Self-Injury Awareness Month Interview & Advocacy Guide
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“Talking about mental health, in general, can still be taboo, and when you go into certain intricacies or categories of it, it becomes even more taboo. But self-injury is real, and we need to spend more time talking about it.”
Dr. Beverly Smith, President and Interim CEO/ED of the American Mental Health Counselors Association (AMHCA)
Self-injury is when an individual deliberately harms themselves in a manner that is not intended to be lethal. It can also be referred to as self-harm, self-abuse, self-mutilation, or non-suicidal self-injury (NSSI). In the moment, self-injury may provide an individual with a sense of emotional relief, but it often also leads to feelings of shame and guilt. And while self-injury is not in itself a mental disorder, it may sometimes exist alongside other serious conditions.
March 1 is Self-Injury Awareness Day (SIAD), and March is Self-Injury Awareness Month. These mark the efforts of a grassroots movement to raise awareness about self-injury and self-harm, to dispel the myths and stereotypes surrounding them, and to provide both the public and the healthcare community with resources that can help.
For mental health counselors, it’s an opportunity to reflect on how to better assist, and advocate for, those who may be suffering in silence.
Self-injury may be complicated, but it shouldn’t be taboo. To learn more about the myths around self-injury, along with ways to identify and treat it, read on.
Meet the Expert: Beverly Smith, PhD, LPC, NCC, CCMHC, ACS, NCSC, CFT, BC-HSP, BCC, MAC, CPCS, BC-TMH, BCPCC, CCTP
Dr. Beverly Smith is the President and Interim CEO/ED of the American Mental Health Counselors Association (AMHCA). She has professional counseling experience in various settings including private practice, public education, corrections, community counseling, and higher education.
Dr. Smith is the owner and principal therapist of BSmith Consulting Group, LLC, and a PhD mentor at Capella University. She is a proud two-time graduate of Tuskegee University (BS-Biology, MEd-Counseling & Higher Education) and has earned counseling degrees from Troy University (EdS) as well as Amridge University (PhD). Additionally, Dr. Smith has a certificate in Administration and Leadership from Kennesaw State University.
Myths and Stereotypes Around Self-Injury
“There are a lot of myths and stereotypes around self-injury,” Dr. Smith says. “One of the biggest ones is that self-injury is not common, that it’s not really a problem, and so we don’t really need to talk about it. That’s just not true.”
One of the most pernicious effects of a cultural taboo is that it fosters the distortion of facts around the subject in question. That’s particularly true when it comes to self-injury. Maybe you’ve heard that only teens self-injure, only white girls self-injure, men never self-injure, or people only self-injure for attention. Perhaps you’ve assumed that self-injury is just a phase, self-injury is something only mentally unstable people do, or if someone’s self-injuring, they should just stop—but none of those statements are true, and most are actually harmful.
“Self-injury is real, and it’s happening,” Dr. Smith says. “But because we don’t talk about it, we have not created those safe spaces for individuals to self-report or to seek out help. So instead, they try to hide from it.”
Self-injury can manifest in a number of different forms: cutting, burning, scratching, hitting, punching, and banging. To conceal the effects of self-injury, someone might wear long sleeves (even in warm weather), stacked bracelets, or wristbands. But there are no foolproof warning signs, Dr. Smith emphasizes, just like there is no single archetype for someone who self-injures.
“Self-injury can occur with anyone,” Dr. Smith. “You can look at someone and not suspect that self-injury is taking place. But we need to foster an environment where individuals who do engage in self-injury can reach out and receive help.”
Research into non-suicidal self-injury is not as abundant, nor as clear, as it is with other mental health issues. Some studies suggest that self-injury rates could be as high as 22 percent in the United States; others believe the number to be even higher. As the Covid-19 pandemic and its resulting lockdowns have increased instances of depression and anxiety, it’s possible that self-injury rates have increased, too. But while the general public may have a basic understanding of how to identify depression and anxiety in others, the warning signs of self-injury have not been as well communicated.
“Warning signs for self-injury include the isolation of an individual,” Dr. Smith says. “Are they isolating themselves excessively? Have they exhibited a dramatic change in mood in reference to how they interact with others? Do they display a major lack of confidence? These attributes alone don’t mean an individual must have engaged in self-injury, but they can act as things to look for when interacting with our friends, family, and communities.”
While self-injury is not an official mental health disorder, there are still best practices in identifying it. For mental health counselors and other mental health professionals, active listening and motivational interviewing are both important when communicating with someone who is or may be engaged in self-injury. The Deliberate Self-Harm Inventory (DSHI) and the Functional Assessment of Self-Mutilation (FASM) are key resources as well. There may be an impulse to group self-injury together with other mental health issues or treat it as a symptom of something else, but that’s not always the case.
“You may find individuals who are experiencing depression, anxiety, borderline personality disorder, eating disorders, or substance abuse disorders, who have engaged in or are more prone to having engaged in self-injury,” Dr. Smith says. “But it doesn’t mean that they must have. You’ll also find individuals who have engaged in self-injury without any of those diagnoses. There is no cookie-cutter method for any one individual.”
Self-injury is complicated. Individuals may self-injure because they’re depressed, anxious, confused, angry, or even bored. But at the core, self-injury often relates to emotional suffering. Mental health professionals may utilize mindfulness training and art therapy as ways of helping individuals come into closer communication with their inner experiences.
“Some individuals who inflict self-injury, particularly those who have borderline personality disorder, have reported that they got some emotional relief from it,” Dr. Smith says. “So our goal in therapy is to help the individual move to a place of acceptance of who they are and where they are in life—the good, the bad, the indifferent—so that we can help them move through change.”
Dr. Smith points to cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are two more powerful tools for treating self-injury. CBT attempts to change one’s negative thinking patterns and push for positive behavioral changes; DBT teaches patients the skills they need to cope with, and change, unhealthy behaviors. Both can help an individual better understand their emotions and reduce their emotional vulnerability.
“You have to think differently if you want to behave differently,” Dr. Smith says. “Part of the goal when we’re working with self-injury patients is to help them go through a process of accepting where they are, without judgment.”
If there is a unifying characteristic amongst a majority of individuals who have engaged in self-injury, it might be an experience with trauma. Trauma can be experienced in a wide variety of different ways, but its effects are layered, complex, and sometimes severe. As the healthcare system as a whole begins to move towards a trauma-informed approach, mental health professionals should also consider the relationship between those who self-injure and the trauma they may have experienced, either consciously or subconsciously, in the past.
“Trauma is a foundational issue that we have to address,” Dr. Smith says. “And when you’re talking about trauma-informed care, you have to approach the individual holistically, and take into context everything that they’ve experienced.”
One of the most effective ways of treating and preventing self-injury is to talk about it more openly. Self-Injury Awareness Month is a small step towards that end. This March, we all have a chance to enter into a compassionate and intelligent conversation around self-injury, one that makes for a healthier, and less painful, world.
“Talking about mental health, in general, can still be taboo, and when you go into certain intricacies or categories of it, it becomes even more taboo,” Dr. Smith says. “But self-injury is real, and we need to spend more time talking about it. We need to increase our own awareness, and increase awareness for the general public so that individuals will feel more at ease reaching out and receiving services.”