
                            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: [1]telling
   others, answering [2]intrusive questions, [3]hiding and [4]healing
   scars, and a few [5]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 [6]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,
   [7]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.
   [8]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:
   
   [9]Rejuveness
          [10]Syprex
          [11]Clinicel (a cushion)
          [12]Cicacare
          [13]ReTouch
          [14]ScarFX
          [15]ScarEase
          [16]Mepiform
          
   to name a few. Syprex also makes a cream, a topical gel, and a special
   cleansing wipe. A new product, [17]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 [18]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,
   [19]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 [20]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
   [21]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.
   
   [22]Dehydration can send you into [23]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.
   
   [24]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.
   
   [INLINE]
   
  next section: [25]Help for families and friends
  return to [26]SI main page

References

   1. file://localhost/usr/home/llama/Web/psych/living.html#out
   2. file://localhost/usr/home/llama/Web/psych/living.html#questions
   3. file://localhost/usr/home/llama/Web/psych/living.html#scarhide
   4. file://localhost/usr/home/llama/Web/psych/living.html#scarheal
   5. file://localhost/usr/home/llama/Web/psych/living.html#med
   6. http://www.dermablend.com/
   7. http://www.jnj.com/innovations/in_advanced_heal.html
   8. http://www.mederma.com/
   9. http://www.rejuveness.com/
  10. http://www.syprex.com/scars.cfm
  11. http://www.lifemed.com/clinicel/
  12. http://www.cicacare.com/worldhtml/index.html
  13. http://www.midcoast.com/%7Enatejan/Scar.html%20%20
  14. http://scarheal.com/
  15. http://www.scarease.com/
  16. http://www.directmedicalinc.com/scar
  17. http://www.scarguard.com%20/
  18. http://www.curad.com/scar_main.asp
  19. mailto:llama@palace.net
  20. mailto:llama@palace.net
  21. http://www.scarcare.org/
  22. http://www.nlm.nih.gov/medlineplus/ency/article/000982.htm
  23. file://localhost/usr/home/llama/Web/psych/firstaid.html#shock
  24. http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm
  25. file://localhost/usr/home/llama/Web/psych/ffriend.html
  26. file://localhost/usr/home/llama/Web/psych/injury.html
