Post by Mel on May 1, 2006 16:21:00 GMT -5
SELF-INJURY: THE SECRET LANGUAGE OF PAIN FOR TEENAGERS
Why would students purposefully harm themselves? Why would they cut their own wrists, yet not be suicidal? These questions are addressed in this article that explores the myths and types of self-injury in which children and teenagers engage. Research indicates a connection between self-injurers and home abuse, and anorexia. This article discusses those connections and the psychological nature of self-injury, and its addictive quality. In addition, there are suggestions for parents, teachers and counselors, on bow to give assistance to those children who would harm themselves. A case study is also included.
"You have so much pain inside yourself, you try and hurt yourself on the outside because you need help,"
- Princess Diana, 1996
Self-injury has not been a topic discussed over family dinner.
Although self-injury has been plaguing lives for quite some time, with increasing incidences being cited in middle school and high school, it was not until 1996, when Princess Diana admitted to bouts with self-injury, that articles, books, and television documentaries began to appear. Now, conversations about self-injury are appearing at the dinner table, despite its remaining distastefulness.
Today, researchers are describing the phenomenon of self-injury among teenagers as "the deliberate, direct, non-suicidal destruction or alteration of one's body tissue" (Favazza, 1996), and quantifying it under three major categories: a) Major Self-Injury (the most rare form which usually results in permanent disfiguration), b) Stereotypic Self-Injury (which consists of head banging and biting), and c) Superficial Self-Injury (the most common which involves cutting, burning, and hair pulling) (Anonymous, 1999).
Why would students purposely hurt themselves? Our personal research indicates that most students self-injure themselves because they are unable to handle intense feelings, and so they turn to self-injury as a way to express their feelings and emotions. We tell audiences, "Pain that is self-inflicted is pain over which a person has control. Just enough pain will cause a person to divert their attention away from the outside pain over which they have no control to the known pain they self-inflict." We like what psychologist Scott Lines so eloquently said, "The skin becomes a battlefield as a demonstration of internal chaos.
The place where the self meets the world is a canvas or tabula rosa on which is displayed exactly how bad one feels inside."
Research indicates that cutting is the most common method of adolescent elf-injury, and is usually done with razor blades, knives, or matches.
In the following excerpt, note the priority system involved in cutting, and how this priority system centers on victim convenience (i.e., the ability to hide the injury the easiest). In the 1999 docudrama movie titled, Secret Cutting it was revealed that the most common parts of the body injured include (in ranked order) "the forearms and wrists, upper arms, thighs, abdomen, and occasionally, breasts and calves. The reason for the variation in the ranked locations is that those most concealed by clothing are the most preferred areas."
Crucially important to the victim is concealment of the injury. By keeping self-injuries away from peering eyes, the adolescent can increase the ability to do it more often without interruption. The fact that self-injury has been so little documented until recently is due in part to the "almost expert awareness" on the part of the victim to be able to avoid detection.
It is common to associate a great number of ancillary activities with self-mutilation, but differentiate between what is, and what is not harmful self-injury needs to be made.
Adolescent activities such as skin piercing, tattoos, and group rituals fall into the category of simple adolescent trends. Although these activities fit the description of self-injury, the motivation to engage in these actions differs greater from intention physical self-injury.
For instance, teens want a tattoo, and they do it for the tattoo or from peer pressure, and not the pain that is involved in the procedure. When a self-injurer cuts his or her skin it is to feel the pain, and not for the decorative results (Levenkron, 1998).
We tell high school students that self-injury is a self-inflicted act most often used as a coping mechanism for relieving an unwanted emotion, or as Jimmy Buffet (1999) said in a song, "It's a permanent reminder of a temporary feeling." Basically, it is a way to alter a mood state by focusing pain in a controllable area of the body. Think of a child who is riding his or her bike right after a heated argument with a sibling.
That child would still be feeling angry or upset about the argument. But if that child falls off the bike and skins a knee, the primary concern instantly becomes focused on the knee, not on the anger. Falling off the bike made the child focus on the feeling of physical pain, or the skinned knee. The emotional anger that the child was feeling on the inside has now seemed to vanish.
Teens seek physical pain to distract themselves from emotional pain. In popular culture we see common examples of this everywhere, especially in movies and television shows. Certain comedic moments, such as illustrated in the following excerpt by Steven Levenkron, mirror this tendency of: "It's like the old movies where someone was hysterical, someone slapped them and they said, 'Thank you.' We all understand the physical can mediate the emotional" (Levenkron, 1998). Levenkron helps the uninitiated by relating a story that many can understand.
Self-injury, the author argues, is not as foreign a concept as people would like to believe. It is prevalent in everyday life, including popular culture, and on this ground alone it should be accepted and understood.
The average self-injurer starts to hurt himself/herself at the age of 14 years and continues with increasing severity into his/her late 20s. The most common professions of self-injurers, interestingly enough, are teachers, nurses, and managers (Secret Cutting, 1999). It is estimated that three million Americans suffer from self-injury, and one in every 200 teenagers suffer from chronic self-injury.
Women are twice as likely to engage in self-injury as compared to men.
This may be because, as the feminist poet Adrienne Rich put it, "Most women have not even been able to touch this anger except to drive it inward like a rusted nail." Women are more likely to suppress unwanted feelings of anger or anxiety. But, self-injurers do come from all walks of life. People who self-injure can be male or female, come from any ethnicity, be a follower of any religion, have a Ph. D or be a high school dropout. They may be rich, poor, married, or single. They may be
14 or 54 years old and can be found working at any profession in any country around the world.
The question that is most difficult to answer is why a student would take a razor blade to his or her own skin to feel better. Here a teenaged self-injurer describes her first experience with cutting: "When I discovered the razor blade, cutting, if you'll believe me, was my gesture of hope. That first time was like some kind of miracle, a revelation. All the chaos, the sound and fury, the uncertainty and confusion and despair- all of it evaporated in an instant, and I was for that moment grounded, coherent, whole" (Kettlewell, 1999). There are many speculations as to why self-injury makes some teens feel better. It could be a biological predisposition, reduction of tension, or lack of experience in dealing with strong emotions (Martinson, 1998). In most cases of self-injury there is also a lack of role models. "Some experts theorize that cutting and other self-injurious behaviors release beta-endorphins, or the brain's 'feel good' chemicals, which act as the bodies own opiates" (Crying Through Their Cuts: The Stark Reality of Physical Self-Abuse, 2001).
Steven Levenkron illustrates exactly why teens who self-injure will use such seemingly drastic methods to inflict pain. He cites implicit psychological tendencies on the part of the victim- tendencies that make one believe that helplessness has set in, and the only cure for this helplessness is to regain control, by any means necessary. The use of a razor, or anything else, gives the victim total control over his/her body, and this control issue is fundamental. He also said, "When a person attacks his or her own body with an instrument that will wound the skin, and often worse, it means that the person feels helpless to use any other means to manage the mental anguish and chaos that is borne out of unmanageable feelings. This goes far beyond frustration, as self-mutilating behavior means the mind has slipped away from its ordinary context or perspective, losing sight of the impracticality of pain and danger in order to commit an act that will bring an immediate solution (however unrealistic or temporary in nature) to emotional pain"
(Levenkron, 1998).
Notice that Levenkron criticizes the mistaken thinking of the teen with his argument that the "impracticality" that is obvious to everyone but the teenager is never made known to the teen without outside assistance.
The notion of the "immediate solution" is key to what is at stake here.
The self-injured teen, unwilling to believe that any source outside of himself/herself exists to alleviate the pain, makes it a personal mission to take away the pain. The psychological error here, according to Levenkron, is that self-injuring teens firmly believe no one could ever understand what he or she is going through.
Case Study
The following story is written by a 21 year old college student who has injured herself for the past twelve years. Her story gives clues as to what fosters a person to hurt him or herself.
It is difficult to explain my own self-injury behaviors. To look back at my life and analyze potentially triggering events is difficult to do. I grew up in an invalidating environment. Communication with my parents was not substantial and emotions were disregarded and never nurtured.
Despite the fact that my parents showed little emotions, I grew up being very emotional and sensitive. By the time I reached fourth grade and started to deal with stresses, I needed to find an outlet for what I was feeling. Since I couldn't express emotions outwardly through words, my mechanism for channeling pain began to come out in the form of self-injury. I don't remember how I discovered that hurting my body would make whatever feelings I had inside go away. All I know is that it worked, and it worked well. I would constantly scratch at my skin with my fingernails until I bled. My parents labeled it as a bad habit. If I had to label my childhood I would use the word "miserable."
Two years later I was raped by a couple of older boys who were friends of my brother. The rape continued to occur for the next four years. My parents labeled my pleas as childish; the boys were just being boys.
With each penetration my life grew more and more out of control. I had so much anger and guilt inside me that I literally had to rip away layers of my skin to feel better. My anger and impulses to cut seemed to come out of nowhere and only a sharp blade would calm me down.
When I entered middle school I was not only cutting, but also I had developed a mild case of anorexia. I used food as another way to gain and keep control of my body. Avoiding school lunch attracted too much attention and counselors began calling my parents, who only became more neglectful. My parents labeled it as a phase, saying that every girl goes through it to fit in.
Through my high school years I became very attached to cutting. I relied on the cold edge of a razor for support. I figured that it's a lot easier to deal with a pain that I can see and bandage and take care of, then it is to deal with the emotional stuff that was really tearing me up. I played with knives and suicide as a way of escape from memories.
The pain was a form of control, and I desperately needed control. I could control the blade slowly dancing across my wrist. The blood dripping down was my shout of anger. I had no voice, so I created my own. I danced on the edge of a blade and played with fire. I cherished the pain, because I was the one causing it, and I could stop it. I was in control, and I had the power. I was screaming in the only way I knew how. My parents didn't know what was hidden behind my long sleeve shirts, but they saw my depression and labeled it as adolescent anxiety.
I hated them for pretending to be blind and deaf.
I entered college cutting more severely then ever before. I cut with no restraint on my arms, legs, and occasionally my stomach. It became addictive and I had to cut deeper to get the same sense of relief. I watched myself in a state of detachment as I cut through layers of skin to find comfort. I went through therapists left and right, trying to find someone to help me. I have yet to find a professional who understands and is willing to work with self-injury.
In the past two years, through a series of decisions and chance happenings, my life has mellowed out. I married a great guy and I am living in a loving environment and going to college. I am learning to express my feelings and cope with my past. I am learning to let someone comfort me and I am learning to love.
This story is similar to most stories of self-injury. People who self-injure share a lot of the same background and characteristics as defined in the story.
There is a solid relationship between a child who self-injures and a home where there is a breakdown in communication. When a child feels like he or she cannot talk to a parent about a problem, that anxiety is usually turned inward. In extreme cases, the parent's neglect toward the child's emotions will result in the child self-injuring as an alternate form of communication (Levenkron, 1998). "In addition to being a life-sustaining and sanity-maintaining way of managing inner states, cutting is a primitive yet powerful form of communication for people unable to adequately verbalize their feelings. Self-mutilation provides concrete expression for the pain they feel inside -- a language written on the body, through blood, wounds, and scars... It's like saying 'I've been torn open, intruded upon, broken into' in a very literal way"
(Strong, 1998).
It seems that through this body language, self-injuring children and teenagers can communicate much more directly and forcefully than they can speak in words. Because of this same inability to communicate, many of them cannot or do not like to go to professionals with their problems. It therefore becomes incumbent on professionals to discover these symptoms and act accordingly. The professional must initiate the first step of communication and yet at the same time give the teenager power to communicate back. If the professional drives all of the communication between him/herself and the teenager, little progress will be made.
A common issue reported by more than half of self-injuring teens is that of being sexually abused as a child. The triggering event of sexual abuse seems to lay a foundation for later cutting. "There are many roots to cutting, but the single, most common causal factor is childhood sexual abuse. In fact, sexual abuse is now recognized by experts as the primary diagnoses of self-mutilators" (Strong, 1998).
Self-injury, as in the story above, can be used as a coping mechanism for survivors of abuse. Victims need assurance that they can still control at least one aspect of their lives, and that one aspect is usually the manipulation of their own body. "Sexual abuse is the ultimate boundary violation. The rape of a child is an intrusive, violent act that disrupts the integrity of the body and creates a very real and frightening sense of fragmentation and disintegration. The body comes to feel as unreal as a phantom, the physical and psychic boundaries as porous as a veil" (Strong, 1998). The child has had everything taken away, except their bodies. "Self-injury may allow abuse survivors to reclaim their bodies," said Strong (1998). Sometimes blood speaks louder then words. The blood of self-injuring teens replaces the words that they are unable and unwilling to express, and this blood should be a clear sign that they can communicate and is communicating that he/she wants help.
A severe lack of familial support also lends credence to a self-injurer's choice to inflict pain on their body. As seen in the case study above, the college student began cutting before she was sexually abused, and only after this repeated sexual abuse did her self-injury become more frequent and more severe. A strong family structure is the best single tool that a victim can have toward recovery, but many times the ability to create a strong family structure is impossible because the victim's family (or lack thereof) is very unlikely to change.
Why would students purposefully harm themselves? Why would they cut their own wrists, yet not be suicidal? These questions are addressed in this article that explores the myths and types of self-injury in which children and teenagers engage. Research indicates a connection between self-injurers and home abuse, and anorexia. This article discusses those connections and the psychological nature of self-injury, and its addictive quality. In addition, there are suggestions for parents, teachers and counselors, on bow to give assistance to those children who would harm themselves. A case study is also included.
"You have so much pain inside yourself, you try and hurt yourself on the outside because you need help,"
- Princess Diana, 1996
Self-injury has not been a topic discussed over family dinner.
Although self-injury has been plaguing lives for quite some time, with increasing incidences being cited in middle school and high school, it was not until 1996, when Princess Diana admitted to bouts with self-injury, that articles, books, and television documentaries began to appear. Now, conversations about self-injury are appearing at the dinner table, despite its remaining distastefulness.
Today, researchers are describing the phenomenon of self-injury among teenagers as "the deliberate, direct, non-suicidal destruction or alteration of one's body tissue" (Favazza, 1996), and quantifying it under three major categories: a) Major Self-Injury (the most rare form which usually results in permanent disfiguration), b) Stereotypic Self-Injury (which consists of head banging and biting), and c) Superficial Self-Injury (the most common which involves cutting, burning, and hair pulling) (Anonymous, 1999).
Why would students purposely hurt themselves? Our personal research indicates that most students self-injure themselves because they are unable to handle intense feelings, and so they turn to self-injury as a way to express their feelings and emotions. We tell audiences, "Pain that is self-inflicted is pain over which a person has control. Just enough pain will cause a person to divert their attention away from the outside pain over which they have no control to the known pain they self-inflict." We like what psychologist Scott Lines so eloquently said, "The skin becomes a battlefield as a demonstration of internal chaos.
The place where the self meets the world is a canvas or tabula rosa on which is displayed exactly how bad one feels inside."
Research indicates that cutting is the most common method of adolescent elf-injury, and is usually done with razor blades, knives, or matches.
In the following excerpt, note the priority system involved in cutting, and how this priority system centers on victim convenience (i.e., the ability to hide the injury the easiest). In the 1999 docudrama movie titled, Secret Cutting it was revealed that the most common parts of the body injured include (in ranked order) "the forearms and wrists, upper arms, thighs, abdomen, and occasionally, breasts and calves. The reason for the variation in the ranked locations is that those most concealed by clothing are the most preferred areas."
Crucially important to the victim is concealment of the injury. By keeping self-injuries away from peering eyes, the adolescent can increase the ability to do it more often without interruption. The fact that self-injury has been so little documented until recently is due in part to the "almost expert awareness" on the part of the victim to be able to avoid detection.
It is common to associate a great number of ancillary activities with self-mutilation, but differentiate between what is, and what is not harmful self-injury needs to be made.
Adolescent activities such as skin piercing, tattoos, and group rituals fall into the category of simple adolescent trends. Although these activities fit the description of self-injury, the motivation to engage in these actions differs greater from intention physical self-injury.
For instance, teens want a tattoo, and they do it for the tattoo or from peer pressure, and not the pain that is involved in the procedure. When a self-injurer cuts his or her skin it is to feel the pain, and not for the decorative results (Levenkron, 1998).
We tell high school students that self-injury is a self-inflicted act most often used as a coping mechanism for relieving an unwanted emotion, or as Jimmy Buffet (1999) said in a song, "It's a permanent reminder of a temporary feeling." Basically, it is a way to alter a mood state by focusing pain in a controllable area of the body. Think of a child who is riding his or her bike right after a heated argument with a sibling.
That child would still be feeling angry or upset about the argument. But if that child falls off the bike and skins a knee, the primary concern instantly becomes focused on the knee, not on the anger. Falling off the bike made the child focus on the feeling of physical pain, or the skinned knee. The emotional anger that the child was feeling on the inside has now seemed to vanish.
Teens seek physical pain to distract themselves from emotional pain. In popular culture we see common examples of this everywhere, especially in movies and television shows. Certain comedic moments, such as illustrated in the following excerpt by Steven Levenkron, mirror this tendency of: "It's like the old movies where someone was hysterical, someone slapped them and they said, 'Thank you.' We all understand the physical can mediate the emotional" (Levenkron, 1998). Levenkron helps the uninitiated by relating a story that many can understand.
Self-injury, the author argues, is not as foreign a concept as people would like to believe. It is prevalent in everyday life, including popular culture, and on this ground alone it should be accepted and understood.
The average self-injurer starts to hurt himself/herself at the age of 14 years and continues with increasing severity into his/her late 20s. The most common professions of self-injurers, interestingly enough, are teachers, nurses, and managers (Secret Cutting, 1999). It is estimated that three million Americans suffer from self-injury, and one in every 200 teenagers suffer from chronic self-injury.
Women are twice as likely to engage in self-injury as compared to men.
This may be because, as the feminist poet Adrienne Rich put it, "Most women have not even been able to touch this anger except to drive it inward like a rusted nail." Women are more likely to suppress unwanted feelings of anger or anxiety. But, self-injurers do come from all walks of life. People who self-injure can be male or female, come from any ethnicity, be a follower of any religion, have a Ph. D or be a high school dropout. They may be rich, poor, married, or single. They may be
14 or 54 years old and can be found working at any profession in any country around the world.
The question that is most difficult to answer is why a student would take a razor blade to his or her own skin to feel better. Here a teenaged self-injurer describes her first experience with cutting: "When I discovered the razor blade, cutting, if you'll believe me, was my gesture of hope. That first time was like some kind of miracle, a revelation. All the chaos, the sound and fury, the uncertainty and confusion and despair- all of it evaporated in an instant, and I was for that moment grounded, coherent, whole" (Kettlewell, 1999). There are many speculations as to why self-injury makes some teens feel better. It could be a biological predisposition, reduction of tension, or lack of experience in dealing with strong emotions (Martinson, 1998). In most cases of self-injury there is also a lack of role models. "Some experts theorize that cutting and other self-injurious behaviors release beta-endorphins, or the brain's 'feel good' chemicals, which act as the bodies own opiates" (Crying Through Their Cuts: The Stark Reality of Physical Self-Abuse, 2001).
Steven Levenkron illustrates exactly why teens who self-injure will use such seemingly drastic methods to inflict pain. He cites implicit psychological tendencies on the part of the victim- tendencies that make one believe that helplessness has set in, and the only cure for this helplessness is to regain control, by any means necessary. The use of a razor, or anything else, gives the victim total control over his/her body, and this control issue is fundamental. He also said, "When a person attacks his or her own body with an instrument that will wound the skin, and often worse, it means that the person feels helpless to use any other means to manage the mental anguish and chaos that is borne out of unmanageable feelings. This goes far beyond frustration, as self-mutilating behavior means the mind has slipped away from its ordinary context or perspective, losing sight of the impracticality of pain and danger in order to commit an act that will bring an immediate solution (however unrealistic or temporary in nature) to emotional pain"
(Levenkron, 1998).
Notice that Levenkron criticizes the mistaken thinking of the teen with his argument that the "impracticality" that is obvious to everyone but the teenager is never made known to the teen without outside assistance.
The notion of the "immediate solution" is key to what is at stake here.
The self-injured teen, unwilling to believe that any source outside of himself/herself exists to alleviate the pain, makes it a personal mission to take away the pain. The psychological error here, according to Levenkron, is that self-injuring teens firmly believe no one could ever understand what he or she is going through.
Case Study
The following story is written by a 21 year old college student who has injured herself for the past twelve years. Her story gives clues as to what fosters a person to hurt him or herself.
It is difficult to explain my own self-injury behaviors. To look back at my life and analyze potentially triggering events is difficult to do. I grew up in an invalidating environment. Communication with my parents was not substantial and emotions were disregarded and never nurtured.
Despite the fact that my parents showed little emotions, I grew up being very emotional and sensitive. By the time I reached fourth grade and started to deal with stresses, I needed to find an outlet for what I was feeling. Since I couldn't express emotions outwardly through words, my mechanism for channeling pain began to come out in the form of self-injury. I don't remember how I discovered that hurting my body would make whatever feelings I had inside go away. All I know is that it worked, and it worked well. I would constantly scratch at my skin with my fingernails until I bled. My parents labeled it as a bad habit. If I had to label my childhood I would use the word "miserable."
Two years later I was raped by a couple of older boys who were friends of my brother. The rape continued to occur for the next four years. My parents labeled my pleas as childish; the boys were just being boys.
With each penetration my life grew more and more out of control. I had so much anger and guilt inside me that I literally had to rip away layers of my skin to feel better. My anger and impulses to cut seemed to come out of nowhere and only a sharp blade would calm me down.
When I entered middle school I was not only cutting, but also I had developed a mild case of anorexia. I used food as another way to gain and keep control of my body. Avoiding school lunch attracted too much attention and counselors began calling my parents, who only became more neglectful. My parents labeled it as a phase, saying that every girl goes through it to fit in.
Through my high school years I became very attached to cutting. I relied on the cold edge of a razor for support. I figured that it's a lot easier to deal with a pain that I can see and bandage and take care of, then it is to deal with the emotional stuff that was really tearing me up. I played with knives and suicide as a way of escape from memories.
The pain was a form of control, and I desperately needed control. I could control the blade slowly dancing across my wrist. The blood dripping down was my shout of anger. I had no voice, so I created my own. I danced on the edge of a blade and played with fire. I cherished the pain, because I was the one causing it, and I could stop it. I was in control, and I had the power. I was screaming in the only way I knew how. My parents didn't know what was hidden behind my long sleeve shirts, but they saw my depression and labeled it as adolescent anxiety.
I hated them for pretending to be blind and deaf.
I entered college cutting more severely then ever before. I cut with no restraint on my arms, legs, and occasionally my stomach. It became addictive and I had to cut deeper to get the same sense of relief. I watched myself in a state of detachment as I cut through layers of skin to find comfort. I went through therapists left and right, trying to find someone to help me. I have yet to find a professional who understands and is willing to work with self-injury.
In the past two years, through a series of decisions and chance happenings, my life has mellowed out. I married a great guy and I am living in a loving environment and going to college. I am learning to express my feelings and cope with my past. I am learning to let someone comfort me and I am learning to love.
This story is similar to most stories of self-injury. People who self-injure share a lot of the same background and characteristics as defined in the story.
There is a solid relationship between a child who self-injures and a home where there is a breakdown in communication. When a child feels like he or she cannot talk to a parent about a problem, that anxiety is usually turned inward. In extreme cases, the parent's neglect toward the child's emotions will result in the child self-injuring as an alternate form of communication (Levenkron, 1998). "In addition to being a life-sustaining and sanity-maintaining way of managing inner states, cutting is a primitive yet powerful form of communication for people unable to adequately verbalize their feelings. Self-mutilation provides concrete expression for the pain they feel inside -- a language written on the body, through blood, wounds, and scars... It's like saying 'I've been torn open, intruded upon, broken into' in a very literal way"
(Strong, 1998).
It seems that through this body language, self-injuring children and teenagers can communicate much more directly and forcefully than they can speak in words. Because of this same inability to communicate, many of them cannot or do not like to go to professionals with their problems. It therefore becomes incumbent on professionals to discover these symptoms and act accordingly. The professional must initiate the first step of communication and yet at the same time give the teenager power to communicate back. If the professional drives all of the communication between him/herself and the teenager, little progress will be made.
A common issue reported by more than half of self-injuring teens is that of being sexually abused as a child. The triggering event of sexual abuse seems to lay a foundation for later cutting. "There are many roots to cutting, but the single, most common causal factor is childhood sexual abuse. In fact, sexual abuse is now recognized by experts as the primary diagnoses of self-mutilators" (Strong, 1998).
Self-injury, as in the story above, can be used as a coping mechanism for survivors of abuse. Victims need assurance that they can still control at least one aspect of their lives, and that one aspect is usually the manipulation of their own body. "Sexual abuse is the ultimate boundary violation. The rape of a child is an intrusive, violent act that disrupts the integrity of the body and creates a very real and frightening sense of fragmentation and disintegration. The body comes to feel as unreal as a phantom, the physical and psychic boundaries as porous as a veil" (Strong, 1998). The child has had everything taken away, except their bodies. "Self-injury may allow abuse survivors to reclaim their bodies," said Strong (1998). Sometimes blood speaks louder then words. The blood of self-injuring teens replaces the words that they are unable and unwilling to express, and this blood should be a clear sign that they can communicate and is communicating that he/she wants help.
A severe lack of familial support also lends credence to a self-injurer's choice to inflict pain on their body. As seen in the case study above, the college student began cutting before she was sexually abused, and only after this repeated sexual abuse did her self-injury become more frequent and more severe. A strong family structure is the best single tool that a victim can have toward recovery, but many times the ability to create a strong family structure is impossible because the victim's family (or lack thereof) is very unlikely to change.