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Finding out that someone you know is self-harming can be confusing and unsettling. In today’s episode we learn more about this behavior and what causes people to self-injure. How common is it? What type of person self-injures? Most importantly, is this something people can overcome? If so, what steps can we take to move past self-injury?
Dr. Mark Mayfield is a licensed professional counselor (LPC), a board certified counselor, and founder and CEO of Mayfield Counseling Centers.
He has more than 14 years of professional counseling experience in clinical, judicial, and faith-based counseling settings across a wide range of patient demographics. Mayfield has professional experience in treating and addressing anxiety, depression, and PTSD, substance abuse, domestic violence, self-injury, and suicide.
Dr. Mayfield recently launched his book, titled “HELP! My Teen is Self-Injuring: A Crisis Manual for Parents” which addresses his own suicide survival story, self-injury, and how to help your child who might be going through this.
He has been featured in prominent media outlets including Woman’s Day, Hello Giggles, NBC, Reader’s Digest, Byrdie, and more. Dr. Mayfield is on a list of mental health professionals that was invited to the White House in December and has periodic calls with the White House to discuss mental health in America.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author.
To learn more about Gabe, please visit his website, gabehoward.com.
Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors.
Announcer: You’re listening to Inside Mental Health, a Psych Central Podcast, where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.
Gabe Howard: Hi Everyone! You’re listening to the Inside Mental Health podcast, formerly The Psych Central Podcast, I’m your host Gabe Howard and I want to thank our sponsor, Better Help. You can Save 10% and get a week free by visiting BetterHelp.com/PsychCentral. Calling into the show today we have Dr. Mark Mayfield. Dr. Mayfield has professional experience in treating and addressing anxiety, depression, PTSD, substance abuse, domestic violence, self-injury and suicide. He recently launched his book titled Help! My Teen is Self-Injuring, A Crisis Manual for Parents, which addresses his own suicide survival story, self-injury and how to help your child who might be going through this. Dr. Mayfield, welcome to the show.
Dr. Mark Mayfield: Thanks for having me, I really appreciate it.
Gabe Howard: And we appreciate you being here now, self-injury, much like suicide, is very misunderstood with many people believing that because this is something that someone does to themselves, that it is not a disorder or an illness process at all, but rather a choice that somebody is making. Now, this couldn’t be further from the truth, correct?
Dr. Mark Mayfield: Yes, I think it’s such a complex topic, so there’s a lot of different reasons, sometimes it is attention seeking and that’s very far and few between. Most of the time, it’s a coping mechanism of a deeper issue.
Gabe Howard: Now, when you say it’s a coping mechanism, I think that many people would hear that and they think, wait a minute, harming yourself is a coping mechanism? I understand why people might cock their head to the side and think what kind of a coping mechanism is self-injury?
Dr. Mark Mayfield: Well, Gabe, let me give, can I give you a definition that might help a little bit?
Gabe Howard: Yeah,
Dr. Mark Mayfield: I say that self-injury is a deliberate and intentional, self-induced non-lethal act of bodily harm, which is done to reduce, avoid and/or communicate mental, emotional, physical or spiritual distress.
Gabe Howard: I think the key word there is it reduces some sort of stress. Is this an example of the thing that is happening in the person’s life is actually worse than self-injury? And maybe the reason that people don’t understand it is because in our lives or in their lives, they see self-injury as really bad. But in the person who is using this as a coping skill, it’s actually I don’t want to say a better choice, but it’s helping alleviate something.
Dr. Mark Mayfield: Yeah, exactly, and I don’t, maybe not a better choice, but it’s an effective choice. What self-injury does in that moment is it allows the individual to control and modulate their pain. And so when you said that the pain outside or the struggle outside seems bigger and is more detrimental or hard than the actual self-injuries, you are very right in that. A lot of times individuals that are choosing self-harm as a coping mechanism, it’s a release. It’s a I can’t control what’s going on around me, but I can control my own pain through self-injury. So it’s like almost like a pressure cooker type of thing where they build the outside stuff is building and building and there’s no way to release it. And when somebody’s self-injures, it releases. But it also engages the endorphins, dopamine receptors in the brain, and it creates this almost peaceful high. And again, for people listening from the outside in, it doesn’t make a whole lot of sense unless you’re in the mix of it with somebody.
Gabe Howard: Dr. Mayfield, is everyone who self-injures suicidal?
Dr. Mark Mayfield: That is a big myth, and I think this is where in some ways we have to throw logic out the door. Because logically it would make sense that if I’m cutting myself, I want to die. But individuals who self-injure don’t set out to be suicidal. But individuals who self-injure have a higher chance of suicidal ideation in the long run, whether it be passive suicide ideation or active. Most of the time it’s passive in that they’re searching for the bigger high or the deeper cut and they unintentionally create problems for themselves from a suicidal standpoint. And so I think one of the big things we need to understand is that immediately somebody who is self-injuring is not going to be suicidal, but we should assess for suicide.
Gabe Howard: When we talk about the stigma surrounding self-injury, I think I would be remiss if I didn’t mention the stereotype of a self-injurer is this white middle class teenager most often like a white adolescent girl. Is this accurate?
Dr. Mark Mayfield: I think that stereotype was pretty accurate in the 80s and 90s. In the 1980s, there was a reported 400 per 100,000 participated in self-injury. Toward the end of the 80s, that was up to 750 for 100,000. In the early 2000s, that jumped to 1,400 for 100,000. So 350% growth rate in 20 years. It used to be that stereotype of that the white teenage girl. But now we’re finding that it is across the board, across demographic, across age, across gender, and it’s just mind boggling how much of it is jumped. And I think there’s a lot of reasons for that. But it’s not an easy demographic to pinpoint anymore.
Gabe Howard: I think it’s important to point out that even if that stereotype were true, that it is often white, adolescent, young ladies, who cares?
Dr. Mark Mayfield: Right, sure.
Gabe Howard: Who cares if something only impacts one? So it’s sort of interesting that as a society, we’re like, oh, we can ignore it. It’s white teenage girls. I’m like, well, wait a minute, you. We’ve just established that this serious thing is happening to this group of people and you’ve decided that it’s easy to ignore? And I don’t even know if you know the answer to this next question. I just think that it’s interesting. Why is that? Why are we looking for reasons? We as a society, looking for reasons to ignore people who self-injure?
Dr. Mark Mayfield: I think we don’t want it to be our problem. For a couple of reasons, one, we don’t know how to respond and there’s a fear behind responding wrong or don’t know what to say or how to say it. And then two, I think a lot of it is that we are so busy with our own struggles in our own lives that we don’t want to be sucked into somebody else’s problems. If we made mental health and even self-injury a communal problem where we all were coming together for the solution, that would be a whole different ball game.
Gabe Howard: Now, self-injury is often compared to eating disorders, which, while better understood than self-injury still has a lot of myths and misinformation associated with it. And the eating disorder that it is most often compared to is anorexia. Is this an accurate comparison or are they just so different that you don’t even understand why people are conflating the two?
Dr. Mark Mayfield: We need to understand that there is a spectrum of self-injury. On one end, there is the overt, direct, active self-injury. Right? I’m going to cut. I’m going to burn or punch. I’m going to do it. I’m going to hide it so that people don’t see it. My cuts are going to get deeper and deeper. That’s the overt and a high lethality on the overt side is when cuts get more or deeper or in more precarious places or they engage in self-injury while on drugs, those kinds of things with high lethality. But on the subtle side or the indirect or passive side, we have things like spinning down the highway without a seatbelt. That’s considered self-injurious behavior, but it’s low lethality. And then there’s on the high lethality subtle side or indirect side is eating disorders, is anorexia. Eating disorders are a form of self-injury and a form of passive self-injury and a form of passive suicide, in my opinion. And I might have people disagree with me on that one, but in my research, that’s what I found.
Gabe Howard: Let’s talk about your research for a moment. Do you have any indication or has your research uncovered any reason that people self-injure?
Dr. Mark Mayfield: I think it’s very complex and I’m glad that you asked that question, because from the outside looking in, we’re like, why are you hurting yourself? It makes no sense to me. But if we look and I call this looking behind the veil, what’s going on behind the things that we aren’t seeing? That the internal processes. A lot of it has to do with a complex cocktail of insecure attachment and imprinting. Maybe they don’t have a safe place to return to. The idea of not being seen, soothed and safe. They don’t have a place that they can go to just to be themselves. The contributors to self-injury can be the fact that they don’t have a place where they feel listened to and/or loved. And so behind the veil can be are they being bullied, you know, at school? How are their emotional intelligences? Are they able to pinpoint why they are feeling the way they’re feeling? A lot of teenagers have these big expressive emotions they can’t put a voice to, and so it becomes overwhelming. But I think a lot of it, too, and I’m going to make a statement here that can rub people the wrong way. But I think a lot of it is misdiagnoses. I think a lot of times we get very structured in our diagnoses. And a lot of times I find that kids that are self-injuring are very intelligent in their sensual expressions, meaning their five senses. So sensory processing stuff, emotional intelligence, meaning they’re picking up on a lot of people’s emotions around them and it’s overwhelming. And then there’s the intellectual piece, too. But we look at it from a medical model versus a different framework.
Gabe Howard: I think it’s important that our listeners understand how complicated this is and something this complicated, it needs intervention, right? It needs medical intervention. It’s not something that we can handle for our loved ones, especially in the case of adolescents or teenagers. I know that sometimes we have this well, I’m just going to order them to stop it. Well, I’m going to put my foot down or I’m going to tell them that this is nonsense behavior and they need to quit it. But it’s so much more complicated than that. And I think one of the reasons that self-injury maybe has become so pervasive is because people are trying to handle it on their own. People that, frankly, shouldn’t be.
Dr. Mark Mayfield: Yes, I think there’s definitely well-meaning people out there. I really do believe that you need to educate yourselves, and that’s part of the reason I wrote this book in a layperson’s framework and why I’ve made it free, a free download, because I want everybody to access it. It’s important, then, to know your resources in your community. There’s a lot of different resources out there you can search counselors on. But to find a professional that has some understanding and you find something that you think would be a good fit for your teenager. There’s not a whole lot of good resources for the layperson, and so it becomes this mysterious struggle that a lot of parents, a lot of family members don’t know how to respond to. And a lot of times we have those responses that are shame inducing, judgmental or placating because there’s just that lack of understanding.
Gabe Howard: Should the loved ones of people who self-injure get any sort of therapy or treatment or education? Because it really seems like a theme running through this conversation is that the well-intentioned standers by are doing a lot of damage.
Dr. Mark Mayfield: Yes, obviously, I hope it’s unintentional damage, but you’re right, and I do think. One of the things that I require, not require, but really strongly suggest to my clients that I’m working with a teenager, you know, self-injuring, that the parents are seeing a counselor at least once or twice a month for that support, or at least we talk about what their support group looks like. Do they have a group of friends, neighbors? They’re part of a faith community where they can receive some support? Because they shouldn’t be doing this on their own. And I will say this to parents, parents, if you are struggling with a teen that is self-injuring, it does not make you a bad parent. And I think there’s a lot of shame that goes in with individually parents that have a child that is struggling with mental illness or through self-injury, that somehow, they dropped the ball or they made mistakes. And I want to free them of that. Even if you have, it’s not your fault. What you do from this point on is really important. But to keep it hidden or to keep it secretive because you feel like you’re going to be judged is not, not a good reason.
Gabe Howard: Thank you, Dr. Mayfield, for saying that. I know that oftentimes people don’t realize that they can influence the outcome. Folks can influence the outcome either way. So we want to make sure that people have the education and the resources that they need to ensure the most positive of influencing.
Dr. Mark Mayfield: Correct, and I think the greatest form of strength is recognizing your weakness and asking for help.
Gabe Howard: We’ll be back in a minute after we hear from our sponsors.
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Gabe Howard: We’re back discussing self-injury with Dr. Mark Mayfield. There’s this persistent myth that everybody who self-injures is just looking for attention, it’s attention seeking. And what I’ve discovered and again, a Google search, I want to be clear that you’re the expert, is that many people who self-injure are very adept at hiding it, well, frankly, under their clothing.
Dr. Mark Mayfield: Right.
Gabe Howard: Or choosing self-injury methods that aren’t noticeable. Why do you think this attention seeking myth persists when even a 10-minute Google search shows that this is, frankly, just not even based in any sort of reality?
Dr. Mark Mayfield: I think a lot of it is misunderstanding. So, as we’re sitting here and talking about this, there’s people listening, going like I still don’t understand why somebody would hurt themselves to feel better. Like that doesn’t make any sense. If we leave it at that statement, then the next logical step is they must be doing it for attention. And my response to that is whether or not they’re doing it for attention, they’re trying to communicate a need that is not being met right now. Take a step aside from self-injury. And when I work with families and parents and they are telling me that their kid is acting out and all they’re doing is trying to fight the acting out. I keep on telling them you’re missing the point. The acting out is trying to communicate a need. And the only way they can communicate that need is through the acting out. And so we as adults, as parents need to take a step back and go, OK, what need is not being met in this teenager that is causing them to act out in this way? And we focus less on the behavior and more on the need. I think this is the same for self-injury. And this is where I talk a lot about in the book, how do we respond to somebody that’s self-injuring? There’s a lot of bad ways that we can respond. And one of them is just telling them, well, you’re just doing it for attention. If we do that, what tends to happen is it becomes more subversive and it becomes more hidden and then in turn becomes more dangerous.
Gabe Howard: You alluded to some of the wrong ways to respond to self-injury, let’s educate people on the correct way to respond to self-injury. If somebody that you know and love and care about is self-injuring, how should you intercede?
Dr. Mark Mayfield: Let me answer that in a roundabout way, I think the first way is recognizing what questions shouldn’t we ask? One of them is just saying, you know, why can’t you just stop? Or what were you thinking? Or what’s wrong with you? You need to be on medication or saying things like, I know exactly how you feel or can I see your scars? I think those are all inappropriate ways to respond because it takes away from the actual struggle. If people want to jump start the process with questions, I think, first of all, the person that is asking the questions needs to be in the place of curiosity and not judgment. And a lot of times when we deal with self-injury, it really makes people squeamish because it has to do with blood or injury, and that scares some people. So making sure that you’re in control of your breathing and your heart rate and you’re not overreacting when you’re sitting with this individual. But some of the questions that I really encourage parents that I work with to ask and those that I work with in the community is asking the question, in what ways does your self-injury benefit you? So being curious and going, OK, why are you choosing this behavior? One of my favorite questions is to ask if your scars could talk, what would they say? And it’s giving a voice to the individual in that moment. The next question I’d like to ask is if I, as your parent, could make one small change to help you overcome the self-injury, what would that be? And again, it empowers the individual to develop a voice. And then the big question is often people who self-injure use this to cope mentally, emotionally and spiritually. What distress are you trying to cope with that you’re not able to communicate right now?
Gabe Howard: Let’s look at this from the perspective of the person who is self-injuring for a moment. What can they do to help themselves? What is their option to move past this? How should they advocate on their own behalf?
Dr. Mark Mayfield: One of the common threads with individuals that self-injure is lack of a voice, lack of being seen or understood. Oftentimes they feel stuck, really stuck. I think the big piece is developing the courage to find a trusted adult that they can confide in. I think a lot of times our teenagers will try to confide in other teenagers. That can be good at times, but it can also be bad. The teenage frontal cortex is not developed fully. And so that part of the brain, the higher order part of the brain, needs a trusted adult to help guide it. So, you can find some safety in a friend. But ultimately, you’re going to need to find a trusted adult to confide in and begin to figure out the process of replacing that coping mechanism with a different one. I often have parents come in and say, I’m just going to make them stop. And I’m like, if you make them stop, they don’t have anything to replace it with. The actual self-injury could get even more dangerous and tip towards suicidal reaction. And so, what we do is we try to titrate off of it in a place that is giving them a replacement coping mechanism that can replace the self-injury.
Gabe Howard: I imagine that the advice for adults is similar? The trusted adult is just your peer. Is it the same treatment for adults as adolescents?
Dr. Mark Mayfield: It can be. Because I think a lot of times, and I’m not sure if you’ve talked about this on previous podcasts, when we have trauma, when we have things happen to us, we have arrested development. And a lot of times we get stuck in our teenage years emotionally or cognitively from a traumatic event. And when I work with adults that are self-injuring, a lot of times they’re stuck in those teenage mindsets. There’s some similarities in that. And I think there’s also some differences in the development of a treatment plan and of the ability to engage in healthy coping skills.
Gabe Howard: So now let’s talk about this from the perspective of a provider like yourself. You’re sitting across from a patient; the patient has disclosed that they’re self-injuring and they’re ready to do something about it. What do you do? How do you develop and define and work with somebody who’s self-injuring to get them to the point where they no longer need to do so?
Dr. Mark Mayfield: Each individual that comes into my office that I’ve worked with has had a different treatment plan or a different roadmap to success. A lot of it is really figuring out what need, what core longing is not being met or has been traumatized that they’re trying to cope with. What are they trying to express in their self-injury? As I work with teenagers through this, each treatment plan is going to look differently. The big piece of it is for the first time in their life, possibly, they’re being seen, they’re being valued, they’re being known, and they’re being loved in a way that they’ve never been before. And so that counseling, therapeutic relationship in and of itself becomes healing. And then we collaboratively figure out ways to engage in more beneficial behaviors and coping skills. For teens that I’m working with, it could be anywhere from six months to a year of consistent counseling to figure out a transition and a way to move away from it. In a lot of ways, because of the dopamine and endorphin receptors that are engaged in the self-injury process, it has the potential to become addicting. So not only are we working with combating the coping mechanism, but we’re also combating probably a low level addiction there as well. So, it does become complex as we work to find a way out.
Gabe Howard: Do people who self-injure get better? Is this something that people recover from?
Dr. Mark Mayfield: Oh, 100%, yes, absolutely. I use the thirds principle. When I talk with clients, when I do an intake and I usually say one third of my clients have these huge aha moments. Life changes on a dime. Everything’s great. We have these big changes. A third of my clients have small changes that we have to pause every six, eight weeks and look back and see how they’ve snowballed into big changes. And then a third of my clients don’t change at all. And I ask the client, tell me, what do you think the factor, the reason change happens? And we sit with that for a little bit. And the big part of it is the willingness and the desire to change. When a client has made their mind up, they are going to change. I would say and many people disagree with me, I would say that’s 75-80% of the battle right there, the willingness to change and that’s why therapy will work is if you have people that are partnered and want a change. And a third of clients come in because of their world is falling apart or they’ve been told they have to go to counseling and that kind of stuff, and they’ve not made their mind up. And that’s where change doesn’t happen. When I work with patients and clients that are ready, their world is falling apart. They don’t want this to be the way it is anymore. They’re tired of it. They want to make a difference. Then we have that partnership that we can begin to work our way out, develop change and change becomes lasting.
Gabe Howard: Is there any message of hope or positivity that you would like to give to people who love somebody who’s self-injuring or somebody who’s self-injuring themselves?
Dr. Mark Mayfield: The people that are walking with somebody that is self-injuring, I just want to validate the fact that it is scary and this is something that is not easy to walk through. But I will encourage that if you take the mindset of wanting to understand, the curiosity piece. You’ve got to put yourself outside of your family to process with and to freak out with, honestly. It’s OK to freak out, but don’t do it in front of your individual who is self-injuring. The process and the patience of being in relationship with this individual and wanting to see them for who they are and their struggles, it will get better, but it will take time. And I think for those that are self-injuring, it’s important to know that they’re not alone, that there are people out there that want to help, that understand the need for support and engagement and want to hear their stories and want to walk with them through it. And that this can be different. It can change and it will get better.
Gabe Howard: Dr. Mayfield, thank you so much for being here. Now, your most recent book is Help! My Teen is Self-Injuring, A Crisis Manual for Parents. Where can we find that and where can people find you?
Dr. Mark Mayfield: Yeah, they can find it on my website, DrMayfield.com. It’s a free download. And then my second book, The Loneliness Epidemic, will be out in major bookstores and Amazon and stuff next September. You can also follow me on Instagram at @thedrmayfield or on Facebook @TheDrMayfield. And then we also have a podcast called Candid Conversations with Dr. Mayfield on Spotify and Google Play and Apple iTunes.
Gabe Howard: Thank you so much, Dr. Mayfield, for being here. It’s really appreciated.
Dr. Mark Mayfield: Yeah, absolutely. Thanks for having me.
Gabe Howard: Thanks, everybody, for tuning in. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole and Other Observations, which is, of course, available on Amazon.com, or you can get signed copies for less money, including free Psych Central Podcast swag, just by jumping over to gabehoward.com. Please, wherever you download the podcast, subscribe. That way you don’t miss a single episode. Also, rate, rank and review. Tell people why they should listen as well. We’ll see everyone next week.
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