Self-harm is the Symptom, Not the Disease

Deliberate Self-Harm is an umbrella term that encompasses any non-accidental activity that a person engages in that, well, harms that person physically. Cutting is the most talked about self-harm behavior. But the term also includes head-banging, pulling out hair, biting, burning, picking at scabs, and frequent biting/picking at nails and cuticles until they bleed. I think the term is mis-leading because it implies that the person’s aim is to inflict pain on himself or herself. But some self-harm behaviors–especially hair-pulling and extreme nail-biting–are unconscious; they serve a role in dissociation. And the purpose of self-harm is not a masochistic desire for pain, but rather an attempt to escape or control unbearable psychological pain.

Today I want to talk about why kids and teens self-harm, have eating disorders, and attempt suicide. Obviously when a kid does any of these things, something is wrong. But I think we err when we treat one of these problems as The problem instead of as a symptom of a larger problem. And it’s a dangerous error.

All of these behaviors are linked to trauma. According to Jon Allen in Coping with Trauma: Hope Through Understanding, “a high proportion of women with eating disorders report a history of childhood sexual abuse.” He goes on to say that eating disorders are also linked to other forms of abuse and neglect and are more likely to develop when women “have problems with attachment.”

Attachment–that’s psych talk for kids (and adults) who don’t feel that they have someone they can count on. I mean, epically. They have been (physically or emotionally) abused, neglected, or abandoned by their caretakers and they neither feel that they can trust someone nor have they developed the skills to do so.

Eating disorders and cutting are both used as forms of control for people who don’t feel like they have any other control over their lives, and as ways to alleviate psychological pain that they don’t have the resources to deal with. Inflicting physical pain on oneself can be a way to focus the pain outside of oneself. Self-harm is often brought on by intense feelings of neglect, rejection, and abandonment that the person can’t deal with. In addition, in families where the caretakers are often abusive or unstable, self-harm is a way to re-direct anger, that it would be unsafe for the child to express externally, back at himself or herself.

Suicide attempts, likewise, are linked to childhood trauma, and are the extension of these other behaviors. If self-harm is used to alleviate immediate, unbearable psychological pain, then suicide attempts are when psychological pain is not only unbearable, but the child or teen is hopeless and can see no way out besides death.

All of this is to say, that if a kid is banging his head on the ground, the problem is not really that he is banging his head on the ground–the problem is that he is in severe pain that he can’t handle. Just stopping him from banging his head on the ground is actually going to be counter-productive because it is going to take away his only tool for dealing with the pain. Instead, someone needs to figure out what has happened to him or is being done to him that is causing him such psychological distress. And after that has been discovered and taken care of, then he needs to be taught other, less injurious ways of dealing with his emotional distress.

Likewise, if a teen girl is cutting herself, someone needs to ask what has happened to her or is happening to her? Likewise if she’s starving herself or forcing herself to throw up or is slitting her wrists.

Too often we focus on the behavior and try to fix it without looking for the cause. As children’s writers what we can do about this is to write books that link these behaviors with their cause.

I know that there must be more books about eating disorders, self-harm, and suicide attempts out there than I know of, but for the life of me, the only one I can think of is Winter Girls by Laurie Halse Anderson in which the protagonist struggles with her own anorexia after her best friend has died of the same thing. It’s a great book (IMO) and a good cautionary tale for teens struggling with eating disorders. But what it lacks almost entirely, is any suggestion that there is a cause for these girls’ disordered eating.

As far as I know, there is no starvation gene. It certainly wouldn’t work in Darwin’s worldview. I think what kids who are starving themselves need (besides, yes, the warning that if they keep doing so, they will die) is to see that their starvation is a coping mechanism. And they need to see why they are using this particular coping mechanism and how they could get out of the situation that is causing them to want to starve, and how they can develop other coping mechanisms.

I think we need to write the books that make these connections, and I think when we work with kids, we need to be more aware of these symptoms and of what the underlying causes might be.

Next Week’s Topic: What I need to know about attachment, I’ve learned from cats.


About pamwatts

Writer, Reader, and Children's advocate
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7 Responses to Self-harm is the Symptom, Not the Disease

  1. farrind says:

    Dear Pam- and readers,

    What an interesting, timely and poignant topic.

    Just wanted to chime in- these things are all symptoms. I have read one or two books and heard (but not read) more. Right off, I remember the title of a book by a celebrity with anorexia- “Starved for Attention”- I believe she had someone help her write it, but it is HER life. Though I do not recall who it was! Anther one in that vein is “Wasted”. These are NOT fiction!
    Through addiction and even use of plastic surgery, Michael Jackson did some self-harming things. No surprise- I read his older sister LaToya’s autobiography and there it is- Michael and LaToya were abused as kids. (Self harm stems from childhood abuse??) Laurie Anderson is a great writer for young adults- though the one you read is new to me. She wrote two describing very realistic teen girls in tough situations, “Speak” and “Catalyst”. Neither girl is really doing “self harm” in a direct way, though both are dealing with terrible stress. And the two girls featured in these books go to the same (fictional) high school! But from what I read, I suspect Anderson in “Winter Girls” was trying more to get her readers to think about how serious the behaviors of her protagonist are. It is a book for young adults- there may be reasons for the girls’ self destructive actions, but that was not what Anderson wants you to focus on (am I way off on this interpretation?).
    Mary Pipher’s classic “Reviving Ophelia” talks about one of her clients who has an eating disorder. I do not recall if any sections of this book talk about other self harming actions but I think it might….and of course, there is a school of psychology which traces all of these things back to how we learn to deal with anger. To overgeneralize, boys “act out” to a greater extent than girls when angry- and girls tend to inflict the harm on themselves, though anorexia/bulemia is not that unusual in teen boys. Overgeneralizing is dangerous! The last book I will mention, then, is written about women but I think that some of it could just as closely describe men. It is “The Dance of Anger” by Harriet G. Lerner. There is a great chapter on eating disorders, and I encourage anyone who can relate to read it!
    Thank you for this thoughtful part of your blog… Farrind

  2. farrind says:

    I am new to your blog…do you only want books you would ask a YA to read? or are adult titles (for the people who LOVE the young adult- but are ten, twenty 0r, in my case Many years older) welcome too?
    In that latter class- I Never Promised you A Rose Garden is based on the real life of Johanna Greenberg. The protagonist is just 16 at the start and turns 19 during the three years she is treated for serious emotional problems. She is a cutter. I do not recommend anyone under 16 read this. But, for young people “Belle Prater’s Boy” is wonderful! Gypsy, the protagonist cuts her hair in a self-destructive way at the end. I am not sure, but I think the “boy” referred to in the title is also an abused kid- though I think the point of the book is that he has very mature coping strategies and does not resort to self-harm.
    I read this book because my son’s English teacher assigned it, when he was 15.
    I appreciate the comments of your other readers, and can hardly wait to see what else is on your blog!

  3. pamwatts says:

    Hi farrind, thanks for chiming in. My blog is specifically about books for kids and teens. Yes, books that would be appropriate for them to read. Because my point here is for us to help them cope with the tough stuff in their lives. However, for some teens, in particular, who have lived through trauma and are at a specific stage of coping, many adult books might be appropriate for them. It all depends on the kid really.

    I read Reviving Ophelia as a teen, and it had a profound impact on me. I don’t remember specifics, though, so I should probably go back and reread it. And thanks for pointing out Speak and Catalyst. I haven’t read the latter, but I meant to comment that Speak actually does have self-harm in it. The way that Miranda chews her lip constantly until it’s bloody constitutes self-harm and is probably a stress-release technique.

    And I think you’re right that Laurie Halse Anderson’s purpose in Winter Girls was to show teens how serious anorexia is. And she does a wonderful job of it. My point was simply that in addition to stories that show the devastating consequences of self-destructive behaviors, I think teens also need stories that explain some of the causes of the behaviors. If we only focus on the behavior (say, Anorexia) and not its cause, then it seems to me to sort of be sending the message that the teen is doing something wrong instead of saying that the teen is suffering and is trying to deal in a way that probably isn’t going to be good in the long run. Does that make sense?

  4. hollie says:

    When I was 7, I was sexually abused and my mum was physically abused, she developed bi polar and I developed the need to extreme nail bite, my fingers would bleed yet I would feel no pain that I can remember, I have been unconciously doing this for 6 years and I want to thank you for making this webiste, I decided to read up on it tonight and I just want to hug you, if there is people out there self harming please stay strong, you are loved and you are not alone, no matter how much you feel in dispair there is always someone who cares, someone who will help and someone who has shared your experience, thank you x

  5. pamwatts says:

    Hollie, I am so sorry for what you have been through. I am glad if my site has helped you even a little. I have been an extreme nailbiter for similar reasons since I was a very small child. You have my prayers (if you want them.)

  6. hollie says:

    Thank you, I could really use those right now! Do you have any ways to cope with it? I hate my fingers as they are rough and uneven and sometimes hurt, I’m sorry for what you’ve been through and you’re very brave for doing this blog! I’m sure you’ve helped hundreds of people, especially me! Thanks again x

  7. Pingback: Mental Illness Resource Round-up | Strong in the Broken Places

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