Detached9: Why do you think self-injury is so common in people with anorexia or bulimia? possibly punishment?

Dr. Farber: Well the fascinating thing is that punishment is one of the functions it can serve, but for many people it's a form of their body's speaking for them. In other words, the body says for the person what they cannot allow themselves to say or know in words. It's about speaking about emotional pain that they cannot put into words, so their body speaks for them. If you want to think of the bleeding as a form of tears that they couldn't cry, I think that's a good metaphor.

It can be about punishment. Punishing one's self or punishing another. It can be about ridding themselves of something bad or evil inside. A form of cleansing or purifying themselves, except, of course, it doesn't work. If it did work, they would only do it once and they would be sufficiently cleansed or purified.

It starts as someone's solution to an emotional problem, but the solution can become more problematic than the original problem. The solution can take on a life of its own, and become like a runaway train. One of the psychological problems with self harm is that it creates, for the person, a sense of being in control but then it becomes very out of control.

Cissie_4233: But anorexics and bulimics deal with a certain amount of vanity, therefore why are they now concerned with the scarring?

Dr. Farber: Well because anorexia and bulimia are not always about vanity. It's not always about wanting to look thin. For many people it is more about emotional pain. And for many people who have a problem with eating they have difficulty with using words to express their emotional pain. So when someone says "I feel fat," they really mean "I feel anxious" or "I feel depressed" or "I feel lonely." For many people with eating problems, the obsession with their physical appearance is just a cover for much deeper emotional pain.

David: I just want to clarify one thing. You are saying that there's a link between eating disorders and self-injury. But, of course, there are people who self-injure who don't have an eating disorder. What about them? Why have they turned to self-injury to cope with their emotions?

Dr. Farber: What I have found in my study is that the people who have suffered the most trauma in their lives, especially childhood trauma (and that trauma can be the trauma of physical or sexual abuse, or children who suffer through various medical or surgical procedures), may need to use more than one form of self harm.

Sometimes trauma is not the dramatic kind of trauma that I have just mentioned. It can be loss, like a child suffering the loss of a parent or grandparent in childhood. Children can be traumatized by being constantly or chronically neglected (either emotionally or physically or both).

Abi: How/why, as you say, is body piercing, tattooing or branding described as a 'passive' form of self-mutilation when there are obviously so many people that have such things done and yet do not self-harm as in cutting or burning, etc?

Dr. Farber: Because they are having someone else mutilate their skin, their body tissue, you know? With people who get themselves tattooed constantly, many of them do it not only for the way it looks but for the experience of the pain. Some people will get a buzz from the tattooing. Some people even experience this erotically and get turned on by it. And the same thing goes for the people who purge.

About the piercing and tattooing, I am not talking about someone who just gets a tattoo in order to look cool or because their friends are doing it. I am not talking about that. I am talking about people who feel a "need" to do this to their bodies and have this kind of a physical experience. What it does for them is what cutting or burning does for others. It distracts them from the pain that is inside; the internal pain. In other words, they'll have pain inflicted on themselves in order to divert the emotional pain that is inside.

TheEndIsNow: Many people talk about cutting, or other forms of self-injury prevalent among the abused. Are there other common reasons as to why a person might turn to self-injury?

Dr. Farber: Yeah. As I have said before, it usually comes from experience in childhood of trauma, but the trauma doesn't have to be the trauma of physical or sexual abuse; it certainly can be. It can be the trauma of losing a parent or grandparent. They may have no one in their lives that can help them express their pain so they may turn to doing something to their body.

lra20: What about the people who don't know why they do it? I have never been physically or sexually abused.

Dr. Farber: You don't have to be physically or sexually abused. People experience events very very differently. Trauma can be parents splitting up and all of a sudden the child no longer sees his or her father or mother, and that is a terrible trauma for a child, and that is terribly painful, and that child may start to express that pain through scratching himself or throwing up.

The trauma of physical or sexual abuse is certainly one of the major factors in self harm, but there are many people that have been traumatized, but not through physical or sexual abuse. Trauma comes in many different forms.

David: Here's the link to the HealthyPlace.com Self-Injury Community.

If you are looking for information on Self-Harm, we have two excellent sites in the Self-Injury Community: "A Healing Touch" and "Blood Red."

David: I want to address the treatment of self-injury, Dr. Farber. What does it take to recover from self-harm?

Dr. Farber: Well, first of all I think it takes a lot of courage. I think it also takes a relationship with a therapist in which you feel really safe -- And this feeling of safety doesn't have to start right from the beginning of therapy.

Most people who harm themselves come into therapy feeling very suspicious or wary of the therapist, but over time a sense of trust develops and the patient feels the therapist is not trying to control her (but when I say her, I am speaking of my own experiences, where most people who do this are female. Please understand when I say her, I mean her or him). I think when you are in therapy, you need to feel in control of yourself and that your therapist isn't trying to control you or insisting you stop hurting yourself. That is a good start. What can be very helpful is if a therapist can try to help you make it less dangerous (through medical help).

Also, it helps if a therapist can let someone know, right from the beginning, that even if you can't articulate in words why you are doing what you are doing, you must have good reasons for doing it. I think in good therapy, the patient and therapist work together to try to understand how and why self injury became necessary in your life. When you do that, you can try to find other ways to make yourself feel better that are not so harmful - ways that can make you feel better about yourself, ways that you don't have to hide. And I think while all of this is going on, you start to have more control over yourself than you thought, and you find you are more able to speak about the pain that you are feeling inside than you thought, and you don't need to cut yourself or burn yourself so much in order to express that.