Dear Patti, 

My sister, Natalie, 17, is two years older than me. We’ve always been honest with each other, so I was blown away when I realized she’d been keeping a huge secret from me for over a year. A friend told me Nat was cutting herself. When I confronted her, she repeatedly lied until I made her show me her upper arms and legs. She had multiple scars, burns and unhealed cuts. She had cut herself with broken glass and burned herself with a cigarette lighter. I was in shock. Then I was furious and very, very sad.

She made it clear that if I told our parents, she’d feel betrayed and would never forgive me. I don’t rat on people but I did tell our parents because Nat needs help. Now she refuses to talk to me, but that’s OK, as long as she gets help.

She’s seeing a therapist every other day and is realizing she’s angry. Even if she’s angry at our parents, why would she hurt herself instead of getting mad at them?

I think my grandfather might have molested her when she was a young child. Could this behavior be a result from that time? Does she want to mutilate herself? Is she doing this to get attention? Could this lead to suicide? Does this signify a long-term mental illness?  Is she crazy?     

  — Anthony

Dear Anthony,   

Self-injury is an expression of underlying psychological distress that’s projected upon one’s own body, done with the intention to relieve emotional upset Self-injurious behavior is a way to cope with overwhelming thoughts and feelings by inflicting physical harm severe enough to cause actual tissue damage.

I’m very glad your sister is getting professional help. Treatment is critical for emotional support. The trust she establishes with her therapist is vital to learning how self-mutilation gives only temporary relief to her anguish and powerlessness. Further, it prevents her from confronting core problems and working toward real solutions. The degree of psychopathology can vary, and a complete diagnostic and developmental work-up is needed to determine if this is the major problem or part of another disorder. There is often a rage that can’t be expressed or even consciously perceived toward a powerful or once-powerful figure, often a parent. In this case, it could be your grandfather. For some people, self-mutilation is a form of self-punishment or to reinforce the sense of revulsion attributed to the participation in sexual abuse.

Typically, self-mutilators have unusually strong emotions which rise very fast and are very slow to dissipate. This leaves them in a constant state of feeling out-of-control as a result of an overwhelming emotional pain or a sense of inescapable numbness and emptiness. To understand Natalie, it’s necessary to comprehend that, at this time, she doesn’t have other ways to handle her emotions, much less articulate them or form the trust necessary to the healing process.

It’s common to assume teens cut themselves as a cry for attention, but it’s actually the opposite. If she were seeking attention, she would not have successfully hidden her self-injuring behavior for over a year. The act of cutting becomes a barrier laden with shame about one’s behavior and fear about how family and friends will react if they’re discovered. The motivation behind this behavior isn’t to mark or maim the body. Most people who self-injure don’t want to leave marks. They’ll go to great lengths to hide any marks or scars because they feel that others will subsequently force them to get help.

Self-injury isn’t the result of failed suicidal attempts. There is, however, always the risk that if self- injury stops providing the relief that some individuals need, they could commit suicide, accidentally or intentionally.

Self-injurers aren’t “crazy.” While many people may consider a self-injurer “crazy” for committing these acts, the person herself views the act as a means of coping.

You’re not alone. It’s common (after initial shock) for a loved one’s emotions to include confusion, guilt, rage, sorrow and, understandably, worry. Natalie’s recovery process may be lengthy or perplexingly uneven. It’s, therefore, vital you have compassion and empathy for her. Remember to keep the long-term goal of Natalie’s recovery in your sight.

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 offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her website,