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I never understood why people would harm themselves to feel better. It just didn't make sense to me. I heard about this in high school and more in college but it wasn't news that would spread rapidly. This was likely because most people would hide the fact they had scars that were from self-harm. They would also not be likely to talk about it as well. I really started to hear more about self-harm scars during my practice. It is through this experience that I gained more understanding of what happens emotionally and why someone would do it.
A 45-year-old male comes to visit me regarding scars on his arm that was caused by using a razor blade. He was married and had kids but always had to wear long sleeve shirts to hide his scars. This was the worst during the summer. He told me that he wanted to live a normal life. One where he didn't have to hide. The scars were a painful reminder of his past and markedly affecting his life - the good life he had now.
Here is a picture of this type of scar on a person's forearm (click here for more pictures: Treatment of Self-Induced Scars. This picture is not from this fictitious person in this story but serves as an example of what they can look like
The 45-year-old male goes on to tell me that when he was a child about 14 years old, he witnessed his brother, who was then 19, get shot and killed in front of his home. He remembers that day like it was yesterday. He remembers his father and mother screaming like he never saw before. He was numb. "This wasn't happening," he thought. This was just a bad dream. He goes on to tell me that his family never got over it. His parents got a divorce and he was troubled ever since. He left his mother's home after he turned 18 and rarely saw his family afterward. He still has dreams of his brother being alive and still has nightmares of that incident. Now his life is changed so much for the better. He loves his life. He went on to become an engineer. He loves his 2 daughters and boy and wants to live a life without that pain he felt for so many years. The scars were his physical reminder and emotional trigger. That's what eventually brought him to our office for a consultation on scar revision.
Self-harm scars are defined as the intentional, direct injuring of a person's body without the intent to commit suicide. The self-harming can be in the form of burning, scratching, hitting body parts, interfering with wound healing (dermatillomania), hair-pulling (trichotillomania), swallowing harmful substances including very sharp objects. Each year, 1 in 5 females and 1 in 7 males engage in self-injury. It affects 2 million people per year approximately in the United States. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV-TR) lists self-injurious behavior as a symptom of borderline personality disorder, but recent research indicates that it also occurs with other mental health disorders, including: Eating disorders, Depression, Anxiety disorders, Substance abuse, Conduct and Oppositional disorders.
What happens to the person that makes sense for them to self-harm? The thought is that Hyperstress or Dissociation leads to feeling overwhelmed, unable to cope (hyperstressful type) feeling numb, lost and alone (dissociative type). Self-Injury leads to feelings of relief, control calmness for the hyperstressful type and for the dissociative type it leads to feelings of being alive, real and the ability to function again.
After years of treating these patients, I have come to understand why people hurt themselves. It's analogous to the situation when we scream at the top of our lungs, vent, lash out, or hit something. It's a release of the pain we are feeling inside. Now when I feel stressed or in pain of some sort, I think of these situations others have had and I can relate. Of course, I don't think I will ever do this same sort of thing but I understand better why people do it. Instead, I can use this to recognize my own ways of dealing with stress. I can recognize the physiological processes that are going on in my body to create these feelings of "emotion". I can then, in turn, realize it can also be assessed and controlled to help me be a better person. I haven't learned fully how to do this but I'm definitely on the path.
Lastly, in a recent social media post (we have links below), I talked about self-help books. I read or listen to these all the time and need to do much more. But one thing I think I've learned is that in order to put these books into practice it all starts with one thing related to what I just discussed. It's recognizing your emotions and being able to change how you respond. It's the start to a more emotionally intelligent life. I'm no where close, but I keep trying. I hope you enjoyed this story.
"A coward is incapable of exhibiting love; it is the prerogative of the brave." - Mahatma Gandhi
Dr. Philip Young
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