, it can take very little stress or emotional pain in normal daily living to trigger an episode of self harming. They may want to stop, but they don’t know how or it may be the only thing keeping them from completely losing control. The urge to cut can seem too hard to resist. A behavior that starts as an attempt to feel more in control can end up controlling you.
Most people who self harm keep it a secret because they fear if they tell anyone, they might be locked away. People who intentionally self-harm do so as a way to cope, because they may never have been taught how to deal with intense feelings and emotions in healthy ways. Unfortunately, the public still tends to place labels on them as being “crazy” so many people will not reach out for help and stay silent.

What are the Warning Signs?
·         Unexplained frequent injuries, such as cuts, burns or bruises, usually on the wrists, arms, thighs, or chest.
·         Low self esteem
·         Problems handling emotions
·         Problems with relationships
·         Frequent wounds like cuts, burns or bruises that they can’t explain
·         Covering their body with long sleeves or long pants even during warm weather
·         Blood stains on clothing, towels, or bedding; blood-soaked tissues.
·         Possessing sharp objects or cutting instruments, such as razors, knives, needles, glass shards, or bottle caps
·         Claiming frequent accidents or claims of being clumsy to explain injuries.
·         Being irritable, needing to be alone for long periods of time, especially in the bedroom or bathroom.

What can be done?
Understanding the person and their pain is an important first step in helping someone. Being there, listening and relaying understanding is so important.

The earlier a person can deal with the underlying issue causing the self harming behavior, the less self harm will take place and perhaps the self harm can be stopped before it becomes a habit for coping or an addiction. Some teens stop injuring themselves once their behavior is out in the open. Also, once it is out in the open others who care can offer a supportive network of family, friends, teachers, counselors and doctors further reducing their need to harm themselves. Once the self harm is disclosed then other issues like mental illnesses such as depression or anxiety may be revealed and can be treated.

Changing any kind of behavior is difficult, and deciding to change is a decision that only they can make for themselves. It is very difficult to stop self-harming without having other ways of coping to replace it so the key to recovery is finding better ways to deal with the internal pain. Self-injury can get out of control really quickly, and then it is difficult to stop. That’s why seeking help is so important. The thought of telling someone might scare them at first, so help them take little steps to start. If not you then perhaps another person they trust and feel they can talk to. It could be a friend, counselor, teacher, parent, or a coach.

As a friend you can:
  • Educate yourself about self-harm
  • Avoid anger and judgment.  Your child isn’t trying to hurt you, make you feel guilty or get attention
  • Focus on their concerns or issues, not the act of self-harm
  • Encourage positive, healthy coping methods. It takes time to learn the positive coping skills that can replace harmful coping skills.
  • Let them know you’re willing to listen, but don’t force them to talk
  • Encourage them to seek professional help
If someone who self harms decides to open up to you:
Telling somebody for the first time you self-harm can be a very scary situation and takes a lot of courage. It can be hard for both for the person who is sharing and the person who is listening but it is an important key step to transforming a situation. Listening can be scary, especially if it is someone you care about and want to protect. But try to remember that them coming forward to talk is a really good thing.
·         Be that someone that they can trust
·         Choose a good time when you won’t be interrupted
·         Allow them to write down what they want to say if their scared or if it helps them feel prepared
·         Let them know you are there for them and will stand by them as they move forward.
·         Be patient and listen – this is a really big step for them!
·         Try not to make demands or ultimatums
·         Ask them what help they would like
·         Be honest – if you need to tell somebody else then let them know
·         Know that it’s ok if you don’t have all the answers – the listening is the help


3 comments:

  1. I'm 11 and in 5th grade and my friend her name is eden she cuts herself and I'm the only person that know i want to talk to her but i don't want to say the wrong thing to her and i don't want her to cry cause I'm really scared of saying the wrong thing and making her cry cause she has attempted suicide once and I'm afraid she might do it again what do i do i really want to help her

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  2. Hi Alexis, I will assume that Eden has talked to you and that’s how you know she cuts. That is a really good thing because it is not easy for someone to talk about their cutting and will usually try to hide it. So that fact that you know, means Eden has opened up to someone and she is reaching out for help in a small way.
    When a person cuts, it is because there is an awful lot of pain that is bottled up inside of them for some reason, and the cutting is a way to temporarily leave go of the pain they feel. The best thing you can do is to let your friend know that you care about them, you are there for them, that they can count on you and that you will listen and not judge them on what they say. It may be scary for Eden to express the feelings that have been built up inside of her but try to understand her pain and allow her to let it out. It is important to create a safe space to talk and allow a healthy way of releasing the pain by letting her share some of that pain with you in her words and her tears. It may not be easy to hear some of the things Eden may have to tell you but if you’re willing to listen, it will help her. If Eden wants to cry, don’t be afraid of her emotions because it is simply another healthy way of releasing the pain she is feeling. Let her tears flow and be a kind and caring friend by listening and accepting what she tells you with an open mind and an open heart.
    Also Alexis, an important thing to remember is that talking to someone about their cutting or even about suicide will not make them attempt suicide. It will help them by knowing they have a friend. Although it is a difficult question to ask, but if you think Eden is thinking about suicide then you should ask her directly “Are you thinking about killing yourself.” Talking to her about her thoughts and feelings is the best thing you can do. People who are thinking about suicide really don’t want to die they just don’t know how to deal with problem they feel they have. By asking them directly if they are thinking about killing themselves allows them to release the huge secret they have been carrying around with them and finally let someone know how they feel. People think about suicide because sometimes they get to a place in their mind where they can’t see any other way out of the pain or trouble they are in. They want to talk to someone and they want to find another way out of their trouble but they may not tell you if you don’t ask them.
    And finally Alexis, always remember that you and Eden are never alone. There are so many people who care about you and that you can reach out to for help and support, many of which are listed here on the right side of my blog page. Let Eden know that you care and that you will be there to help her on her journey and together you can find help.

    I hope this helps.

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  3. My friend cuts herself, im pretty confident its because she has self-esteem issues. Shes 18, gorgeous and has loads of friends. Her relationship with her parents are complicated but at the end of the day she believes shes a burden on her friends and family. I want to help her and to get her to stop but i dont know how

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