Dear Patti,

I’m a sophomore and my sister, Autumn, is a high school senior. Last night I accidentally walked in on her. I knocked but I guess she didn’t hear me because she had earphones on. When I opened the door, she was burning her upper arm with a cigarette lighter. At first she screamed for me to get out of her room and denied she had been doing anything weird. Eventually she admitted that she sometimes burns herself when she’s bored or nervous right before school. I now know why she always wears long-sleeved shirts and won’t wear a bathing suit. Autumn claims that she’s like a tattoo artist. She showed me other marks on her upper legs and arms that just looked like scars to me but she said were positioned in an artistic pattern. I don’t believe that.

My dad used to hit my mom and us. I think Autumn got the worst of it. Mom left and took us to live with Grandma and I don’t think Autumn ever got over that time. I don’t want to cause trouble for my sister, but I’m worried. I told her that she had to tell Mom or I would. She refused but promised me that by tomorrow before dinner she’d tell Grandma. If she doesn’t, I will. Grandma’s ill and I don’t want Autumn to upset her, but I can understand why Autumn wants to turn to her. Our grandmother adores both of us and doesn’t flip out like our mom can.

I hope I’m doing the right thing by insisting she talk to somebody. I don’t want to embarrass her, but I don’t want her to hurt herself anymore. I hope Autumn isn’t crazy. I told her it didn’t make sense; we left Dad because he hurt us and now she’s doing the same thing to herself.

— Camila

Dear Camila, 

I’m honored that you reached out to me and commend you for showing such character as it’s not easy to stand up to a sister. Insisting that Autumn get assistance and reach out to a loving, responsible adult is definitely the correct thing to do. Bruising, cutting and burning oneself is an expression of underlying psychological distress and an attempt to control built-up emotions. This self-injurious behavior is a sign that Autumn is trying to cope with mental anguish and is in need of help.

Directly before she injures herself, she probably experiences a high level of tension, anger, anxiety, or panic and then feels relief simultaneously with the physical pain. The reprieve, though, is only temporary as the feelings most likely will continue to occur, rebuild and overwhelm her. A sense of shame and fear probably occurs as well, causing her to attempt to hide her scars and other evidence of burning herself. This behavior isn’t used by Autumn to gain attention as it actually increases feelings of isolation and alienation.

Tattooing and skin piercings are usually not viewed as self-mutilation and are considered as “body art” versus acts of repetitive self-harm that elicit relief from psychological distress.

Autumn is not “crazy” but feels overwhelmed and turns to self-harm as the only way she knows how to deal with her situation. When a person doesn’t know how to find emotional containment in a healthy manner, one might use self-injurious behavior to help re-establish control, even if it’s only temporary. Individuals who self-injure tend to suffer from chronic anxiety, depression, feelings of emptiness, and often have angry and aggressive feelings which they strongly disapprove of and turn inward. Further, they usually haven’t developed ways to cope with daily life stressors, tend to be emotionally reactive and often invalidate their own thoughts, feelings and opinions.

I highly recommend that you, your grandma and mother urge Autumn to see an empathic, confident therapist who is knowledgeable about self-injurious behavior, has an understanding of the kind of despair Autumn feels, and will provide a nonjudgmental and supportive environment where she can openly discuss, without shame, her self-mutilating behavior and the trauma that instigated it. Autumn can heal. Together, the therapist and Autumn can establish safer ways for her to express feelings and put an end to her self-injurious behavior. 

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has an office in Pasadena. Contact her at (626) 584-8582 or email Visit her website,