Self-Injury Q&A with Dr. Tracy Alderman
By Dr. Tracy Alderman
The Prevention Researcher,
Volume 8, Number 5, 2001, Pages 1,3
Editor's Note:
Due to the overwhelming interest in our issue on adolescent self-injury, we are pleased that Dr. Tracy Alderman, author of "Helping Those Who Hurt Themselves" (The Prevention Researcher, 7(4), pp. 5-8) and The Scarred Soul: Understanding & Ending Self-Inflicted Violence (New Harbinger, 1997) has to agreed to the following Q&A session. The following questions were posed by you, our readers, via our web site.
Question
I am a high school counselor and it seems that we currently have quite a few students engaged in cutting behaviors. Can you make a recommendation regarding the best response a school can take when confronted with a cutting student? It seems that some are reported and get some treatment and yet others are deemed "not as serious" by our social worker. My understanding is that all cutters should be taken seriously. Can you comment in a general way?
Answer
Cutting often signifies that a person is enduring great emotional pain. The behavior of cutting is sometimes used as a way of releasing that emotional distress. When schools are confronted with students who cut themselves, several steps should be taken. First and foremost, make sure that the student is okay medically and that no further medical attention is necessary.
Next, school staff should talk with the student and learn as much as possible about the cutting behaviors and what is behind them. Sometimes the parents of the student should be notified and consulted about their child's behavior, but this really depends on the circumstances and the family dynamics. While there isn't one set approach to dealing with students who hurt themselves, it's important to realize the intensity of their feelings and be willing to listen and offer support to the student.
Question
When one feels the urge to self-injure, is there any key phrase, or such, they can be taught to remember and use as an automatic response, to possibly diffuse the desire?
Answer
It would be great if there were a magic word like "abracadabra" which could take away the desire to self-injure. Unfortunately, there's not. Once people get the urge to self-injure the best thing that they can do is to change their behaviors. If they typically hurt themselves in isolation, have them go somewhere where there are others, like a mall or a restaurant. Also, it's nice to have an available list of alternatives to self-injury. This list should be made before the desire to self-injure is present and should include at least five things to do other than self-injure. Once a person does all five things (or more) on this list, chances are the urge to hurt him or herself won't be as strong.
Question
In my experience, self-mutilation is a response to emotional pain. One would rather feel physical pain than the degree of emotional pain they are feeling. I believe that such people haven't been taught healthy ways of dealing with emotionally stressful situations. Do you agree and do you have suggestions for healthy ways of dealing with emotional stress?
Answer
I totally agree with you that self-injury is a response to emotional pain. In essence, self-injury is just a coping mechanism that some people use to deal with intense emotional distress. Learning alternative ways to deal with these overwhelming feelings will help to decrease the incidents of self-injury. Each one of us has different methods of coping with stress and other negative emotions.
Some people try to cope by using methods which aren't all that healthy, like using drugs or alcohol, overeating, gambling, smoking, or spending too much money. Some of the healthier ways of coping include things like talking with someone, exercising, sleeping, writing, and drawing. However, any coping mechanism can become problematic if it's taken to the extreme.
For example, someone who exercises ten hours a day to deal with stress is probably going a bit overboard and may actually be harming him or herself physically. The basic idea behind coping mechanisms is to find one (or several) which make you feel better and aren't going to hurt you in the process.
Question
A friend of mine just told me she is a cutter and so is her best friend. What can I say to them, and how do I not sound like a mother?
Answer
Learning that a friend self-injures can be really difficult. The best thing that you could do is simply to listen. Talk with your friend about why she is hurting herself and what's happened before she cut. By offering your support and continued friendship you're giving your friend an incredible gift.
Also, try to remember that you really can't do anything to change your friend's behaviors. If she wants to hurt herself, you aren't going to be able to stop her. All that you can do is be there for her and hopefully your friendship and support will help lessen her need to cut herself.
Question
As an editor of a youth prevention magazine, I am curious why self-injury is becoming more prevalent among today's teenagers. It seems local counselors and healthcare professionals are witnessing more and more "cutting" cases in young people ages 12 to 18.
Do you think it has something to do with all the media attention on the subject?
Answer
It's hard to know if self-injury is becoming more prevalent or if it just seems so because more people are talking about it. Because it's typically such a secretive behavior, obtaining a good estimate on how many teenagers are self-injuring is nearly impossible.
I think the recent media attention on self-injury has made people feel better about talking about it with others. Now people who injure themselves can see from the media that they aren't the only ones doing this, that they aren't freaks or crazy. By knowing that there are others out there doing the same thing, individuals who self-injure may be beginning to have the courage to come forward and talk about their behaviors and try to get some support and help.
Question
I am a school counselor and I work with elementary aged students. We have a class of 6th graders who have been participating in a form of self-mutilation. They are using pencil erasers to "burn" themselves. They rub the erasers on their skin until the skin is gone. I can't understand why they're doing this.
I feel that it's peer pressure more than anything. What approach should I take in discouraging the students from this behavior?
Answer
A long, long time ago, when I was in 6th grade, my friends and I used to participate in a "game" in which we would grab the other's forearm with both hands and twist the skin in opposite directions. The idea was to see how much pain the other person could handle.
By the end of this "game" we would each have extremely red forearms that could ache for hours. In our 6th grade minds, this was extremely fun.
I agree with your assessment that the students in your school are doing this based on peer pressure and in their minds this is something fun to do. Although as a counselor this may be very distressing to observe, it's probably not very dangerous and it's probably something that they will soon give up, replacing it with another "game."
In the meantime, I'd suggest talking with them about their reasons for participating in this activity and maybe suggesting some alternative "games.". It may be that they simply need something to do with their hands while they're in class. You may want to suggest that the teacher finds a suitable substitution, like coloring, drawing, or playing with a Koosh ball.
Question
How do you help a self-injurer who has stopped cutting but continues engaging in other self-destructive behaviors?
Answer
Self-injury is usually just a symptom of an underlying problem. Without treating the problem, symptoms will continue to occur. It's really common for someone who gives up self-injuring without getting help for some of the underlying issues to develop other types of self-destructive behaviors (some of which may be much more dangerous than self-injury).
I'd suggest getting some help via therapy or counseling to deal with the underlying issues that are creating such distress.
Question
How can we raise awareness about self-inflicted violence?
Answer
In the past five years awareness of self-inflicted violence has grown tremendously. More and more people are talking about self-injury and helping to dissolve the secrecy and shame surrounding it.
The best way to raise awareness about self-inflicted violence is to keep addressing the issue, continue talking about it, and persist in educating others through the media and personal contact.
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This article can be found in the issue:
Resource Issue 2001
The Prevention Researcher,
Volume 8, Supplement, 2001
Our annual Resource Issues are designed to provide supplemental material to our more research-focused quarterly issues. This Resource Issue includes a Q&A on Self-Injury with Dr. Tracy Alderman, the author of the well-known book The Scarred Soul: Understanding & Ending Self-Inflicted Violence, and an interview with Dr. Andrew Weil on holistic health and prevention.
This issue also featured these articles:
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