I am a self-injurer and have been for 8 years. I am clinically depressed, and have been hospitalized 6 times for attempted suicide and self-injurious behavior.

What are some alternatives to self-injury? How can I find better ways of coping other then cutting?

mmocean (18 year-old woman) from Calagary, AB

Self-injurious behavior is a difficult compulsion and often leaves people feeling helpless after years of attempting to stop. From your background it sounds like you have attempted to address this and other issues in the past.

Usually, self-injurious or self-mutilative behavior is part of a cluster of symptoms generally associated with a history of abuse or neglect. Many people with self-injurious behaviors have been diagnosed with bipolar disorder, borderline personality disorder or dissociative identity disorder.

The self-injurious behavior dissipates once the original trauma (usually from childhood) is dealt with. Long term psychotherapy is generally recommended, particularly if the self-injurious behavior escalates to suicidal ideation and attempts.

There are many reasons why people self-mutilate, including to feel alive, to feel real, to punish themselves or to feel physical rather than emotional pain. Some people feel a rush by hurting themselves, other people immediately feel numb when self-mutilating. Each person is different, consequently, substitutes for the behavior will be different as well.

In order to develop a new way of coping, the meaning and function of the self-injurious behavior needs to be understood. In addition, thoughts and feelings leading up to the self-injurious behavior should be explored as well. This is the work that is usually accomplished in therapy.

Once the meaning of the behavior is better understood, new coping strategies can be introduced. You must come up with a strategy to do something different that is not self-destructive. You must be motivated to change and also must understand that the replacement behavior may not be an exact substitute for the sensation sought during self-mutilation. In other words, you must be prepared to accept the idea that the new coping strategy might not provide the same kind of satisfaction that was received through self-mutilation.

Once a commitment to change has been made, several different coping strategies can be introduced. These strategies might range from art to exercise to journaling.

Hopefully this has given you a "jumping off" place. There are many resources on the web for people who self-injure, ranging from online support to referrals for psychotherapy. Good Luck. You obviously want to change and that is the first step.

DeeAnna Merz, M.Ed., LPC, CRC