Dear Alice,

I am very concerned about a friend of mine who recently has taken to self-mutilation. She makes multiple scratches on her arm on a daily basis with a knife or scissors. I asked her why she does this, and she is not sure; she just feels like it. PLEASE, PLEASE tell me if my concern is warranted and what I should do.

— What's normal?

Dear What's normal?,

Your concern is definitely warranted. Many people turn to using sharp items to cut their skin (what is often referred to as cutting) or other self-injurious behaviors as a way to cope with or relieve painful or hard-to-express feelings. While many aren't using self-harm associated with suicidal thoughts or intentions, and even if your friend doesn’t mean to hurt themselves seriously, this behavior can cause life-threatening complications. In general, mental health professionals agree that individuals who cut themselves often have some psychological disturbance that leads to this behavior. This, however, doesn't mean that helping your friend is a lost cause — there's evidence to suggest that people who self-injure are able to stop cutting and live their lives after seeking proper treatment.

Although your friend self-injures (also often referred to as self-harm) by scratching her skin with a sharp object, it’s worth noting that individuals may employ a range of strategies to self-injure. Cutting, specifically, occurs mostly among teenagers and young adults. Some other strategies to be aware of include burning the skin, hitting themselves or banging their head against solid surfaces, inserting objects under the skin, and pulling hair out from their head and body. The arms, legs, and front of the torso are the most common targets of self-injury, but could be done on any area of the body. People who self-injure may also use more than one method to harm themselves; some individuals may only do it on a few occasions while others engage in this behavior for a longer period of time. It’s not uncommon for people who self-injure to try to conceal their marks with clothing or make excuses as to how an injury happened, if discovered.

The reasons behind self-harm are numerous, complex, and specific to the individual. Some people who self-injure say they feel numb or empty inside, unable to feel or experience anything. They might note that self-harm is an attempt to feel something in their lives. For others, self-harm is a way of temporarily coping with emotional pain that seems to go away as they feel physical pain from self-inflicted wounds. Similar to your friend, some people may not fully understand why they self-injure. Research and data collected from clinical populations also shows that self-injury is often linked to:

  • Childhood abuse or trauma, especially childhood sexual abuse
  • Eating disorders
  • Substance abuse
  • Post-traumatic stress disorder
  • Borderline personality disorder
  • Depression and anxiety disorders

List modified from Cornell Research Program on Self-Injury.

Unfortunately, there hasn’t been a consistent strategy to prevent someone from self-injuring, but there’s research to support ways to keep the behavior from continuing. Getting people the help they need may involve other people who are close to them, including family members, teachers, friends, etc. It may also be helpful, and sometimes necessary, to work with a mental health professional.

In order for treatment to be successful, it’s recommended that they first get evaluated for any underlying or related mental health disorders. A mental health professional will likely suggest a treatment plan that addresses these underlying concerns. In many cases, professionals have prescribed a combination of medication, cognitive behavioral therapy, and interpersonal therapy to treat self-injury. Some additional therapies that may be used are dialectical behavior therapy and mindfulness-based therapies. The road to recovery may take time, hard work, and dedication from the individual to recover.  ​

It's likely your friend may benefit from speaking with someone, not only to help heal her visible wounds but her invisible ones as well. If or when you choose to talk with her, it’s good to first think about when and where to have the conversation. It’s best to talk with her one-on-one in an environment that’s private and has minimal distractions. Consider your verbal and non-verbal language — using a warm and listening tone while using open body language will likely make both you and your friend more comfortable. You might start the conversation by telling her that you care about her and you're concerned about her self-injurious behaviors. From there you may see where she takes the conversation, keeping in mind that it's ultimately her decision to seek help.

Your genuine concern may be just enough to help her feel supported and ready to make the next move toward recovery. Unfortunately, it's also possible she'll brush off your concern the first time. If this happens, you may want to just keep her on your radar and check in with her later. Emphasizing that you’re there to support her whether or not she chooses to seek help may continue to send the message that you care. When she's ready to look for help, your willingness to understand and support her might be just what she needs.

It may be helpful to do some homework and look into resources that are available in your area. One place to start is the Self Abuse Finally Ends (S.A.F.E.) Alternatives, which is an educational and treatment resource for those who self-injure. If she's interested (or becomes interested) in counseling, you can point her in the direction of mental health services. Anyone can visit the Substance Abuse and Mental Health Services Administration (SAMHSA) resource for locating therapy services nearby. If your friend has health insurance, her plan may have a list of mental health professionals and a procedure for connecting with services. She can call the company or look on their website for more guidance.

Now that you know more about self-injury, you may be better equipped to understand your friend's situation. With some encouragement and finesse, a supportive conversation might nudge her toward seeking the help she needs. You seem like a genuine, concerned friend that anyone would be lucky to have!

Good luck,

Alice!

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