Self-Injury

Transcript from online Concerned Counselling¹ conference
with Dr. Tracy Alderman on Tuesday, March 3, 1998

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Bob M is Bob McMillan, editor of online magazine CCI Journal who chairs this conference.
Dr. Alderman is self-injury expert, psychologist, and author, Dr. Tracy Alderman.
The people color-coded in green are audience members who had questions.
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Bob M: Our topic tonight is SELF-INJURY. Our guest is Dr. Tracy Alderman. Dr. Alderman is a psychologist, an expert in self-injury, and has written the book: The Scarred Soul: Understanding and Ending Self Inflicted Violence. Welcome Dr. Alderman to the Concerned Counseling website. Would you please tell us a bit more about your expertise in the area of self-injury and how you came to write the book?

Dr. Alderman: I first began researching the area of self-injury about 9 years ago when I was working with a 13 year old girl who was cutting on herself. I couldn't find any information that was practical, so I decided to do some research and write my own book.

Bob M: And could you tell us some of the more informative or startling things you discovered in your research?

Dr. Alderman: One of the things that amazed me was how common self-injury actually is. Somewhere between 1 and 2 million people are doing this to themselves.

Bob M: And why are the doing it? What motivates them?

Dr. Alderman: Most people are doing this as a way of coping with overwhelming negative emotions. It provides release of sorts.

Bob M: And when you say "overwhelming", what do you mean?

Dr. Alderman: Well, sometimes things just build up, sort of like when you shake up a can of soda. And during these times it feels like there's no other way to deal with things but to hurt yourself.

Bob M: For those who don't know, Dr. Alderman's book: The Scarred Soul, is a self-help book for self-injurers. Can individuals who self-injure really help themselves recover completely from this behavior?

Dr. Alderman: I think that most people if they want to, can stop. Sometimes it takes a bit of help from others, like a therapist, and a lot of willpower. But, in my book there are lots of great activities to get someone started on recovery from this.

Bob M: Let's talk about that. The first step you identify in the move towards recovery is: Identifying and Changing feelings, thoughts and behaviors. Please explain that to us?

Dr. Alderman: Anyone can stop a behavior for a short period of time, but getting to the underlying causes such as thoughts and feelings is a way to make the change more complete. By starting with changing the behaviors, you break the patterns that lead to self-injury.

Bob M: For those just arriving, our guest tonight is Dr. Tracy Alderman, author, psychologist and self-injury expert. Here's a couple of audience questions Dr. Alderman...

Issbia: That's a good question Issbia. This is where challenging some of the thoughts you have about why you self-injure is important. Once you change your beliefs about needing to be hurt, you'll not be as likely to want to hurt yourself and I'm sure that you know that you don't need to be hurt anymore, Issbia.

Bob M: So what are people supposed to do, treatment wise, to help themselves recover?

Dr. Alderman: The first thing is to commit themselves to being willing to be uncomfortable while they work on quitting. Also, they need to be patient with themselves. It's a long process. Next, work on changing the behaviors. So, if you usually hurt yourself in your home after work, change your behavior so you're not home after work. Also, try to make it more difficult for you to hurt yourself. So if you "cut" yourself, put your knife in a box in the garage. This will make it harder to access. The more work there is, the less you'll want to hurt yourself.

Emmy: As someone who suffers from self mutilation and strong suicidal tendencies, self harm is like a steam vent, and without it I fear I really WILL explode once and for all. How can I keep that from happening?

Dr. Alderman: Self-mutilation is an effective coping technique, but there are others, Emmy. By learning some of the other ways to let off steam, you won't need to hurt yourself. It just takes a while to find these ways. Self-injury is often related to childhood abuse. You can look at self-injury as a symptom of a much larger problem and learning to deal with the original probems is more than half the battle.

Donnna: I used to do alot of self injury to myself, but came to the realization that I had no control over that it. I then turned to anorexia, something I knew I'd have complete control over. Dr. Alderman, would you consider this self injury?

Dr. Alderman: Donna, I wouldn't call it self-injury per se. But it is definitely a similarly self-destructive action. Both eating disrders and self-injury tend to have similar causes -- childhood abuse. And, both self-injury and anorexia can be cured with some work Self-injury and eating disorders are very related to each other. Many people with eating disorders also self injure.

Bob M: There are many people here tonight who are self-injurers and what they are looking for Dr. Alderman is an A-B-C, step-by-step guide on how to stop. Can you outline that for us? And then, if they need further explanation, we'll go into that.

Dr. Alderman: Sure thing. First you need to want to stop. Without that, you won't be successful. Next, change some of your behaviors to make it less likely that you'll self-injure. For instance, surround yoursef with friends, get rid of the things you use to injure youself, etc. Third, find some alternatives to self-injury and write these on a list you keep with you. You can do things like draw on yourself, call a friend, go to a movie, exercise, hold an ice cube, throw something soft against a wall, hit golf balls, etc. and find what works for you. Next, work on identifying the thoughts and feelings which make you want to hurt yourself. You'll probably find that many of your thoughts aren't real logical. And, hopefully, you'll find some ways to accept and deal with your emotions in a less destructive way. Finally, learning to communicate and connect with others is what will help you the most. If you can say to someone, "I hurt" rather than showing them through the injury, you'll be a whole lot better off. You'll also find that connecting with others helps get rid of many of the feelings that lead to self-injury.

ibkathyinsd: The longer I self-injure, the more desire I have to injure more severely. Is this a common problem and how dangerous does that become?

Dr. Alderman: It is a fairly common problem. Self-injury changes the chemicals in your brain. Just like doing drugs, you build a tolerance to self-injury. And just like drugs, if it goes this far, it's important to stop really soon.

Bob M: Here are a few audience comments:

Meg: Dr., I find that even though I have a blade hidden, its like a security thing for me--just knowing its there. But I find other ways to stop from cutting. For instance, I come here and talk out what is really bothering me. That helps alot.

Dr. Alderman: Meg, there's nothing wrong with keeping a blade for security. Self-injury is always a choice. I'm glad you're fnding different ways of coping. This is important for anyone to do.

ccindgo: Dr. A., do you feel medications are helpful in the recovery from self-injurious behavior? If so, which ones have you found to be the most beneficial?

Dr. Alderman: Actually, research shows that medication isn't really helpful. But, the extra attention that people receive from going to a doctor and receiving extra care is helpful -- but it's not the medication that helps. It's really the support and connection that you reveive that is important.

braks: My wife cuts herself constantly because she says it relieves the pent up stress and pressure. I dont undersand how cutting can relieve stress?

Dr. Alderman: It provides an outlet for the pain which can be tangible.

Ganymede62: I'm not sure about self-punishment- but having BPD is like being strapped to the front of a speeding train. The panic makes you want to die. Self-injury relieves the panic in minutes. What if you are so distraught with suicidal ideation that self-injury seems the lesser of the 2 evils? Dr.A., any thoughts relating to BPD and SI? This problem is getting worse over time.

Dr. Alderman: Always choose the lesser of two evils. If self-injury keeps you safe then, by all means do what you have to do.

Bob M: Here's an audience comment:

TallTam: My boyfriend doesn't understand why I cut either. I think he's frustrated because it's not something he can help with.

Bob M: I want to make sure I am interpreting what you are saying correctly. Are you saying in some instances, it's okay to self-injure?

Dr. Alderman: If it is keeping someone from suicide...absolutely.

Natalie: Is where you cut / burn on your body significant? For example, arms, legs, stomach, breasts, etc.

Dr. Alderman: Not according to my beliefs. There is one researcher who does believe it is significant, but I don't agree with him at all. I think the reasons behind self-injury are common, as I mentioned earlier.

Wolfeyes: Dr. Aldrman, my cuts and scars on my arms are sometimes visable to others, although I am embarrassed about it. How do I tell friends and family members about this behavior that I have? I want them to understand and not turn away from me.

Dr. Alderman: One suggestion is simply to be direct and honest about why you hurt yourself and how it helps you cope with a really tough situation. Scars are a sign of survival and they are nothing to be embarrassed about.

Eleanor: I think that medications can help. A lot of people have said that benzodiazpines and antipsychotics help them when they're having an urge to cut. My own experience is that Xanax has helped. And antidepressants can take the edge off of the feelings that lead to cutting, by making me less sensitive, less angry.

Dr. Alderman: I'm glad that works for you. That's not what I've read, but if it works, then great.

g3: Are there any national organizations that deal directly with self-injurious behavior?

Dr. Alderman: Not national. There is one in-patient hospital which runs an out-patient group called "self-abuse finally ends". That's the Rock Creek Hospital.

SenzEnina: When in need of medical attention, what is the best way to get the help we require (stitches, dressings, etc.) and not be terrified about being "commited". I deny myself much needed medical attention because of the treatment I am afraid I will recieve.

Dr. Alderman: This is a big problem because medical people don't understand that self-injury is not "suicide". And sometimes the best way to deal with the situation is not to be totally honest about the source of the injuries.

ioLuS: Can you be locked up for cutting/burning if you seek medical attention?

Dr. Alderman: That's a good question. If whoever sees you, believes you are in danger of significantly harming yourself, yes you can. And sometimes, self-injury gets mistaken for suicide. Once people begin to understand more about what self-injury actually is, this will be much less of a problem.

Ganymede62: Re: ioLus's question...My marriage counselor drew me out over several weeks regarding self-injury. Then when I finally admitted it, phoned my Dr and said "Admit her today"!

CryCEE: Dr. Alderman, I have tried in the past, and currently, to stop my self injurous behavior, by attending Dialectical Behavior Therapy classes, using different coping strategies and techniques, even trying relaxation techniques. All those things may work for a short period of time, but what does a person do, when they feel that they have exhausted all options and the only one left is what they know will work, self injury?

Dr. Alderman: Then you forgive yourself for self-injury and go back and try and find different options like art, exercise, talking to others and getting a good support system.

Miktwo: Can the loved ones help the victims of this disorder?

Dr. Alderman: Absolutely. They can help provide support and understanding and connection and sometimes intervention when the person feels like injuring themselves.

Bob M: When, if anytime doctor, does a loved one have the right to say...enough is enough...you need help and I am having you hospitalized?

Dr. Alderman: I don't think a loved one should ever threaten hospitalization. They should offer support instead. That does not mean make the person stop hurting themselves. Only the self-injurer can do that.

Crickey: How can I tell the difference between regular injury from self-injury. I am trying to stop. Sometimes though, I bite my nails without realizing it, until I bleed . How do I know the difference, so I know when I have stopped self-injuring?

Dr. Alderman: Self injury is best defined as being intentional and done to one's self. If you are not doing this intentionally, then it's probably not self-injury.

ibkathyinsd: To your knowledge, is there any training required for physicians regarding self-injury? I have found some of them to act disgusted when going to the E.R. for treatment, which makes the whole feeling of worthlessness start all over again.

Dr. Alderman: To my knowledge there is no training for anyone in the medical field regarding self-injury. This makes it very tough because they don't have a clear understanding of what is going on, so they cast their own feelings out on the patients.

Bob M:We are talking to Dr. Tracy Alderman author of The Scarred Soul: Understanding and Ending Self-Inflicted Violence. By the way, you can get the book at our online bookstore or at any big bookstore.

Crickey: I got the book a few months back online and it's been helping me tremendously as I slowly work though it.

TiggsLynne: What about people who also suffer from Dissociative Identity Disorder/Multiple Personality Disorder? Is there a way to help them?

Dr. Alderman: The strategies are basically the same and self-injury is very common among people with DID/MPD.

ioLuS: My parents are concerned about my burning when they see it. They are actually afraid of me. They think if I can hurt myself, then I can hurt them. How do I ease their fears?

Dr. Alderman: You might want to talk with them about why you hurt yourself and show them this is your way of coping. Hurting yourself and being violent towards others has no connection at all.

Bbox: If you can manage to heal the source of the pain (in my case, incest) as you mentioned earlier, don't you think stopping cutting would naturally follow?

Dr. Alderman: Absolutely. But sometimes it's easier to control the things you see first...like self-injury. Also, even though you think "you have gotten over" your incest, there still may be other things going on. You might want to explore that.

Emmy: Can the PAIN of incest ever be healed???!

g3: Based on your research or your knowledge of this disorder, is it common for people who self-injure to use the behavior as a way to "ground" themselves?

Dr. Alderman: Yes it is. It's all about finding ways to make yourself feel better and get back to a state where you feel more relaxed, more like yourself.

Lynne: I haven't self-injured in about 7 months. It was hard to stop, but it has gotten easier. Sometimes it worries me to hear that it's something that I will struggle with the rest of my life. Do you hold with the idea that once you have self-injured, it will always be a problem in your life?

Dr. Alderman: For some people, it always will be. For others, it doesn't have to be. The difference is like any difference in getting over an addictive behavior. It depends on how much you depend on it and why you want to stop doing it, along with a host of other reasons.

Bob M: Here are some more audience comments:

SenzEnina: For those who want to know WHY?--when my mind is racing out of control and I feel like I am not real, self-injury is a way of slowing the world down, a way to come back to reality.

Donnna: It's much easier to control other aspects of my life.

Meg: Well I'll tell you, if people that self injure like myself just really try and come here first and talk with their friends here first, you might be surprised that you will more times than not feel better.

jm: What about those alone who do not display their injuries for others? Only self injure in private --where it is not visible to others.

Dr. Alderman: Actually, most people don't display their injuries. They injure in secret. It's a very secretive disorder. And that's why many people don't know about it or understand it. So if you do this, you are not alone.

1. Acknowledgements to www.concernedcounseling.com/ccijournal/index.html