Living with self-injury

"to be nobody-but-myself in a world which is doing its best, night and day, to make me everybody else means to fight the hardest battle which any human being can fight, and never stop fighting" -- ee cummings

As much as we'd like it to be, self-injury isn't something that can be tucked away in a little corner of your life where it doesn't touch anything else. Even after you've stopped, it continues to affect who you are and how you interact with people. Scars fade but never disappear entirely. Feelings of alienation may subside but still lurk in the background. If you're still actively hurting yourself, life gets even more complicated. This page is meant to offer some answers for the unique dilemmas self-injury brings into your life: telling others, answering intrusive questions, hiding and healing scars, and a few medical issues. I am not a medical professional and these pages are presented for informational purposes only. No diagnosis or treatment is intended.

Coming out

Admitting to the people in your life that you self-injure is analogous in many ways to the process of coming out as gay or bi. This list of things to consider when deciding to tell those you love about your way of coping with stress is adapted from a coming-out list in Bass and Kaufman 1996.

The assumption here is that you'll tell people about your SI in a conversation, but that's not the only way to come out. Some people have found that writing down everything they want to say and presenting it to someone has worked for them. If you choose this approach, follow the general guidelines below and be sure you remain available for discussion after the person has read what you've told them. If you want to come out to someone via email, I'd suggest you follow up immediately with a chat session or a telephone call.

Be willing to give the other person some time to digest, though -- if you follow up with them and they say "I'd like to think about this for a while," give them space. Ask them to let you know when they're ready to talk, and let it go.

Be sensitive to the other person's feelings
It can be nearly as hard for them to hear it as it is for you to tell them. Realize that they're probably wondering what they did wrong or how they could have prevented you from feeling so much pain or why you turned out "sick." You don't have to accept their value judgments about your SI, but be open to hearing what they have to say about it. You might learn something, and you can teach them a great deal.
Explain that coming out is an act of love
Let them know that your deciding to tell them about self-injury is a sign of your love for and trust in them. Usually, a person decides to tell someone about his/her SI because s/he loves them, wants or needs their loving support, and is tired of keeping a whole part of her/himself from them. The desire to be open and to trust outweighs the fear of rejection or hatred or disgust. Let the person you're telling about your self-harm know you're not trying to punish. manipulate, or guilt-trip them.
Pick a place that is private and a time that is unhurried
This is serious stuff. Find a time when everyone involved is available for a long conversation. Do it in a place where everyone's comfortable and there's no need to worry about being overheard. If you're rushed or hurried or afraid other people nearby will hear and react, you're not going to be able to give your full attention to the conversation and neither will anyone else.
Don't tell others in anger
Don't use your SI as a weapon: "Oh, yeah, well look, you made me cut/burn/scratch/hit!" To get the love and understanding you're seeking, you may have to give some in return. Whether or not the person you have decided to share your secret with has contributed to the problems that led to your SI is irrelevant to the coming-out conversation. If you start getting angry and blaming, you're going to put the other person on the defensive and they'll get angry. The whole process will bog down and be hideously unpleasant and unproductive. Using SI as a weapon also increases the likelihood that the person you're coming out to will react in exactly the ways you're hoping they won't.
Consider enlisting an ally
If you have a friend or therapist who understands your SI you might want to ask them to sit in on the conversation. A neutral third person can help keep things calm.
Provide as much information as you can
This is crucial.The more someone knows about something, the less they fear it. Many people have never heard of self-injury or have heard weird sensationalized tabloid reports. Be prepared to give the person books or names of books, articles, photocopies, printouts, addresses of web sites, etc. Gather as much information as you can so you can answer their questions accurately and honestly.
Be willing (and prepared) to answer their questions
You may have to educate them about SI. Encourage them to ask whatever questions they may have. If they ask a question you don't have an answer to,say "I don't know" or "I can't say" or even "I prefer not to get into that right now." Be as open as you can. You might want to anticipate questions they'll ask and get an idea of how you want to answer those before you come out. You can ask other people who've come out what they were asked to get some ideas.
You should also have a good idea in your mind of what you want to do about the self-injury -- they're going to ask. Do you want treatment? What sort? If not, what's the rationale for not treating it? Do you want them to help you stop or control it? How can they help? What's too intrusive and what isn't? Now is a good time to start setting boundaries.
It's not necessary to bring up the most disturbing topics in the first conversation
Don't start by describing in technicolor detail the time you needed 43 stitches and a transfusion. It's probably best to avoid graphic descriptions of what you do; if asked, just say "I cut myself on the wrist" or "I hit the walls until I get bruises" or whatever. Try not to freak them out; you can give details (if necessary) in some other conversation.
Trust your own judgment
Do what feels natural to you. You know yourself and your family and friends far better than I ever will.
Communicate
Be willing to talk to the people you're coming out to about your reactions, and ask them to let you know what they're thinking. Communication goes both ways.

Scars

For some people, scars aren't an issue -- they self-injure in ways that don't leave permanent marks or they only injure in places that are normally covered by clothing (the torso, shoulders, etc). For most people who cut or burn, though, scars happen. Some people like their scars and look on them as battle wounds or even life-maps. Many others hate their scars and want to find ways to get rid of them. Both attitudes are equally valid.

The two most common scar questions I hear are "How do I explain them?" and "How do I make them go away?"

Dealing with unpleasant questions

It happens sooner or later - you're at school or work, on the bus, in a shop, and someone notices. "What happened to your {arm, leg, face, whatever}?"

People aren't usually trying to make you uncomfortable. Quite often, they're just making conversation; they don't really want to know why you have scars, but it's something to say. Nevertheless, you're stuck coming up with an answer.

Quite often, the easiest solution is to half-laugh or make a rueful face and say "It's a long story." Then change the topic. This deflects most people; if they persist, you can say, "I would really rather not discuss this." You can be a bit icy here -- after all, they're being a bit rude by asking you personal questions and not letting you gracefully avoid answering.

On the other hand, you could try some of the suggestions that came up during a discussion of excuses on the bus email list. You prolly won't use most of them, but read them for the laughs:

I had unprotected sex with a porcupine.
I took my lizards for a walk and they held on for dear life.
The neighborhood cat and I had a disagreement about the paw prints on my truck.
The police didn't comply with the terrorists' demands fast enough, so they took it out on us hostages.
This first one is kind of lame, but it's what I use most often: "Um, uh...I, uh....you see....I...uh...Well,...." At which they usually try to help me out by replying, "Did you fall?" And I say, "Yes, thanks."
Well, let me just tell you this: You should NEVER EVER, under ANY circumstances, go out with a guy/girl that you met on the internet.
I hurt myself.
I keep falling off of cliffs trying to catch that damned roadrunner.
"I was oyster hunting." They give me a blank stare. Then I say, with a wink, "You've obviously never been oyster hunting before."
"It's a long story." They usually leave me alone, but this one guy said, "I've got time." Then I said, "I fell. [long pause] Ok, so it's obviously not THAT long."
I was at this party with Marilyn Manson and everyone was giving out hugs.
I lost a fight with a can of tuna fish.
I slipped while making a salad.
I fell asleep, and the clown got me.
I'll just put it this way: when they tell you not to feed the bears, it's for a damned good reason.
I thought those security tags on pants just sprayed ink, but apparently they spray shards of broken glass, too.
Those aren't cuts, they're mehendi.
Don't worry about it. Because of me, they now have a warning label!
What are you talking about?? (as I quickly pull my sleeves up.)
Damn Cat.
Well, when I was younger, I had this dream that a dog was following me...he ran, and I ran, but the faster I ran, the more he sped up. I wanted to get to safety, to my house...I was almost there...but right when I got to the front porch, he bit me. Everywhere. Lots of times. Making marks that don't look like bites at all. And when I woke up... ::wide eyes:: and I had THESE.
"What scars?" They usually reply "those ones," to which I reply, "I don't see anything."
The voices told me to do it.
I wrestle Tigers...
I got them climbing a fence to escape this hell-hole. (said at school)
(said to a guy who thinks I worship the devil) I did this as a sacramental offering to my dark lord, you prick. ::Smile::
(about scars on my stomach) "Oh, those are from having my baby." "You don't have a baby!" "No, but I could."
None of your business, you stupid (insert appropriate curse word here)
I did it. (Hey, honesty works sometimes)

Dealing with scars themselves

If you hate your scars and want to do something about them, you have two options: You can find ways to conceal your scars, or you can try to heal/minimize them.

Hiding scars

Sometimes it's possible to hide scars.

Wrist scars can be covered by long sleeves, bracelets, or watches.
In summer, wear long-sleeved shirts of light material (silk, gauzy cotton, and the like).
Another summer idea is to wear a long-sleeved shirt open over a tank top or t-shirt. If anyone questions it, you can tell them you're worried about sun exposure.
Some leg scars in women can be hidden by pantyhose or tights.
Concealer makeup (like Dermablend) can be used to hide some scars. You can get more info at dermablend.com. People have reported getting very good results with Dermablend, which was formulated for covering port-wine birthmarks and skin conditions like vitiligo. It's waterproof and can be blended to match skin color very closely.

Healing scars

The first step in healing scars is probably good wound care. Wash with Betadine if appropriate, and use a good antibiotic ointment (like Neosporin) on the wound daily. Johnson & Johnson make a new bandage, Band-Aid Advanced Healing, that seals the wound completely. Fluids from the wound are absorbed by special particles in the bandage that turn them into a gel to cushion the wound. This keeps the wound moist, which reduces itching and helps it heal faster. It also can reduce the urge to pick at the wound, because you are meant to keep the bandage on continuously until the wound has healed, or about a week.

For some types of scarring, special creams or bandages may help. Mederma is a cream designed to minimize scarring, but it must be used when the scar is very new. Reports on its efficacy are mixed.

There are several brands of silicone sheets and pads available:

Clinicel (a cushion)

to name a few. Syprex also makes a cream, a topical gel, and a special cleansing wipe. A new product, ScarGuard, combines liquid silicone, mild cortisone, and vitamin E. You paint the liquid over the scars to form something similar to a silicone sheet, and use it in the same way you use the sheets.

Silicone sheets are taped tightly (a few now are self-adhesive) over the scars for several hours each day. Treatment continues for varying lengths of time (days to weeks). The manufacturers claim that these sheet can soften and fade most raised or red scars, even keloids. Some burn centers do use them to help diminish scarring after grafts, and unlike Mederma, they are meant for old scars as well as new. None of these products will make scars disappear but they can help make them less obvious (and cut down on intrusive questions. I've seen Rejuveness and Cicacare at Walgreen's in the US.

Curad recently introduced ScarTherapy, a new product for reducing scar tissue. It uses polyurethane instead of silicone, which allows air to get through; instead of wearing the sheet a few hours every day, you wear it continually; each day you take off the old sheet and put on a new self-adhesive one. Like the silicone sheets, it claims to be able to flatten and lighten scars (in other words, none of these will do much for flat scars that are paler than surrounding skin). I'm interested in hearing reports on this product; if you try this, email me.

Plastic surgery might be effective for some sorts of scarring, but it is very expensive and leaves scars of its own. Dermabrasion might work for very light scarring, but I've heard from several people who found it useless, expensive, and painful. The same holds for laser resurfacing. I've not heard of either working well for SI scars -- if you know of someone it's helped (or it helped you), please email me.

Cortisone injections combined with laser therapy can flatten large keloids, but you'll still have a remnant of a scar. The treatment can be painful, and results aren't guaranteed.

Skin grafts can be done to reduce a network of scars to one big scar which can be more easily explained, but they still leave you with a big ugly scar. Someone reported having wedge surgery in which the scarred areas were cut out in a wedge and skin edges sewn back together, leaving one long scar. I've also heard about a procedure in which balloons are slipped under the skin and slowly inflated to stretch the skin out. The loose skin is then sewn over the scarred area. If you know anything about this, I'd love to hear details.

If you decide to have plastic surgery done, you will have to convince your surgeon that you are through self-injuring; most doctors will not help you cover scars if they think you're going to go out and get new ones right away. Some may require that you be SI-free for a set period of time before they'll consider doing the surgery.

Tattooing over scars may be an option for some people, but scarred skin is very difficult to work with and may not hold ink well. If you want to try this route, ask around and check references until you find a very good, very experienced tattoo artist and set up a meeting to discuss the possibilities. If the artist thinks tattoos wouldn't work well on your scar, it might be best to drop the idea. Again, this is something to do only if you're pretty sure you're not going to scar the area afterward.

A good source for information about scars and plastic surgery is http://www.scarcare.org. Remember that nothing can make the scar go away completely; treatments can only change the shape, appearance, or location of it.

Medical concerns for people who cut

If you are still using self-injury as a way to cope with overwhelming situations, you need to pay attention to your health and monitor yourself for symptoms of anemia or dehydration.

If you cut, you're losing two important things: fluid (plasma) and red blood cells. Your body can replace the plasma in about 48 hours if you drink enough liquid. The red cells will take about two months to be replenished.

Dehydration can send you into shock. The most common symptom is dizziness, especially when changing positions (for example, standing up after having been lying down for a while). You may also have a very rapid pulse. If the dehydration is severe (you're very dizzy, your eyes look sunken, you can't keep fluids down, your skin is clammy and you feel weak), go to the doctor immediately -- they'll give you IV fluids and you'll be fine in a few hours. To avoid getting to that point, be sure to drink 8 glasses of water daily (more on days you've lost blood). If you feel dizzy after SI, drink as much water or juice as you can and monitor yourself for symptoms of shock.

Anemia happens when you lose too much iron by losing too many red cells. If you are anemic, you will be pale and feel very weak. You might be irritable and short of breath and just feel bad. If you have these symptoms, you can see a doctor and have the anemia confirmed; the doctor will then give you iron supplements and vitamin C and tell you that you'll feel better in a couple of months. If you want to avoid becoming anemic, but you're not ready to stop cutting, you should take a multivitamin with iron and vitamin C daily and stop the bleeding on your cuts as quickly as possible.