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Self-Injury: Healing the Wounds

Self-Injury: Healing the Wounds

Can I get better?
What treatment is available?
Does medication help?
Does psychotherapy help?
How can I help myself?

Can I get better?
Yes, you can. In fact, some people who self-injure may be able to stop on their own. They may simply grow out of a behavior that got them through a crisis. But most people need treatment because self-injury has become so much a part of their daily life. And because the emotional problems that caused the disease are so deep, it could also take time to make progress. So you and your mental health professional will need to have patience. Together, you can work to build a relationship of safety and trust, something that the person who self-injures has not known for most of her life. back to top

What treatment is available?
No single treatment works with all self-injurers because the roots of the disease vary from one person to the next. But some effective treatments are being used all over the world. back to top

Does medication help?
Many mental health professionals will want to put you on medication right away to help bring your symptoms under control. That should make it easier for you to begin exploring your deeper problems. One of the most common medications used to treat self-injury is a fairly new type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor). You may have heard of Prozac, which is one example of an SSRI. Another type of antidepressant known as MAOI (monoamine oxidase inhibitor), along with antianxiety medications and mood stabilizers, have also been helpful in treating symptoms like depression, anxiety, mood swings, and racing thoughts. You may need to try a few medications before you and your mental health professional find the one that works best for you.

Any medication can cause unwanted side effects. If you are taking a medication, it is important to ask your mental health professional about the possible side effects. Make sure you or a parent knows what to do if side effects occur. Don't stop taking your medication or change your dose without talking with a mental health professional first. back to top

Does psychotherapy help?
Medication alone is rarely enough to heal you if you self-injure. Psychotherapy is almost always needed as well, because self-injury is a pattern of behavior that relates to painful thoughts and feelings that have developed over a long period of time.

One of the challenges of psychotherapy is that talking can bring everything up to the surface and make the problem worse, at first. This often happens when you try to stop a behavior that has become a habit. But eventually, as you begin to trust your mental health professional, you will be able to make progress. Sometimes, you may find it hard to believe that he or she actually cares about you, because you have often been treated so differently. So you may test his or her commitment every so often (maybe even by injuring yourself). Over time, therapy will help you learn how to soothe and care for yourself. And you will begin to feel worthy of such care. Once you realize that the loss or abuse you suffered was not your fault, you will feel much better.

Some mental health professionals use cognitive-behavioral therapy (talking therapies) to treat patients who self-injure. This kind of treatment believes that, just as you "learned" self-destructive behaviors, you can "unlearn" them by changing negative thought patterns into positive ones. Other therapists combine cognitive-behavioral techniques with more traditional psychotherapy.

Along with individual psychotherapy, your mental health professional may also suggest group therapy and family therapy. Group therapy will give you a chance to meet other people who self-injure. By connecting with each other, you can let go some of the shame and secrecy that so many self-injurers feel. Family therapy can help improve communication and change some of the unhealthy family patterns that led to your illness. Your parents may also learn some new ways to manage and express their own emotions.

Hypnosis has also been successful in helping some people who self-injure, as have the expressive arts such as writing, painting, drama, and dance. Activities that boost a person's physical sense of safety, power, and control, like the martial arts, can also be useful.

In some cases, a person who is at risk for suicide or very serious self-injury may need to be hospitalized. Otherwise, it's usually more effective to learn how to cope with everyday stresses when you're out in the real world, not in an artificially safe environment like the hospital. back to top

How can I help myself?
Of course, no treatment for self-injury will be successful unless a person truly wants to stop the self-injury. It takes a lot of faith, courage, and commitment to endure the pain of the past and create a healthier future. Developing your own support network of friends is probably the best way you can help yourself through these tough times.

One way of doing this is to join a self-help group. Self-help groups provide guidance, support, and encouragement. A few cities have chapters of a 12-step group for self-injurers, based on the principles of Alcoholics Anonymous, called Self-Mutilators Anonymous (SMA). The only requirement for membership in SMA is a desire to stop hurting yourself. For many people, sharing their secret at an SMA meeting is the first step to recovery.

Many people find it helpful to stop self-destructive behaviors by doing other things that are physical, but not harmful, to themselves. Some of these include:
  • squeezing a handful of ice cubes, or rubbing an ice cube on your face
  • sticking your fingers in a tub of ice cream for a few minutes
  • taking a cold bath or shower
  • biting into a food with a strong flavor, such as hot peppers, ginger, or an unpeeled lemon, lime, or grapefruit
These techniques may sound a bit strange, but they usually work because they create an intense sensation, much like self-injury—only you aren't really hurting yourself. The more you get through the urges to self-injure with these techniques (and without hurting yourself), the stronger you become.

One young woman who spent many years injuring herself developed a list of questions to ask yourself the next time you feel the urge. You may want to start a journal to record your answers to these questions over time.
  • Why do I feel I need to hurt myself right now? What got me here?
  • Have I been here before? What did I do to deal with it? How did I feel then?
  • What else can I do that won't hurt me?
  • How do I feel right now?
  • How will I feel when I am hurting myself?
  • How will I feel after hurting myself?
  • How will I feel tomorrow morning?
  • Can I deal with my stress in another way in the future?
  • Do I need to hurt myself?
Hopefully, some day soon, the answer to this last question will be "no." back to top

Last Modified Date: 4/11/2001
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