Approximately 1% of the population has, at one time or another, used self-inflicted physical injury as a means of coping with an overwhelming situation or feeling. ASHIC - the American Self-Harm Information Clearinghouse - strives to increase public awareness of the phenomenon of self-inflicted violence and the unique challenges faced by self-injurers and the people who care about them.

Self-harm scares people. The behavior can be disturbing and difficult to understand, and it is often treated in a simplistic or sensational manner by the press. As a result, friends and loved ones of people who self-injure often feel frightened, isolated, and helpless. Sometimes they resort to demands or ultimatums as a way of trying to regain some control over the situation, only to see things deteriorate further.

The first step toward coping with self-injurious behavior is education: bringing reliable information about who self-injures, why they do it, and how they can learn to stop to people who self-injure and to their friends, loved ones, and medical caregivers. ASHIC was founded to meet this need for honest, accurate information.

About Self-harm

Self-harm, also known as self-injury, self-inflicted violence, self-injurious behavior, or self-mutilation, can be defined as the deliberate, direct injury of one's own body that causes tissue damage or leave marks for more than a few minutes and that is done in order to deal with an overwhelming or distressing situation.

It's important to remember that, even though it may not be apparent to an outside observer, self-injury is serving a function for the person who does it. Figuring out what functions it serves and helping someone learn other ways to get those needs met is essential to helping people who self-harm. Some of the reasons self-injurers have given for their acts include:

• Affect modulation (distraction from emotional pain, ending feelings of numbness, lessening a desire to suicide, calming overwhelming/intense feelings)
• Maintaining control and distracting the self from painful thoughts or memories
• Self-punishment (either because they believe they deserve punishment for either having good feelings or being an "evil" person or because they hope that self-punishment will avert worse punishment from some outside source
• Expression of things that can't be put into words (displaying anger, showing the depth of emotional pain, shocking others, seeking support and help)
• Expression of feelings for which they have no label -- this phenomenon, called alexithymia (literally no words feeling), is common in people who self-harm

See Osuch, Noll, & Putnam, Psychiatry 62 (Winter 99), pp: 334-345
Zlotnick et al, Comprehensive Psychiatry 37(1) pp:12-16.

People who self-injure often never developed healthy ways to feel and express emotion or to tolerate distress. Studies have shown that self-harm can put a person at a high level of physiological arousal back to a baseline state.

It's natural to want to help people who self-injure develop healthier ways of coping when they feel overwhelmed, but it's important not to let your discomfort with the concept of self-harm cause you to issue ultimatums, punish self-harming behavior, or threaten to leave if the person self-harms again. Ideally, you should set boundaries to keep yourself feeling safe while respecting the person's right to make his or her own decisions about how to deal with stress.

Common Myths about Self-Injury

Self-harm is usually a failed suicide attempt.
This myth persists despite a wealth of studies showing that, although people who self-injure may be at a higher risk of suicide than others, they distinguish betwen acts of self-harm and attempted suicide. Many, if not most, self-injuring people who make a suicide attempt use means that are completely different to their preferred methods of self-inflicted violence.

People who self-injure are crazy and should be locked up.
Tracy Alderman, Ph.D., author of The Scarred Soul, addressed this:

"Fear can lead to dangerous overreactions. In dealing with clients who hurt themselves, you will probably feel fear. . . . Hospitalizing clients for self-inflicted violence is one such form of overreaction. Many therapists, because they do not possess an adequate understanding of SIV, will use extreme measures to assure (they think) their clients' best interests. However, few people who self-injure need to be hospitalized or institutionalized. The vast majority of self-inflicted wounds are neither life threatening nor require medical treatment. Hospitalizing a client involuntarily for these issues can be damaging in several ways. Because SIV is closely related to feelings of lack of control and overwhelming emotional states, placing someone in a setting that by its nature evokes these feelings is very likely to make matters worse, and may lead to an incident of SIV. In addition, involuntary hospitalization often affects the therapeutic relationship in negative ways, eroding trust, communication, rapport, and honesty. Caution should be used when assessing a client's level of threat to self or others. In most cases, SIV is not life threatening. . . . Because SIV is so misunderstood, clinicians often overreact and provide treatment that is contraindicated.

People who self-harm are just trying to get attention.
A wise friend once emailed me a list of attention-seeking behaviors: wearing nice clothing, smiling at people, saying "hi", going to the check-out counter at a store, and so on. We all seek attention all the time; wanting attention is not bad or sick. If someone is in so much distress and feel so ignored that the only way he can think of to express his pain is by hurting his body, something is definitely wrong in his life and this isn't the time to be making moral judgments about his behavior.
That said, most poeple who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.

Self-inflicted violence is just an attempt to manipulate others.
Some people use self-inflicted injuries as an attempt to cause others to behave in certain ways, it's true. Most don't, though. If you feel as though someone is trying to manipulate you with SI, it may be more important to focus on what it is they want and how you can communicate about it while maintaining appropriate boundaries. Look for the deeper issues and work on those.

Only people with Borderline Personality Disorder self-harm.
Self-harm is a criterion for diagnosing BPD, but there are 8 other equally-important criteria. Not everyone with BPD self-harms, and not all people who self-harm have BPD (regardless of practitioners who automatically diagnose anyone who self-injures with BPD).

If the wounds aren't "bad enough," self-harm isn't serious.
The severity of the self-inflicted wounds has very little to do with the level of emotional distress present. Different people have different methods of SI and different pain tolerances. The only way to figure out how much distress someone is in is to ask. Never assume; check it oput with the person.

Only teen-aged girls self-injure.
In five years of existence, the bodies-under-siege email list has had members of both genders, from six continents, and ranging in age from 14-60+. It's a person-who-has-no-other-way-to-cope thing, not a teenage (or female or American or whatever) thing.

ASHIC's goals

The American Self-Harm Information Clearinghouse strives to educate the general public and medical and psychological professionals about the phenomenon of self-harm. We hope that by disseminating clear, concise, and accurate information about self-harm, we can improve the treatment that those who cope with distress by injuring themselves receive from hospitals, physicians, therapists, and their own families and friends.

The more people know about the realities of self-inflicted violence, the less fearful and stigmatizing they will be when confronted with it. ASHIC's main project to date has been National Self-Injury Awareness Day (March 1, 2002). Other services we offer now are:

• Sending out fact sheets, brochures, copies of the Bill of Rights for those who self-harm, and other materials on request
• Acting as a media liasion -- putting writers and reporters in contact with self-injury experts and self-injuring people
• Helping with research in special situations (recently, we helped someone put together a package explaining why ionvoluntary commitment to a state hospital might be harmful to a person who self-injures
• Operating a limited Speakers' Bureau
• Producing press kits

We are working on an informational booklet to be released in summer 2002, as well.

Contact information

Materials can be requested by sending a stamped, self-addressed envelope to:
ASHIC
521 Temple Pl
Seattle, WA 98122

E-mail inquires should be sent to ashic@selfinjury.org and telephone inquiries should be directed to Deb Martinson at 206-604-8963.