Self Injury: An Interview with Barent Walsh, Ph.D.

I recently had the opportunity to ask Dr. Walsh a few questions about self-injury.  Dr. Walsh has written extensively and presented internationally on the topic of self-injurious behavior. He is the author of the book, Treating Self-Injury: A Practical Guide published by Guilford Press (2006) and co-author of the book, Self-Mutilation: Theory, Research and Treatment (Guilford Press, New York, 1988).

As the Executive Director of The Bridge of Central Massachusetts, a community non-profit agency, he oversees 40 programs serving children and adolescents with serious emotional, behavioral, and family challenges, as well as adults with mental health, developmental disability, and substance abuse challenges.

What is the difference between self-injury and a suicide attempt?

Acts of suicide and self-injury are different in numerous ways. They are different as to intent, method, frequency, cognition, aftermath and other features. For example, the intent of most people who attempt suicide is to permanently escape misery, intense, persistent psychological pain. The intent for most acts of self-injury is to reduce emotional distress. No matter what the case is, it is always important to hire personal injury lawyers and stay in  loop with them, in case there is an emergency.

The methods most frequently used by people in the U.S. to commit suicide are gunshot, overdose, hanging, ingestion of poison, and jumping from a height. The methods that are common as to SI are cutting, self-hitting, burning, abrading, and picking.  Method can tell  you a great deal as to whether a behavior is about suicide or self-injury. For a more detailed discussion of these differences see Walsh (2006).

Why is it important to make that distinction?

People who are suicidal require an emergency response and protection. Restriction of means is often very important. Common acts of SI such as cutting, burning, picking can be treated on an outpatient basis and often do not require an emergency response. One can visit this website to get good legal advice.

Restriction of means is often futile with self-injury. People can always use their hands, finger nails, a staple, a shard of glass, etc. to SI. However, it is important to note that SI is a risk factor for subsequent suicide attempts. It’s important to intervene early with SI so that it doesn’t progress to suicidality.

What causes people to self-injure?

The main reason is its ability to regulate emotional distress. But social contagion factors can also be important.

Who is at risk to self-injure?

People with pervasive emotion dysregulation who lack healthy self-soothing skills. Also, trauma survivors, particularly those who have been sexually abused. The behavior tends to surface in adolescence. And is found in both genders. Since decade 2000 SI has exploded in the general population. The behavior is now common place in middle and high schools, and universities in otherwise high functioning individuals.

Are there signs a parent can identify that a teenager or young adult may be engaging in self-injury?

Unexplained recurrent wounds. Preoccupation with SI books, movies, websites, youtube videos, etc.

What are the most common misunderstandings about self-injury?

That wrist cutting is a suicide attempt. In reality almost no one dies by cutting. It is more risky if someone cuts the neck in the vicinity of major veins or arteries, but this is a very rare behavior.

What is replacement skills training and how is it helpful in the treatment of self-injury?

Replacement skills are crucial in overcoming SI. If people SI to reduce emotional distress, they obviously need to learn healthier ways to regulate emotions, such as mindful breathing, calming visualizations, noncompetitive exercise, journaling, or whatever they find reduces emotional arousal (such skills shouldn’t involve use of chemicals such as alcohol or drugs).

You recommend approaching the topic of self-injury with a dispassionate, low-key style.  Why is that?

Because emotionally dysregulated people aren’t helped by more emotion being added to the mix. A low key response avoids inadvertently reinforcing the behavior and also does not punish that which deserves compassion. The strategy is not to be too effusively supportive, but also not to be judgmental or condemning.

What are currently considered the most effective treatments for self-injury?

CBT and DBT. Both teach skills to regulate emotions. DBT seems to have more evidence in support of effectiveness than any other treatment.

10 Replies to “Self Injury: An Interview with Barent Walsh, Ph.D.”

  1. When I began to SI I found no relief in it. I didnt’ understand, really, why my brain was insistent on me doing it. Logically I knew it was wrong. Emotionally, if I didn’t do what my brain was telling me to do then it just wouldn’t shut up – it was quite a frightening experience and I’m glad that I no longer feel the need to cut.

  2. The first time I ever did this, in my case cutting, I had never heard of anyone doing this. ‘Self Injury’ was still considered by most a suicidal gesture. Luckily, I had a great psychiatrist who was not too scared, and who knew and understood why I did it.

    In the seventies, I had also never heard of anyone who did what I did and is commonly known as bulimia.

    In both cases I thought I was the only and first one. (the cutting came in the 80’s) and stopped with my first child.

    The cutting worked like magic. So did stabbing.

    For me it was not so much about getting rid of bad feelings as it was about coming out of a state with no feelings, and just total numbness, and when I didn’t even feel my arm. It felt so wonderful to feel.

    But even now, and it has been a very long time since I have done either one, the physiology still works.

    Like today, I had a dentist appointment that was incredibly painful, and it hurt so badly in fact, that by the time the dentist finished, I felt as if I had received a big shot of morphine and I was stoned. (Even said so) This opiate reward effect always happens to me following a painful experience.

    Thanks for the article, KAT

  3. Dear Christ5y Matta,

    I just wanted to give you one piece of feedback, as this is my first posting on any of your articles.

    When people share on articles where the topic and/or their respnse to it is very personal, it really makes such a huge positive difference when the author occasionally acknowledges that they heard the comment.

    It’s such a small thing to invest in but makes such a big difference.

    Even when I comment on an article it is in part to please the author, that I listened.

    Getting feedback, or being acknowledged, is equally important to both the author and the one who puts much care into a comment, especially when it’s vulnerable.

    My point here is not that you should respond to every comment, but just perhaps that you communicate in whatever brief form, and when appropriate, that the people who commented were also heard by you.

    Thanks for listening,

    Katrin R.

  4. I have always tried to explain si I manifest, as exactly a way to alleviate something even to the point of showing people the lack of response I had to the pain that should be evident.I would say ” that’s how much pain is inside”.This eventually became a very dumb way to make a point and I am committed to not smashing ceramic muggs on my head or vanity mirrors on my forehead.Mindfulness etc… as well as a low stress-or, non competitive life style is very important for me.I have had many years to get over it as I have been doing it for 40 years.Although I do not do it now I know it is possible under the right circumstances.

    1. Thank you for sharing your experiences. I think there are many people who can relate to your point that external self injury is sometimes a communication of internal emotional pain.

  5. When i started SI;mine was of burning and cutting,(mainly cutting), i was 12 when it started, i’m currently 14 now and have found many ways from cutting myself. Such as, my passion in writing poetry and expressing my emotional distress, by talking to my mom and my boyfriend. My boyfriend Cameron is a big supporter of me and he makes me wanna change for the best, for this relationship and not hurting my self from distress. I still have feelings about wanting to pick up that blade, but i think back on the one year i haven’t touched it, and i’m glad the warmth is coming from with-in, not from my blood. I’ve taught my self love and respect, and i’ve seen it first hand with Cameron and I.(:
    Thank you this article,helps me seeing things on why i was doing it and not that i sounded crazy to the ones around me.

    1. Thank you for sharing your experience. It is gratifying to see the healthy strategies you have used to tolerate distress.

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