Inner Pain, Outer Scars

By Carrie Jones, LCSW

She walked into my office with her arms extended and wrists covered in startling cuts. “Quick, quick! I need some bandages.” If I hadn’t known her so well, I may have wondered if she had been attacked or perhaps attempted suicide. But I knew differently. This wasn’t the first time Cammy* had come to me with self-inflicted wounds, seeking first physical care, and then more importantly, emotional care.

What is self-injury?

Self-injury (SI) refers to a spectrum of behaviors where injury is repetitively and intentionally self-inflicted. Although the injuries may become life threatening, it usually is not an attempt to commit suicide. Rather, it is a poor coping mechanism. Like Cammy, people who self-injure are looking for a way to escape from an intolerable psychological or emotional state. 

For those who turn to it, SI provides temporary relief or distraction from emotional pain and gives a sense of control over the situation. Some even feel a sense of pleasure or a “high” from the endorphins that are released as part of the body’s response to pain.  For some people, their emotional distress is so intense that they report feeling numb, and engage in SI as a means of feeling anything again, good or bad. SI has been recognized to have an addictive quality and can be difficult for an individual to stop once they have started.

Specific forms and severity of SI vary, but cutting is the most common method. Other forms include: scratching, burning, head-banging, hitting, biting and ingesting toxic substances or objects.

Who self-injures?

Although there are cases of SI among all ages and genders, it is most prevalent among adolescent girls. In fact, some studies have indicated that as many as 15-20% of teenage girls report engaging in some form of self-injurious behavior. Many, but not all, have a history of sexual, verbal, or physical abuse.

Among adolescents, SI also has been shown to have a “contagion factor,” meaning that some teens will injure themselves because they see or hear of peers who do so. It is often mistakenly believed that SI is merely attention-seeking behavior. While in some cases SI can be a way of communicating distress, the majority of self-injurers will go to great lengths to keep their behavior secret, experiencing great shame and isolation.

SI in Shanghai

Individuals anywhere can self-injure, but the expat population in Shanghai may be especially vulnerable to this unhealthy coping strategy for several reasons. First, statistics indicate that SI is especially common among those from upper and middle-class background, precisely the demographic that encompasses the majority of expats. 

Psychological profiles of self-injurers show that many tend to be perfectionists and over-achievers, another two categories that cover a large percentage of Shanghai expats.  It is these very traits that help many expats rise to their positions in their companies and accept such challenging assignments. It comes as no surprise that such accomplished adults also have high standards and expectations for their children, resulting in many perfectionists and over-achievers among children too.

Having high expectations is admirable, but it can come at a cost. Many expats feel like they need to present a polished, perfect image. Life can be competitive, allowing little room for weakness. And, when expats are hurting, they find themselves far removed from their natural support systems and sometimes with very few friends to whom they feel close enough to reveal their deepest thoughts and feelings. These feelings of loneliness, emptiness, and lack of emotional release can lead to destructive habits and practices such as SI.

Warning signs:

–  Unexplained cuts, scratches, or other wounds.

–  Wearing long sleeves, pants, sweatbands on the wrists in warm weather (to hide wounds and scars).

–  Finding lighters, razors, shards of glass or other sharp objects that one would not expect among a person’s belongings.

–  Low self-esteem

–  Difficulty expressing or managing emotions

–  Struggling in personal relationships

If you suspect SI

What should you do if you suspect your teen or someone else you know is self-injuring? Although it is frightening, try not to panic. Address the individual in a direct but caring manner. Do not scold, insult, or treat the self-injurer with aversion. 

Case in point: I worked with one teenage girl who was devastated when, after she finally worked up the courage to tell her mother she was self-injuring and needed help, her mother exclaimed, “That’s so ugly! Why would you do that to yourself?” As a result, the girl felt she could not turn to her mom for help or support. Those who self-injure are already in great emotional pain and judgmental reactions add to the guilt and shame they already feel.  Also, such negative reactions can prompt a person to switch to secretly injuring less visible parts of the body such as the stomach and thighs.

Wherever possible, remove the instruments the individual is using to injury him/herself.  Most importantly, seek professional help immediately. A therapist can work with the individual to address the underlying issues and to teach positive, healthy coping skills. It is vital to find a therapist who is experienced with this specific issue. With professional, caring support, it is very possible for individuals to find healthier ways of dealing with the pain in their lives and to fully recover.

*Name has been changed to protect confidentiality.

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