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What Happens When Self-Harm Becomes Invisible?


I had stopped cutting. But that didn’t mean I wasn’t harming myself.

CW: Self-harm, cutting

A year ago, I stood in my kitchen and called my friend Liz to tell her I had not hurt myself in a year. It was a realization that had dawned on me earlier in the day, and I needed to share the news. Liz told me she was proud.

It had been a rough week, preceded by a rough month, and I had a long history of reacting poorly to emotional stress. My friends almost expected I would self-harm. I almost expected as much as well. I had been a cutter most of my life. It started in elementary school when I would scratch red claw marks into my hands and arms as punishment for egregious sins, like missing the bus or getting a C- on a math test. In high school, I graduated to sharp objects like knitting needles and steak knives. By college, I routinely used the X-acto knife I bought for an art seminar to leave brutal, bloody cuts on my arms. The scars are still there, thin white lines that ensure my mental health history is unconcealable. While I could never hide the self-harm, this also meant no one could ignore it. My friends were always incredibly supportive and, that night, Liz’s pride was the small victory I needed.

“Erin,” Liz said, “That’s amazing.

And I felt amazing, for a bit, but later reflected on how I had treated myself that week. My internal monologue was a vicious, abusive cycle where I constantly reminded myself of my empirical lack of worth. I spent two hours a day at the gym, engaging in vigorous aerobic activity with the elliptical’s incline and resistance maxed out, and ate almost nothing. It was part punitive—a way of hurting myself for perceived sloth—but also impulsive; I felt a need to be in physical pain, one I could not control.

I did not cut myself, but was it fair to say I had not hurt myself? Without the physical marks, no one was aware anything was amiss. My self-harm had not gone away. It had become invisible.

I often feel trapped in a loop in which one form of self-harm usurps another, cycling through negative behaviors without real improvement. I do not understand what drives this desire to hurt myself. The why of self-harm is a question often asked, but the why of any psychiatric condition is multi-faceted and often unclear. With self-harm, the normal level of scientific ambiguity is magnified by the fact that self-harm has only very recently been studied as a disorder in its own right. Once seen only as a symptom of other disorders, Non-Suicidal Self Injury (NSSI) entered into the DSM in 2013 as a topic for “further study” after research took off in the early 2000s. The International Society for Self Harm was formed in 2006 to foster more communication and collaboration among professionals who studied self-harm.

NSSI serves a function for the individual,” said psychologist Lori Hilt, an Associate Professor at Lawrence University who has researched self-harm. “Self-punishment is one function, and it’s also commonly used to decrease acute negative effect (e.g., anxiety).”

As for whether it’s common for self-harm to take other forms, Hilt told me the behavior is frequently comorbid with other maladaptive behaviors.

Without the physical marks, no one was aware anything was amiss. My self-harm had not gone away. It had become invisible. Click To Tweet

“There are many other behaviors that might be able to serve similar functions,” she said, “For example, binging, purging, and other eating disorder-type symptoms often co-occur with NSSI. Other indirect forms of self-harm include substance use and risky sexual behavior. These self-harming behaviors…may serve similar functions for the individual.”

But what are those functions, exactly? I have been suicidal before and, while I no longer actively feel those emotions, I can explain them retroactively. I cannot do the same when it comes to self-harm. Cutting feels like it was something that happened to me rather than something I did.  

Joan Didion once wrote, regarding her daughter’s alcoholism, not even doctors can argue alcohol is not an incredibly powerful anti-anxiety agent. Didion was not advocating for heavy drinking, but trying to show readers how addiction happens. I sometimes walk people down a similar path when explaining why I cut. The main reason I kept up with it for so long was that it worked so well at curbing my anxiety. It provided me the same instantaneous anxiety relief some find in alcohol. Self-harm can simultaneously occur with various substance abuse disorders and Hilt told me some research does indicate self-injurious acts can release feel good chemicals in the brain like endogenous opiates.

“This is part of the body’s natural response to pain/injury, but it can be positively reinforcing,” she said, “Regarding anxiety relief, what is most likely going on is a shift in attention from the feeling of anxiety to the present-moment experience of pain, seeing blood, etc. This shift to something concrete is probably what takes away the feelings of anxiety temporarily.”

The period when my cutting stopped coincided with positive changes in my life. I got out of a toxic relationship. I started taking mood stabilizers. I tried to adopt a healthier diet. Hilt mentioned that self-harm is common in individuals who lack other coping skills and therefore turn to quick fixes to handle stress. I would like to think I discovered long term fixes preferable to the immediate release of drawing blood, but part of me wonders if I’ve ever actually stopped self-harming.

Around the time I stopped cutting, I began going to the gym six days a week. Exercise no doubt has a litany of benefits, but for a time my workout routine was obsessive. I worked out almost three hours a day while eating less than 1,200 calories. I once passed out in the locker room after a particularly brutal session. I wasn’t cutting, but I was hurting myself. People just overlooked as much and, in fact, often complimented me on my dedication.

Did the mood stabilizers and lifestyle changes improved my mental health or did I simply trade one form of self-harm for a more socially acceptable variety?

Cutting feels like it was something that happened to me rather than something I did. Click To Tweet

I should prefer my self-harm is invisible as it’s so stigmatized. People are willing to accept my bipolar disorder and anxiety are beyond my control, but rarely extend any sympathy towards cutting. I once had an ex-boyfriend smack his hand against a desk while screaming cutting was a choice. At an office job, a manager once suggested our publication write a list called “Best Songs To Cut Yourself To.” These reactions stem from the same notion self-harm is a self-indulgent, easily controlled behavior worthy of both scorn and ridicule.

Invisibility protects me from stigma. It does not, however, protect me from myself.

We want the narrative of mental illness to follow a trajectory that ends in cure, but not every story is one of triumph. Many end with ambiguity, partial victories, and ongoing struggles others do not always see.

I do think I am getting better, but progress is slow-going and marked by setbacks and hurdles. Hilt told me the most effective treatments for self-harm involve teaching better coping skills and I am taking active steps—therapy, mindfulness, positive self-talk—to do just that. But I still routinely indulge in emotional self-abuse via a nasty internal monologue. I still do not like myself on many days.

While my scars are now faded, this does not indicate unambiguous triumph. As further research illuminates causes and searches for effective treatment, myself and many others—visible marks or not—struggle each day with the seemingly endless internal urge to hurt ourselves.