The Truth That Is Rarely Sought Out


Happy national self-injury awareness month! Self-injurious behavior (which I will call SIB in this post) is a term associated with a lot of misunderstanding and often elicits a “freeze” response for those who hear about someone they care about engaging in SIB. Through reading this post, you will gain a clearer understanding of the underlying causes for SIB, as well as some tips for how to respond if someone you know confides in you. 


Let’s start by considering the reasons why SIB occurs, in some individuals, who experience a wide array of emotional distress. Often nicknamed “the attention seeking behavior” by clinicians, clients, and family alike, SIB has been found to only be attention seeking about 4 % of the time. That means it is the LEAST likely cause for someone to engage in self-injury. Michael Hollander, PhD, attributes SIB as most often occurring for one of two reasons: 

  1. To control feelings that feel “too intense” or unbearable
  2. To escape a sensation of numbness, otherwise known as feeling nothing at all.

Therefore, we can see that SIB, for some people, is a solution for self-soothing in real (present) time. Regardless of feeling emotions too much or too little, physical pain is often easier to conceptualize than emotional pain. 

I mentioned earlier that attention seeking is the least likely cause for SIB. I will also bring your attention back to the first paragraph, where we discussed a freeze response toward SIB as a concept. As humans, we strongly seek out meaning making (even if the meaning does not withstand a line of evidenced-based questioning). This is often why we prematurely judge people or things, avoid or procrastinate, or create distance between ourselves and those we care about (but feel like we can’t understand). All of these are common reactions when hearing about someone who has self-injured. While these responses make some sense from a biological lens, it can feel extremely alienating and invalidating to those who are in distress. Put differently, it can exacerbate feelings that feel too intense or contribute to a deeper sensation of numbness in those who share that they have self-injured. 


Here are 5 ways you can constructively help someone who has told you they have self-injured:

  1. Ask the person if you can help them understand what their trigger was (problem solving skills).
  2. Focus on function instead of meaning making (i.e. was it to control or to escape).
  3. Avoid asking why because it can feel violating and overwhelming to the person and is sometimes even traumatizing for you! 
  4. Use a neutral tone of voice and abstain from extreme language emphasizing your own feelings about SIB. For example you might say “I can tell it took a lot of courage for you to confide it me, let’s figure this out together” versus “My gosh! That is horrible that you would feel the need to hurt yourself like that”
  5. Ask them if you can help them find a therapist who is knowledgeable in DBT* or somatic awareness.*DBT is a set of therapy techniques called Dialectical Behavior Therapy

For more information about SIB, please make an appointment with a therapist and utilize the following resource: Helping Teens Who Cut: Understanding and Ending Self-Injury by Michael Hollander, PhD

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