Chrissy Tobias was 21 when she sought treatment for a long, secret battle with self-injury — to the shock of family and friends. She started cutting herself and banging her head against the wall when she was 12, but never displayed outward signs of an internal struggle. During high school, Tobias earned good grades and was active in orchestra, church and sports. She’d carefully chosen where to inflict her wounds so they’d be hidden beneath clothing, concealing the fact that she hurt herself. After all, nobody would have ever guessed she was the “type” of person to do so, she says.
But according to experts, the idea that there’s a type of person who self-harms is a common myth — just one of many misconceptions about non-suicidal self-injury.
NSSI is “the direct, deliberate damage of one’s body without the intention of suicide, and for purposes that aren’t socially sanctioned,” such as tattoos or piercings, says Peggy Andover, a professor of psychology at Fordham University and president of the International Society for the Study of Self-Injury. There’s not one underlying reason why people engage in NSSI. But psychologists generally agree it serves as a method of emotional regulation: People use it to cope with sadness, distress, anxiety, anger and other intense feelings or, on the flipside, emotional numbness.
“I would typically use self-injury when things would get overwhelming, or when I felt like I had no outlet and had to do something about it,” recalls Tobias, 28, who lives in Glen Ellyn, Illinois. “I would use it as a relief.”
NSSI touches all ages and genders, subcultures and social classes. Yet there are widespread — and inaccurate — stereotypes about the behavior, says Stephen Lewis, a psychology professor at the University of Guelph in Canada. In 2014, a study conducted by Lewis and his colleagues found that just 10 percent of websites that provided information about NSSI were endorsed by health or academic institutions. Each contained at least one myth about NSSI, further perpetuating stigma and confusion.
Here are some of the most common misconceptions — and surprising truths — that Tobias, Lewis and others say exist about NSSI:
Myth: Self-injury isn’t common.
For years, Tobias kept her self-injury a secret because she was ashamed and didn’t think anyone would understand. It wasn’t until she sought treatment and started attending self-injury support groups through a local chapter of the National Alliance on Mental Illness that she realized she wasn’t alone.
“It’s not as uncommon as a lot of people think,” Tobias says. It’s just that nobody talks about it because of the stigma.
No exact numbers quantify how many people engage in NSSI. But in 2012, the journal Pediatrics found that about 8 percent of children ages 8 to 12 years old had attempted self-injury. And a 2011 study investigating self-injury rates in the general population found that between 4 to 5 percent had tried the behavior. Recent research suggest one-third to half of adolescents in the United States have tried some form of non-suicidal self-injury.
Myth: If you self-injure, you’re suicidal.
While doing research for her book about self-injury, “The Tender Cut: Inside the Hidden World of Self-Injury,” sociologist Patricia Adler says the first misconception she encountered was that NSSI is a suicidal behavior. Just because people cut, she says, doesn’t mean they want to kill themselves.
“What these people have in common is that they’re not all happy,” she says. “They might try suicide. They might try self-injury. But it’s not like it’s a stepping stone — [that] if you try to self-injure, you’re going to graduate to suicide. It’s an anti-suicidal gesture because it’s a way of trying to feel better, rather than [ending one’s life].”
Tobias agrees. Although she has attempted suicide, she says her self-injury is unrelated to the urge to end her life. She’s not trying to kill herself when she cuts; rather, she says, it’s a negative coping skill to alleviate emotional pain. “I was doing it to get through the day,” she says. “I did it to help [myself] live — not to try to die.”
Experts warn, however, that self-injury suggests there’s underlying distress, as well as a lack of effective coping mechanisms. This factor may heighten the risk of suicide.
“If someone becomes suicidal, then the act of having engaged in self-injury does psychologically prepare them to damage their body,” says psychologist Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery at Cornell University. “That piece, for somebody who’s never hurt their body before, is not easy. We have a lot of inner safeguards, psychologically, from taking our own lives. Somebody who really wants to commit suicide is going to have to overcome that. And somebody with self-injury has already practiced hurting themselves that way.”
Myth: If you self-injure, you have a mental illness.
When she was 21, Tobias was diagnosed with borderline personality disorder, obsessive compulsive disorder and depression. However, she knows several people in her self-injury support groups who don’t have a psychiatric illness.
In the Diagnostic and Statistical Manual of Mental Disorders V, self-injury is a symptom of one disorder: borderline personality disorder, which is characterized by unstable moods, relationships and behaviors. Additionally, research suggests NSSI can be associated with anorexia, anxiety, depression and substance abuse. However, experts say many people who struggle with NSSI don’t meet diagnostic criteria for any one of these disorders, yet still use self-injury to cope with their emotions.
Myth: Only women, teens, “goth” or “emo” kids self-injure.
Rates of self-injury are most prevalent among adolescents and young adults. Still, experts say this kind of behavior doesn’t discriminate, affecting everyone from high school students to middle-age adults; from prison inmates to affluent professionals.
One such example is Jacob, 40, whose name has been changed for privacy, and who lives in the District of Columbia metro area. He’s from the Middle East, has a doctorate in genetics and is married with children. Throughout his entire life, he’s engaged in a specific type of self-injury — he picks the skin around his fingernails, or cuts it with a sharp object.
“I started to wonder when the first time was that I remember doing it,” Jacob reflects, guessing the behavior began around age 5 or 6. “I went back and back in time, and then I realized it was like someone asking me, ‘When was the first time you remember eating?'”
Myth: It’s not self-injury if you don’t cut yourself.
Many people don’t realize they engage in self-injury until they learn it isn’t restricted to cutting behaviors. Cutting is the most well-known — and visible — form of NSSI. But researchers say there are many types, ranging from burning and biting to banging one’s head against the wall or hitting oneself. Skin picking, or scratching oneself with a paper clip or other sharp object, like Jacob does, is also common. Studies suggest women cut more, whereas men are prone to skin burning or self-hitting.
Myth: People who self-injure are manipulative, or looking for attention.
The first feeling he gets from hurting himself, Jacob says, is relief — and then shame. He knows there’s a stigma attached to the act, and he doesn’t like people to know about it. “I don’t do it for attention,” he says. Likewise, Tobias says she felt deeply embarrassed and ashamed about cutting, keeping it a secret save for telling a guidance counselor when she was in 7th grade.
Most experts say self-injury is a private act used to manage sadness, anger or other emotions. And if someone is harming himself in hopes of attract attention, it’s to forge an emotional connection or communicate a need for help — not an attempt to manipulate the person.
Myth: If you self-injure, you were abused.
A significant misconception, Lewis says, is that NSSI stems from childhood sexual, physical or emotional abuse.
“A large number of individuals who engage in this behavior wouldn’t have that history,” he says. “We know a risk factor for self-injury is a past history of maltreatment, but it’s a non-specific risk factor. Having a history of maltreatment is a risk factor for a number of different things — maybe it’s post-traumatic stress disorder, maybe it’s depression, maybe it’s self-injury, maybe it’s anorexia. But it’s not specific to self-injury.”
Myth: You can “outgrow” or stop self-injury any time.
“People have said, ‘It’s just a phase — you’ll get over it,” says Tobias, who battles the urge to hurt herself every day. “[They say], make sure you take your medicine, and it’ll go away. But the thing is, it doesn’t just go away.” And Jacob, who tried to stop cutting eight years ago, after his first child was born, hasn’t been able to end the habit.
Nonetheless, experts say many people self-harm intermittently throughout their lives. Sometimes they’ll stop for a few years, and other times they’ll start up again. Or they’ll begin the behavior when they’re teens, and stop after adolescence. There’s no predictor or explanation as to why some people stop and others continue to self-injure for the rest of their lives.
Myth: Self-injury is untreatable.
Various therapies can help end self-injury, including cognitive behavioral therapy and a specific type of CBT called dialectical behavioral therapy, designed to help those with borderline personality disorder. Some people form or join support groups to gain validation or acceptance from like-minded peers. And psychologists continue to develop treatments to help individuals develop new coping mechanisms that aren’t self-injurious in nature, Andover says. These new skills help people regulate their emotions more effectively or change their environments without needing to rely on harmful behavior.
Tobias, meanwhile, withdrew from school and received psychiatric treatment after one of her wounds forced her to the emergency room. However, she says, she continued occasionally injuring herself — and landing back in the hospital — for several years. She finally enrolled in a program called S.A.F.E. Alternatives, a monthlong treatment program that employs therapy, education and support to help people stop self-injuring.
Even after returning home from S.A.F.E. Alternatives, Tobias continued to injure herself. Until she had an epiphany. “I realized I had to take the reins of my own recovery before anything was going to get better; other people couldn’t fix me or make me stop. I had to be the one putting the effort into stopping.”
Tobias began dialectical behavioral therapy, which stresses self-acceptance and validation, and teaches patients coping skills that help control stress and emotions. She also enrolled in support groups with NAMI, where she was able to talk with others who had similar experiences.
On Aug. 12, 2012, Tobias hurt herself for the last time. Since then, she has earned a degree in psychology, has become active with NAMI’s local chapter and is training to become a peer specialist in hospitals. She still feels the urge to self-injure, but says she takes her recovery “one day at a time.”
“I don’t know what tomorrow will bring, but for today, I know I’m not going to do it,” Tobias says. “And that’s what I’m going to have to say to myself when I wake up in the morning: Today I’m not going to do it. It’s not an option.”
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Myths and Facts About Self-Injury originally appeared on usnews.com
