Why Aren't There More Resources for Adult Self-Injurers?

By Renée Fabian 03/21/17

Over time, self-injury itself can become a habitual, nearly addictive behavior, and 8.7 percent of self-injurers are also addicts.

a woman behind glass, with hands against the glass.
It's a myth that self-injury is a behavior relegated to teenagers.

Erin Hardy, a Wisconsin-based therapist, found herself in a quandary when an uptick of people who self-injured came to her about five years ago. This was a new area to her practice, so Hardy sought consultation with her colleagues on resources, but they came up empty. An internet search left Hardy with unsatisfactory results.

"All the sudden I had this flood of individuals that were engaging in self-harm," says Hardy. "There is really nothing [online] about self-harm other than the theme of, 'Anybody who self-injures has borderline personality disorder,' and … 'there's no cure, nobody can get better.'"

Undeterred, Hardy kept searching until she found S.A.F.E. Alternatives, an organization co-founded by Wendy Lader and Karen Conterio in the mid-1980s dedicated to self-injury recovery with the belief, "people can and do stop injuring with the right kinds of help and support." Through their S.A.F.E. Focus program, Hardy got the training and materials she needed to lead a dedicated self-injury support group in her city.

Today, a similar internet search for self-harm resources yields information focused on adolescents. As one PsychForums member put it, "I have been online searching for several hours today regarding finding help for self-harm, and I'm 40. I have been seeing that it is mostly in young people, and feeling pretty embarrassed and ashamed that I'm an adult dealing with it. I feel like I should have grown out of this long ago."

The pervasive idea that self-injury is a behavior relegated to emo teenagers is simply false. Self-injury affects 4 to 5.5 percent of adults, yet the stigma persists, leaving millions of self-injurers to struggle in silence and feel invisible.

Defined as intentionally harming the body without suicidal intent through behaviors such as cutting, burning or hitting oneself, self-injury serves as a maladaptive coping skill to deal with difficult emotions, experiences and feeling states.

"Self-injury is the choice to feel or not to feel, … to escape really negative uncomfortable feeling states," says Wendy Lader, co-founder of S.A.F.E. Alternatives and past CEO of Mending Fences. "They really just want to release some emotional pain."

Over time, self-injury itself can become a habitual, nearly addictive behavior, and 8.7 percent of self-injurers are also addicts. Self-injury, like addiction, often co-occurs with mental health issues such as post-traumatic stress disorder, borderline personality disorder, depression and anxiety, among others — issues that can't always be resolved by the end of adolescence.

So why aren't more resources dedicated to adult self-injurers outside of individual therapy?

The first challenge may be at the research stage. Though new research is now published weekly on self-injury, information largely focuses on adolescents age 22 and under.

"[Self-injury is] just so much more prevalent in young people. You couple that with ease of setting, and you can find groups of young people in institutions like schools or community-based organizations. Then you can do studies there," says Janis Whitlock, director of Cornell University's Research Program on Self-Injurious Behaviors. "It's much harder to figure out where you would do that with adults."

Even getting adults to commit to group therapy can be a challenge. Adults are burdened with more responsibility than adolescents and may have trouble finding the time and effort to make the commitment for their own healing, even when resources are available.

"I hear from other therapists, I hear from clients that they need [group], they want it, but they don't seem to want to make the commitment," says Michelle Seliner, chief operating officer of S.A.F.E. Alternatives and a licensed clinical social worker. "I think that [people] believe that group therapy is somehow diluted individual therapy, but really it can be more powerful."

Group support can be a life-changing tool. Look no further than the abundance of 12-step programs and support and therapy groups for alcoholism, addiction, eating disorders, anxiety, depression, trauma, and a host of other dedicated topics. Except self-injury.

This may be because of the enduring myth that self-injury is primarily an "attention-seeking" behavior. Accordingly, self-injurers will "one-up" each other with dangerous self-harm to gain attention in a group, prohibiting the success of a group setting. This is generally false.

Groups can avoid contagion when run by trained professionals who set clear participant guidelines. Seliner, who runs S.A.F.E. Choice's weekly outpatient group therapy program, has members sign a "heartfelt" promise upon joining that they will make every effort not to self-injure. Hardy asks her group to sign a similar contract.

Facilitators set strong boundaries, such as using generic terms instead of detailed descriptions of self-injurious acts, and focus on the emotions behind the behaviors.

"We never allow them to talk about the specifics of their self-injury in groups," says Lader. "We didn't really care what they were doing. It was more a why they thought they needed to engage in that behavior."

Group members process the emotions and situations behind self-injury, learn alternative coping skills, build their support system and set boundaries, and learn self-care, among other skills, to lead an emotionally healthy life. Groups can provide hope, healing and a critical support system while maintaining a safe dynamic. Yet there are too few self-injury-specific groups available.

The single Self Mutilators Anonymous meeting is based in New York. S.A.F.E. Alternatives' main clinic is based in St. Louis. There are less than 10 S.A.F.E. Focus groups across the country registered on S.A.F.E.'s website. The reputable Center for Self-Injury Recovery Services program is based in Chicago. The resources are few and far between.

Seliner's S.A.F.E. Choice clinic sees clients travel hours just to participate. "I have clients that drive up to about two hours just to come to group," she says. "The resources are so limited people will drive quite a distance to get to us for weekly outpatient treatment."

Clients reach out to Hardy from long distances as well: "Being in Wisconsin, I'm getting calls from all over the place. I had a client that drove two-and-a-half hours to see me."

While some are willing to travel great distances, that's certainly not the case for everyone, arguably because the largest factor limiting resources for adults is still the stigma behind self-injury.

"Over the last decade, we've heard from and met people of all ages who struggle with self-injury," says Jamie Tworkowski, founder of the non-profit To Write Love on Her Arms, which promotes education, awareness and recovery resources for self-harm. "I think the biggest problem is simply stigma, which causes so many people to struggle in silence."

For adults, it can be humiliating to be linked to a behavior primarily associated with teenagers — and might mean they aren't taken seriously, compounding the stigma. The research on self-harm from organizations such as Whitlock's at Cornell University represents great strides in creating needed educated awareness. We're heading in the right direction, but there still aren't enough in-person resources tailor-made for self-injury recovery.

So what's the next step?

"When we begin to talk openly about mental health and substance abuse and self-injury, we give other people permission to do the same," says Tworkowski. "Honesty is contagious. The stigma begins to go away when we realize it's OK to be honest and it's OK to ask for help."

Renée Fabian is a Los Angeles-based journalist who covers mental health, music and the arts. Her work has been published in VICE, Wear Your Voice, The Establishment, Ravishly, The Daily Dot, and The Week, among others.

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Renée Fabian is a Los Angeles-based journalist who covers mental health, music and the arts and cats. Her work has been published with VICE, Wear Your Voice, The Establishment, Ravishly, The Daily Dot, and The Week, among others. Find her on Linkedin and Twitter.