I’ve published this before but, today being the 21st of April and To Write Love on her Arms Day (TWLOHA), I thought I’d give it another whirl. I’ve found a great, but not exclusively successful, pseudo-addiction to take the place of self-harming so I am largely recovered. But from time to time … and this is to remind myself for those times.
The first time I intentionally cut myself I was 15.
I carved a heart into my arm with a razor blade and the word ‘Gill’ inside it. It hurt so much I didn’t complete her name (which was Gillian).
I was seeking attention and I never got any so I gave up.
Eventually I gave up on Gillian too, mostly because her older brother wanted to date me and I wasn’t going there!
In retrospect I have spent my life with sharp objects: blades, needles and, latterly, craft knives. For five years I fed the void in my heart via the veins in my arms, legs and toes. People don’t talk about the toes because it seems to devalue the experience of drug use ~ like it needs any further degradation than what it already is.
It has been said that I have an ‘addictive personality’. I don’t know what that means but it may well be true. If so, add promiscuity to the litany above.
Whatever the ‘deep and meaningful’ I returned to the practice of cutting in 2004.
The surface reason was a simple breach of trust ~ someone I had grown to trust with a belief that I have never felt before or since ~ blew that trust out of the water. Having managed that ~ it must be said not especially significant feat (I’ve always had trust issues) ~ she proceeded to set me up knock me down on a daily basis for the next 3 years. Every time I believed what she said it turned out she was lying ~ and I reeled, rolled and tumbled deeper and deeper into the abyss.
Now let’s be clear about this. Many people would simply have shrugged this off with a ‘well, that’s life’ and, equally likely, most people would simply have come clean and stopped lying after the first exposure of the truth but this wasn’t the way with my friend and I. We had exposed each other’s most raw vulnerability and neither of us could stop.
Add in a vile concoction of misprescribed drugs and my psychotic response to them ~ they were supposed to help ~ and I was hacking myself to pieces with a razor sharp craft knife, in some cases, many times a day.
This was the norm for me for the duration of the prescription of my sunshine-inducing drugs ~ or rather until my friend came home one day to find me in a bed full of blood and I was trucked off to see ‘a mental health professional’.
But the behaviour was embedded and it is my first response now when times get tough ~ as they do often and as they have today.
As might be expected my lay friends were of the opinion that I was attempting suicide ~ which I wasn’t. I’d tried that too, a number of times over many years, but even I knew that this self harming was a different beast. It was actually about staying alive.
Staying alive and staying in control ~ at least of that part of my life that I did control, namely ‘to cut or not to cut’.
When the emotional pain got too great I would give myself a physical reason for the pain. And in so doing I would be in control of the pain and the reason for the pain.
Here I will hark you back to the beginning of this essay. Remember how, when I carved Gillian’s name in my arm at aged 15 the pain was so great that I only stammered ‘Gill’? Well, this time, the pain was minimal ~ in most case there was none at all ~ and remember, this was happening every day and often multiple times a day.
But the actual physical pain was almost non-existent.
‘No brain, no pain’ you might say.
I would prepare myself in the same way a junkie prepares a fix (I know that routine too): I would line up my gear (craft knives), lay a hand towel down and get bandages. then I would decide where and what I would cut.
Frequently I cut words or symbols that represented the nature of my distress: ‘death’, ‘love’, ‘pain’, ‘trust’ ~ but ‘lies’ and ‘liar’ were the favourites. Occasionally her name would appear with a list of words around it, and sometimes simply the words ‘nga roimata’ (tears).
You see, even in this state I was pathetically politically correct.
Once I was stopped by police in a severely distressed state. I was out looking for her ~ oh, yes, hyper-vigilance was a sweet by-product of this malaise ~ and I had ‘death’ carved deep into one forearm and ‘suicide’ in the other and I was bleeding profusely and unbandaged. Only her eventual intervention stopped what could have been a very unpleasant episode.
And it wasn’t just cutting. I was punching myself, hitting, and bashing my head into things as well. Bruises and black eyes were commonplace.
And why?
I believe I was trying to regain some control when everything else was out of my grasp. It’s sad I know to think that all I felt I had control over in my life was the ability to damage myself but there it is: it’s certainly how it seemed ~ and research I have done since supports this belief.
And all because of a simple breach of trust ~ by someone who, because of her own fears, had lied to me in ways ~ and to an extent ~ that even she cannot comprehend.
Trust … it’s at the root of everything.
Have you ever heard of The Slits?
Of course you have: all girl, threepiece, punk band from the Sex Pistols era?
Awesome!
No?
Oh, well. You can still pick up the two vinyl albums they made at good record stores such as Real Groovy or at garage sales ~ they would have liked that.
If you know them (or even if you don’t) you’ll know this song of theirs:
‘Angel of Pain
you were quicksilver
in my hand.
i searched for you
in dreams where
poets lay still,
their heads in ovens
that hissed out gas.
in between the lines
of notes left behind
you lay. you were
a dark growth in
the wombs of girls
who flicked ashes
on their therapists
and spat out
hatred from foam
flecked mouths.
i found you in
my eleventh year
while i huddled
in corners and
dragged my nails
across my arms,
hoping to find
a way into the
very depths of
my flesh.
i found you in my
father’s eyes when
he was drunk or
in all those silly
teen crisis books
where girls talked
about their bout with
you for a few months
as if they’d lay in bed
with you for years.
as if you’d fucked
them with the mouth
where no air ever
passes.
i loved you. i love you.
they try to find
the final solution for you.
instead of poets with
their heads in ovens
they want you.
i find you again and again
in palmed pills
and in razor blades.
i loved you. i love you.’
Great stuff ~ and so incredibly true to the punk idiom. So … theatrical, so destructive!
And they live on … in some new incarnation or other. Somewhere in the world The Slits are still smashing things and breaking boundaries.
Why did I love The Slits so much?
Well, they’re girls, aren’t they?
And they were doing stuff in a boy’s world that only boys were supposed to be doing.
They were wild ~ wild and out of control ~ the music was great and it made Siouxsie and the Banshees seem like Lawrence Welk. OK, you probably haven’t heard of him either.
Music, of course, is the way the angel’s speak to us and these girls often spoke to me in angeltongue especially when I was in a trough, an emotional trough of depression that would make me look at pictures of punk kids razorcut and bleeding with a palpable envy I could taste.
So, when in 2004 I resorted to saving my life by self-harming, the music returned, the taste became the smell and the sanguine lust for peace and control was ever on my mind.
Nga Roimata.
Tears.
So what is this self-harming nonsense, this litany for the living?
What’s written below isn’t by me but it roughly reflects my understandings from my own experience.
‘Self-injury (SI) or self-harm (SH) is deliberate injury inflicted by a person upon their own body without suicidal intent. Some scholars use more technical definitions related to specific aspects of this behaviour. These acts may be aimed at relieving otherwise unbearable emotions, sensations of unreality and numbness. The illness is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder and depressive disorders. It is sometimes associated with mental illness, a history of trauma and abuse including emotional abuse, sexual abuse, eating disorders, or mental traits such as low self-esteem or perfectionism, but a statistical analysis is difficult, as many self-injurers conceal their injuries.
Self harmers are often misdiagnosed as suicidal, but in the majority of cases this is inaccurate. Non-fatal self-harm is common in young people worldwide and due to this prevalence the term self-harm is increasingly used to denote any non-fatal acts of deliberate self-harm, irrespective of the intention.
There are a number of different treatments available for self-injurers which concentrate on either treating the underlying causes or on treating the behaviour itself. When self-injury is associated with depression, antidepressant drugs and treatments may be effective. Alternative approaches involve avoidance techniques, which focus on keeping the self-injurer occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.
Definition
Self-injury (SI), also referred to as self-harm (SH), self-inflicted violence (SIV) or self-injurious behaviour (SIB), refers to a spectrum of behaviours where demonstrable injury is self-inflicted. The term self-mutilation is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive. Self-inflicted wounds is a specific term associated with soldiers to describe non-lethal injuries inflicted in order to obtain early dismissal from combat. This differs from the common definition of self-injury, as damage is inflicted for a specific secondary purpose. A broader definition of self-injury might also include those who inflict harm on their bodies by means of disordered eating.
A common belief regarding self-injury is that it is an attention-seeking behaviour; however, in most cases, this is inaccurate.
Many self-injurers are very self-conscious of their wounds and scars and feel guilty about their behaviour leading them to go to great lengths to conceal their behaviour from others. They may offer alternative explanations for their injuries, or conceal their scars with clothing. Self-injury in such individuals is not associated with suicidal or para-suicidal behaviour. The person who self-injures is not usually seeking to end his or her own life; it has been suggested instead that he or she is using self-injury as a coping mechanism to relieve emotional pain or discomfort.
Studies of individuals with developmental disabilities (such as mental retardation) have shown self-injury being dependent on environmental factors such as obtaining attention or escape from demands. Though this is not always the case, some individuals suffer from disassociation and they harbour a desire to feel real and/or to fit in to society’s rules.
A common form of self-injury involves making cuts in the skin of the arms, legs, abdomen, inner thighs, etc. However, the number of self-injury methods are only limited by an individual’s creativity and include, but are not limited to, compulsive skin picking (dermatillomania), hair pulling (trichotillomania), burning, stabbing, poisoning, alcohol abuse and forms of self harm related to anorexia and bulimia.
The locations of self-injury are often areas of the body that are easily hidden and concealed from the detection of others.
As well as defining self-harm in terms of the act of damaging one’s own body, it may be more accurate to define self-harm in terms of the intent, and the emotional distress that the person is attempting to deal with. Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-injury. It is often seen as only a symptom of an underlying disorder, though many people who self-injure would like this to be addressed.
From a personal perspective, while all the above can be true, each case is different with underlying factors widely variant and manifestations of self-harm equally divergent. For me, the clearest response to a sense of powerlessness over pain was to cut, to replace emotional pain with physical harm (pain wasn’t an issue with cutting as it simply didn’t hurt) and to take control of that ‘pain’ by inflicting it myself. I also engaged in battering myself around the head against walls and with my own fists.
I have little doubt the issues that drove me to self harm related to emotional powerlessness, breaches of trust and an inability to stop emotional pain.
Risk factors
Although some people who self-injure do not suffer from any forms of recognised mental illness, many people experiencing various forms of mental ill-health do have a higher risk of self-injury.
The key areas of illness which exhibit an increased risk include depression (as evidenced in my case), phobias, and conduct disorders. Substance abuse is also considered a risk factor as are some personal characteristics such as poor problem solving skills and impulsivity.
Emotionally invalidating environments where parents punish children for expressing sadness or hurt can attribute to a lack of trust in oneself and difficulty experiencing intense emotions. Abuse during childhood is accepted as a primary social factor, as is bereavement, and troubled parental or partner relationships. Factors such as war, poverty, and unemployment may also contribute. In addition, some individuals with pervasive developmental disabilities such as autism engage in self-injury, although whether this is a form of self-stimulation or for the purpose of harming one’s self is a matter of debate.
For me, an emotionally invalidating environment, abuse during childhood, troubled parental or partner relationships, war and poverty also contributed.
Demographics
Accurate statistics on self-injury are hard to come by since most self-injurers conceal their injuries. Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys.
About 10% of admissions to medical wards in the UK are as a result of self-harm, the majority of which are drug overdoses. However, studies based only on hospital admissions may hide the larger group of self-injurers who do not need or seek hospital treatment for their injuries, instead treating themselves. Many adolescents who present to general hospitals with deliberate self-harm report previous episodes for which they did not receive medical attention.
Current research on self-harm suggests that the rates are much higher among young people with the average age of onset around 12 years old. The earliest reported incidents of self-harm are in children between five and seven years old.
In a study of undergraduate students in the United States, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-injury was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this. This suggests that this problem is not associated only with severely disturbed psychiatric patients but is not uncommon among young adults.
Gender differences
The best available evidence to date indicates that four times as many females than males have direct experience of self-harm.
Caution is however needed in seeing self-harm as a greater problem for females, since males may well engage in different forms of self-harm which may be easier to hide or explained as the result of different circumstances.
The WHO/EURO Multicentre Study of Suicide, established in 1989 demonstrated that, for each age group, the female rate of self-injury exceeded that of the males, with the highest rate among females in the 15–24 age group and the highest rate among males in the 12–34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of self-harm in general.
Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of self-harm are due to deliberate socially-biased methodological and sampling errors, directly blaming medical discourse for pathologising the female.
This gender discrepancy is often distorted in specific populations where rates of self-injury are inordinately high, which may have implications on the significance and interpretation of psychosocial factors other than gender.
A study in 2003 found an extremely high prevalence of self-injury among 428 homeless and runaway youth (age 16 to 19) with 72% of males and 66% of females reporting a past history of self-mutilation.
There does not appear to be a difference in motivation for self-harm in adolescent males and females. For example, for both genders there is an incremental increase in deliberate self-harm associated with an increase in consumption of cigarettes, drugs and alcohol. Triggering factors such as low self-esteem and having friends and family members who self-harm are also common between both males and females.
One limited study found that, among those young individuals who do self-harm, both genders are just as equally likely to use the method of skin-cutting.[30] However, females who self-cut are more likely than males to explain their self-harm episode by saying that they had wanted to punish themselves. In New Zealand, more females are hospitalised for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalisation.
Self-harm in the elderly
In a study of a district general hospital in the UK, 5.4% of all the hospital’s self-harm cases were aged over 65. The male to female ratio was 2:3 although the self-harm rates for males and females over 65 in the local population were identical. Over 90% had depressive conditions, and 63% had significant physical illness.
Under 10% of the patients gave a history of earlier self-harm, while both the repetition and suicide rates were very low, which could be explained due to the absence of factors known to be associated with repetition, such as personality disorder and alcohol abuse.[32]
Self-harm in the developing world
Only recently have attempts to improve health in the developing world concentrated on not only physical illness, but mental health also. Deliberate self-harm is common in the developing world. For example, Sri Lanka has a high incidence of suicide and self poisoning with agricultural pesticides or natural poisons is an important cause of mortality in many rural areas. Many people admitted for deliberate self-poisoning during a study by Eddleston et al. were young and few expressed a desire to die, but death was relatively common in the young in these cases. The improvement of medical management of acute poisoning in the developing world is poor and improvements are required in order to reduce mortality.
Some of the causes of deliberate self-poisoning in Sri Lankan adolescents included bereavement and harsh discipline by parents. The coping mechanisms are being spread in local communities as people are surrounded by others who have previously deliberately harmed themselves or attempted suicide.
One way of reducing self-harm would be to limit access to poisons; however many cases involve pesticides or yellow oleander seeds, and the reduction of access to these agents would be difficult. Great potential for the reduction of self-harm lies in education and prevention, but limited resources in the developing world make these methods challenging.
Psychology
Attempts to understand self-injury fall broadly into either attempts to interpret motives, or application of psychological models.
Motives for self-injury are often personal, often do not fit into medicalised models of behaviour and may seem incomprehensible to others, as demonstrated by this example:
“ My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange.”
Motives for self-injury can be different. Some feel as if they are not good enough and they might not want to take it out on the person who harmed them. It’s often difficult for them to open up and tell about their “secret shame”. Often when the sufferer does tell somebody there is a lack of understanding or knowledge of how to help.
Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assessments show that these differ with professionals suggesting more manipulative or punitive motives.
The UK ONS study reported only two motives: “to draw attention” and “because of anger”.
Many people who self-injure state that it allows them to “go away” or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain.
To complement this theory, one can consider the need to ‘stop’ feeling emotional pain and mental agitation. “A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings.’
The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the person’s wellbeing. (e.g., responses to childhood sexual abuse).
Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness (anhedonia), and physical pain may be a relief from these feelings. “A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’.”
It is also important to note that many self-injurers report feeling very little to no pain while self-harming.
Those who engage in self-injury face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-injurers this relief is primarily psychological whilst for others this feeling of relief comes from the beta endorphins released in the brain (the same chemicals that are thought to be responsible for the “runner’s high”). Endorphins are endogenous opioids that are released in response to physical injury, act as natural painkillers, and induce pleasant feelings and would act to reduce tension and emotional distress.
As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioural pattern that can result in a wanting or craving to fulfill thoughts of self-injury.
Motives
Self-injury is not typically suicidal behaviour, although there is the possibility that a self-inflicted injury may result in life-threatening damage. Although the person may not recognise the connection, self-injury often becomes a response to profound and overwhelming emotional pain that cannot be resolved in a more functional way.
The motivations for self-injury vary as it may be used to fulfill a number of different functions. These functions include self-injury being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. There is a positive statistical correlation between self-injury and emotional abuse.
Intense pain can lead to the release of endorphins and so deliberate self-harm may become a means of seeking pleasure, although in many cases self-injury becomes a means to manage pain, in contrast to the pain that may have been experience through abuse earlier in the sufferers life of which they had no control over.
For some people harming oneself can be a way to draw attention to the need for help and to ask for assistance in an indirect way but may also be an attempt to affect others and to manipulate them in some way emotionally. However, those with chronic, repetitive self-injury often do not want attention and hide their scars carefully.
Self-injury awareness
There are many movements among the general self-injury community to make self-injury itself and treatment better known to mental health professionals as well as the general public. For example, Self-injury Awareness Day (SIAD) is set for March 1 of every year where on this day, some people choose to be more open about their own self-injury, and awareness organisations make special efforts to raise awareness about self-injury. Some people wear an orange awareness ribbons or wristband to show their support for awareness of self-harm.
Treatment
There is considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective and as such further clinical studies are required.
Psychiatric and personality disorders are common in individuals who self-harm and as a result self-injury may be an indicator of depression and/or other psychological problems.
Many people who self-harm suffer from moderate or severe clinical depression and therefore treatment with antidepressant drugs may often be effective in treating these patients.
Cognitive Behavioural Therapy may also be used (where the resources are available) to assist those with axis 1 diagnoses, such as depression, schizophrenia, and bipolar disorder.
Dialectical behavioural therapy (DBT) can be very successful for those individuals exhibiting a personality disorder, and could potentially be used for those with other mental illnesses who exhibit self-injurious behaviour.
Diagnosis and treatment of the causes of self-harm is thought by many to be the best approach to treating self-injury. But in some cases, particularly in clients with a personality disorder, this is not very effective, so more clinicians are starting to take a DBT approach in order to reduce the behaviour itself. People who rely on habitual self-injury are sometimes psychiatrically hospitalised, based on their stability, and their ability and especially their willingness to get help.
In individuals with developmental disabilities, occurrence of self-injury is often demonstrated to be related to its effects on the environment, such as obtaining attention or desired materials or escaping demands. As developmentally disabled individuals often have communication or social deficits, self-injury may be their way of obtaining these things which they are otherwise unable to obtain in a socially appropriate way (such as by asking). One approach for treating self-injury thus is to teach an alternative, appropriate response which obtains the same result as the self-injury.
Avoidance techniques
Generating alternative behaviours that the sufferer can engage in instead of self-injury, and shaping the use of such behaviours, is one successful behavioural method that is employed to avoid self-harm.
Techniques, aimed at keeping busy, may include journaling, taking a walk, participating in sports or exercise or being around friends when the sufferer has the urge to harm themselves.
The removal of objects used for self-injury from easy reach is also helpful for resisting self-injurious urges.
The provision of a card that allows sufferers to make emergency contact with counseling services should the urge to self-harm arise may also help prevent the act of self-injury.
Alternative and safer methods of self-harm that do not lead to permanent damage, for example the snapping of a rubber band on the wrist, may also help calm the urge to self-harm.
The most useful techniques for me were provided by the most useless of counselors ~ actually, I’m sure he was a very good counselor but, being an evangelical Christian, he only allowed me one session with him because he ‘didn’t believe in people like me’.
As I sat in the office of this otherwise ordinary bloke I have to admit to asking myself ~ despite my distress and my inept attempts to quell the bleeding of the 30 or so cuts to my arms ~ ‘how Christian is that?’
He did, however, attempt to help, albeit without actually looking at me. He suggested that I use a ballpoint pen rather than a blade when I had the urge to cut, or to bandage my arms in advance so I would think twice before I acted.
I tried both techniques and, from time to time, they worked. Other times I just said ‘screw it’ and did it anyway.
You see, it was all about being in control, even of the decision-making process that lead to my not cutting.
My experience ~ which is not inconsiderable now ~ would suggest that, while I’m certainly not advocating self-harm as a good thing, it certainly can prevent more drastic outcomes and as such should be recognised for what it is: a survival mechanism for someone who doesn’t see any real reason for continued existence but wants one last positive try.
Oh, and that lyric way back at the beginning …
I didn’t fool you, did I?
That wasn’t The Slits. I just made that up.
I found it on another self-harmer’s website.
You see, it is all about trust.
And you can’t trust anyone now, can you?
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Further reading
Bogdashina, O. (2003), Sensory Perceptual Issues in Autism and Asperger Syndrome, Different Sensory Experiences, Different Perceptual Worlds., Jessica Kingsley, ISBN 978-1-84310-166-6
Farber, S. (2002), When the Body Is the Target: Self-Harm, Pain, and Traumatic Attachments, Jason Aronson Inc, ISBN 978-0-76570-371-2
Favazza, A.R (1996), Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry., Johns Hopkins University Press, ISBN 978-0-80185-300-5
Griffin, J. & Tyrrell, I. (2000), The Shackled Brain: How to release locked in patterns of psychological trauma., Organising Idea Monograph: 5, European Therapy Studies Institute, ISBN 1-899398-11-2
Kaminski, M.M. (2004), Games Prisoners Play., Princeton University Press, ISBN 0-691-11721-7
Levenkron, S. (1998), Cutting: Understanding and Overcoming Self-Mutilation, W. W. Norton and Company., ISBN 978-0-39302-741-9
Miller, D. (1994), Women Who Hurt Themselves., Basic Books, ISBN 978-0-46509-219-2
Plante, L. G. (2007), Bleeding to Ease the Pain: cutting. self-injury, and the adolescent search for self., Praeger Publishers, ISBN 978-0-27599-062-6
Smith, C. (2006), Cutting it Out: a journey through psychotherapy and self-harm., Jessica Kingsley Publishers, ISBN 978-1-84310-266-3
Whittenhall, E. (2006), Cutting: Self-Injury and Emotional Pain, ISBN 978-0-83084-990-1
Retrieved from “http://en.wikipedia.org/wiki/Self-injury”
Wednesday, 21 April 2010
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