Self-injury is a common response to abuse, but shame often keeps self-harmers silent. Here are some ways to break free, from someone who knows.
by Renée Fabian
(Content warning: Discussion of self-harm, abuse)
I was 17 years old the first time I self-injured. I had been sexually abused for two years by then and I finally reached my breaking point. I couldn’t tolerate the distress and I needed a way to express my pent up rage, anger and sadness. Self-injury became my coping skill. And once I started, I couldn’t stop. Nothing could chase away the numbness as effectively or calm down the overwhelming emotions as fast as self-injury. Now that I am working to recover from self-injury, I find it difficult to do without a lot of resources.
Self-injury is defined as inflicting intentional harm on the body without suicidal intent. It primarily serves as a maladaptive coping skill to manage difficult emotions. Statistics indicate that approximately 17 percent of adolescents, 13 percent of young adults and 5.5 percent of adults engage in self-harm. Yet self-harm is still so stigmatized, it can be hard to know where to turn for help. We’ve got you covered. From individual therapy to Dialectical Behavior Therapy classes, books, online links and more, these resources will help you find the support you need.
1. Individual Therapy
Individual therapy is still the most widely available treatment for self-injury, and for good reason. A therapist can work with you one-on-one to dig into the emotions and experiences that cause self-harm. If you need to find a therapist, start with the referral section on self-injury recovery sites such as S.A.F.E. Alternatives or To Write Love On Her Arms. Psychology Today’s therapist directory also has a self-injury designation in their search feature to help you find an expert.
If the cost of in-person therapy is prohibitive, look into online-based therapy, such as Talkspace or BetterHelp. These providers give you access to a therapist via daily text messaging (and occasional video sessions, if you choose) at a fraction of the cost of traditional therapy. Once you identify a potential therapist, don’t be afraid to ask their thoughts about self-injury and their treatment methods. Make sure they truly understand self-injury and can provide a safe, non-judgmental space.
2. Self-Injury Support Groups
Self-harm is, by nature, a secretive, isolating and lonely experience. Discovering you’re not alone by talking with peers is powerful. But self-injury-specific support groups are hard to find. S.A.F.E. Alternatives runs a self-injury recovery outpatient clinic in St. Louis. They also have clinician or peer-run S.A.F.E. Focus support groups in a handful of cities throughout the United States. Self Mutilators Anonymous has a New York-based meeting and, according to their website, they do accept call-ins by request. Chicago has the Center for Self-Injury Recovery Services.
If there isn’t a group in your area, ask your therapist to start one. Or, start your own peer-run group. S.A.F.E. Alternatives offers an affordable leader manual using the tested tenets of their program, if you want a structure to follow. A best practice for a group — use neutral language such as “self-injury” and “self-harm,” instead of specifics, to avoid triggering fellow group members.
3. Other Support Groups or 12-Step Programs
Because there are so few self-injury support groups, sometimes it’s helpful to think outside the box. From depression, trauma or anxiety support groups to Alcoholics, Co-Dependents and Overeaters Anonymous and beyond, there are many other groups that can help, even if they don’t deal directly with self-injury. Often self-harm co-occurs with other issues, so finding a support group or 12-step program that fits your other needs can build in more support and address underlying causes of self-harm.
4. Dual Diagnosis Intensive Outpatient or Inpatient Treatment
If you’re really struggling, also consider dual diagnosis intensive outpatient or inpatient programs. These programs are equipped to treat trauma, substance abuse or eating disorders as well as mental illness in a concentrated environment. Similar to searching for appropriate support groups, find a dual diagnosis program that addresses other major issues and has experience with self-harm. When I was hospitalized, I went into a trauma-specific program that didn’t deal specifically with self-injury. But the coping and distress tolerance skills I learned apply to self-harm as well, which was immensely helpful.
5. DBT Therapy or Skills Classes
Originally developed for those who suffer from persistent suicidal ideation (and commonly linked with treating borderline personality disorder), Dialectical Behavioral Therapy teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. The full DBT program includes individual therapy with additional coaching outside of sessions and skills classes. While research shows the full DBT program to be effective for self-injury recovery, sometimes it isn’t accessible because of location or cost.
In this case, look for a DBT skills class. A DBT group will teach the same critical skills, such as how to cope ahead and anticipate situations that may be triggering so you can pre-plan self-care; how to ride out emotions without acting on them; and how to effectively ask other people for what you need. A true DBT skills class will include logging your emotions, noting your urges to engage in target behaviors (such as self-harm) and the skills used to help deal with difficulties as they arise. Frankly, these skills not only benefit self-injury recovery, they’re just plain good life skills.
6. Online Resources
A lot of websites have the same basic ABCs of self-injury, which you already know if you self-injure — you’ve read about drawing on your arms with red marker or snapping a rubber band a hundred times. If you’re looking for something more useful, start with To Write Love On Her Arms. A non-profit dedicated to raising awareness and providing hope for recovery from self-injury, depression, addiction and suicide, TWLOHA has a great “Find Help” section for local recovery resources. They also have an active blog with great information and stories.
Self-Injury Outreach & Support also has good information, including a section that walks you through coping strategies, stories of those recovering from self-injury and resources for self-injurers and their loved ones. The Self Injury Foundation and S.A.F.E. Alternatives have reliable information and referrals. For the best up-to-date information on self-injury, Self-Injury and Recovery Research and Resources at Cornell University has an amazing library of facts, figures and treatment suggestions.
Similar to websites, books help me understand self-injury better and provide inspiration and tools for recovery. I especially appreciate memoirs and informational books. Memoirs make me feel less alone and illuminate the difficult but attainable process of ending self-harm, which I find hopeful — it can be done. Good memoirs featuring self-injury include Scars by Cheryl Rainfield, Skin Game by Caroline Kettlewell, Dancing In The Rain by Tara L. Nicole and Bloodletting by Victoria Leatham. On the informational side, my favorite book is A Bright Red Scream by Marilee Strong. Written in plain language with a sensitive and respectful tone, it’s a great resource. Other good ones include Bodily Harm by Wendy Lader and Karen Conterio and Freedom From Self-Harm by Kim Gratz and Alexander Chapman. Knowledge is power.
Regardless of where you’re at in the recovery process, know you are not alone. There are resources available and a self-injury free life is possible. I’ll be working on recovery right alongside you.
Self-injury Awareness Day is March 1. Featured photo courtesy To Write Love On Her Arms.
Renée Fabian is a Los Angeles-based journalist who covers mental health, music and the arts and cats. Her work has been published with Wear Your Voice, The Establishment, Ravishly, The Daily Dot and The Week, among others.