Caution: This chapter includes information that those who self-injure, or have self-injured in the past might find potentially ‘triggering’. Please make sure you keep safe. What methods do people use to self-injure? Do cutting and burning serve different purposes? Why the need to see blood? Is there a link between alexithymia and self-injury? What implements do people use to self-injure? Where do people self-injure?Is there significance to the areas chosen? How long does self-injury last? What do people think of their scars? Is self-injury addictive? Do endorphins play a role in self-injury? These questions are addressed in this chapter, together with a glimpse into the effects of post traumatic stress symptoms on the brain.

Because of my concern that discussing methods and implements used to self-injure could prove distressing to those who practise the act, or might pose a risk by giving people ideas, I decided to seek a number of Internet respondents’ views on whether these topics should be included. The general consensus was that to omit the material or ‘water it down’ would make ‘it a book that is lacking in information’. Several respondents thought that inclusion of the material would be helpful to professionals, other caregivers and lay people in general: Several agreed that the material could be potentially ‘triggering’ but considered it should still be included: Other respondents went some way to allaying my foreboding that including the material might give people ideas:

What Methods Do People Use To Self-Injure?

Research has consistently shown that skin cutting is the most common method of self-injury. Figure 3.1 highlights methods used to self-injure compared across three studies.

Cutting Is Rarely The Only Form Of Self-Injury Used

As evidenced from Figure 3.1, while cutting appears to be peoples’ ‘preferred method’ to self-injure, burning is also fairly common: it is also interesting to note that the percentages on burning from all three studies are very close. This set me thinking about whether cutting and burning might serve difference functions.

Do Cutting And Burning Serve Different Purposes?

Surprisingly, a literature search for information addressing the question of whether cutting and burning might serve different functions revealed this to be virtually uncharted territory. Thus, in order to ascertain whether there might possibly be a distinction between the two lead once more to inviting the Internet respondents to comment on the subject. They were asked to respond to the following questions: ‘If you cut and burn, do they serve different functions for you? Can you explain?’ Here are a range of replies received:

Note: The final testimony is from a respondent diagnosed with Dissociative Identity Disorder (DID). Hence, the reason she refers to herself as ‘we’ and ‘ourselves’. This is fairly common practice among people with DID. The subject of dissociation and DID is discussed in various chapters later in the book.

Summary

As can be seen from the testimonies, cutting and burning serve a similar purpose for some, while for others they serve different purposes. The list below provides an overview of possible reasons why people may choose burning over cutting, identified from the responses. However, there does appear to be a degree of overlap in some cases, for example either behaviour may be used to terminate dissociative episodes (feeling numb, unconnected).

Also, the choice of method may depend on the trigger and can go either way. This made it difficult to determine whether a clear distinction can always be made. What did come across is that if the sight of blood is important, cutting is more likely to be chosen over burning. Further, to quote a male respondent’s interesting observation, perhaps: ‘Fire and so on is more anti-dissociative whereas blades are more anti-emotional.’ (Emphasis added).

• Burning provides a more immediate pain than cutting, it hurts more, and the pain and discomfort lasts longer (‘it is the gift that keeps on giving’). This suggests that burning may serve the purpose of distracting one’s thoughts away from the internal emotional pain for a longer period than cutting.
• There is more uncertainty about burning than cutting, and it is can be a more damaging and dangerous method.
• Burning may be chosen over cutting to cope with exceptionally high levels of stress, when a higher level of pain or more damage is needed, when feeling the need to suffer more or to punish oneself more, or to manage intense feelings of anger or powerful negative feelings of self-hatred or self-disgust towards oneself.
• Burning may be selected over cutting to terminate incapacitating episodes of dissociation (feeling exceptionally numb) or when a quick ‘snap back to reality’ is needed.
• Burning may be used to prove to oneself that if one can get through the excruciating pain of burning oneself, one can get through the pain of anything.
• Burning may be chosen if a ‘quick fix’ is needed or if cutting is insufficient to ‘cut’ through the psychological pain.
• On a practical level, burning may be the method of choice for the sake of convenience – it can be carried out quickly, easily, with relatively little mess. It may also be used as a substitute if a person’s ‘cutting tools’ are not readily to hand, and can be passed off more easily as an accident.