The demand for a third edition of Healing the Hurt Within makes quite a statement about the role of self-injury in our society. There is no debate that self-injury is a behaviour that has become much more visible in society over the past several years. Whether this is just a media created mirage or an actual increase in the number of people hurting themselves still remains to be verified through research. Nonetheless, interest in the field of self-injury continues to grow and the need for quality information on this behaviour is enormous. Those who are hurting themselves, those who are helping self-injurers in a professional capacity, and those who care about people who intentionally hurt themselves are finding themselves at a loss when seeking comprehensive written material that explains, educates, and offers hope regarding these behaviours. Jan Sutton’s third edition of Healing the Hurt Within is an excellent resource for anyone wanting to know more about this mystifying and often misunderstood behavior.

You’ll find that the third edition of Healing the Hurt Within is dramatically different from the previous edition. Throughout, the stigma associated with self-injury is reduced and many of the myths and misconceptions regarding the behaviour are clarified and corrected. Jan Sutton explores the reasons why people hurt themselves and the cyclic nature of this act. Noting the impact of trauma on self-injury, this edition of Healing the Hurt Within contains a chapter specifically dedicated to this topic. The role of dissociation in relation to self-injury is also explored more fully as well.

Each chapter is loaded with current research, case studies, and helpful ways to understand this complex topic. Throughout the text, Jan weaves quotations, passages, and stories from those who are most familiar with this topic: those who intentionally hurt themselves. These powerful passages will captivate you and give you a glimpse into the world of the self-injurer: from hurting to healing to helping others.

With her vast experience and decades of work as a counsellor, researcher, trainer, and author, Jan creates a truly comprehensive guide to understanding self-injury and providing information designed to help those who are hurting themselves. The third edition of Healing the Hurt Within is without question an inclusive and indispensable book about self-injury.

Tracy Alderman, Ph.D.
Author of The Scarred Soul: Understanding and Ending Self-Inflicted Violence
Co-Author of Amongst Ourselves: A Self-Help Guide to Living with
Dissociative Identity Disorder

Since publication of the second edition of Healing the Hurt Within, much has changed in the self-injury arena. Thus being presented with an invitation from the publishers to write a third edition is appreciated. This new edition has altered radically from its predecessor. While the popular and eye-catching cover remains virtually unaltered from the previous edition, the text has grown from nine to thirteen chapters and includes four new appendices. To reflect advancements in the field, existing chapters have been reworked and further developed, and new topics, testimonies, artwork and case studies have been added. Fresh diagrams have also been incorporated and, to give the book a more reader-friendly appeal, the layout has undergone a face-lift. Additional enlightening contributions from respected experts and voluntary organisations working in the field add a further new dimension to the book. With the intention of guiding the reader to supplementary reliable sources of information, the resources section has been fine-tuned, and the further reading section revised with details of the latest publications on self-injury. Well referenced to original sources, extensively indexed, and presented in a no-frills style, this engaging third edition offers an unrivalled panoramic view of self-injury.

The timescale set for completion of the manuscript for the second edition prevented the inclusion of a significant amount of new data revealed through a qualitative research study undertaken by me via the Internet with 74 females and 8 males with experience of self-injury. Hence, writing this new edition has afforded a welcome opportunity to present a sizeable quantity of new material, and to build on areas previously examined.

Aims of the book

The overall aims of this new edition are to:

• Raise awareness and understanding of self-injury, reduce the stigma and challenge the myths and misconceptions surrounding self-injury.
• Provide comfort, compassion, acceptance, hope and guidance on healing to those who self-injure.
• Guide family members and friends to responding appropriately to a loved one who self-injures and encourage them to address their own needs for support.
• Present workers with a range of useful tools to direct them in their work, empower them to work more confidently with the challenging issue of self-injury, and to underscore the need for self-care and ongoing supervision to avoid the risk of compassion fatigue.

New material

Many people who self-injure feel invisible, insignificant, ignored and voiceless. In keeping with the popular format of earlier editions, considerable space is given to hearing the poignant voices of those with experience of self-injury. Some are harrowing to hear; others are heartening and inspirational and demonstrate clearly that with courage and commitment, the uphill battle to overcome or reduce self-injury can be won. New to this edition are the voices of males struggling with self-injury, and family members and friends concerned about a loved one that self-injures.

Experienced therapists and authors Tracy Alderman and Karen Marshall offer additional sound and practical advice for responding effectively to self-injuring clients. Furthermore, Consultant nurse Chris Holley and her colleague Rachel Horton (RMN) clearly explain the controversial ‘safe self-harm’ pilot scheme recently implemented at South Staffordshire and Shropshire Healthcare NHS Foundation Trust. Added guidance is also provided for teenagers considering turning to self-injury as a way of coping with their difficulties, and the possible reasons for high self-injury rates in prison are explored.

New appendices include a table of acronyms and colloquialisms, a series of questionnaires used in the Internet research into self-injury, a member code of contact for participating in a survivor-run group, and a reproducible training resource comprising six composite case studies and a set of questions designed to examine reactions to self-injury.

Exploration of the pivotal role self-injury plays in alleviating ‘unacceptable tears’, unhealthy perfectionism, negative core beliefs, and ‘never feeling good enough’ adds another fresh element to the book. Ten common myths about self-injury are examined and challenged, the differences between compulsive and impulsive self-injury explored, and sexual self-injury aimed at stimulating sexual arousal is distinguished from self-injury used as a coping mechanism to regulate acute emotional distress. Other newly introduced topics include the association between body modification and self-injury for some people, the distinct needs cutting and burning serve, and the premise that increased stress levels can result in more serious episodes of self-injury.

Reworked and expanded sections

Reworked and expanded sections focus on increasing understanding of the correlation between dissociation and self-injury and highlighting the role of unresolved trauma and posttraumatic stress symptoms in motivating internal self-injury. More attention is drawn to media attitudes and assertions to demonstrate how inaccurate media coverage can fan the flames of misunderstanding, prejudice, stigma, and inaccurate reporting of statistical data on self-injury. Other more developed themes include counselling and therapy, self-help, and the perceived losses of stopping self-injury.

An overview of the differences between editions 2 and 3

In order to compare the main differences between editions 2 and 3, organisation of the two editions is presented below:

Information removed and relocated

To accommodate space for the inclusion of new material, it has been necessary to remove some information from Edition 2. Extracted subject matter includes Chapter 8 (Eating Distress) (key points now appear in Chapter 1) and the citations section. Those seeking self-injury references are encouraged to visit my SIARI (Self-Injury and Related Issues) website: http//www.siari.co.uk. Other material removed due to space limitations includes the 1997 Guidelines for treating Dissociative Identity Disorder (DID) by The International Society for the Study of Trauma and Dissociation (ISSTD) which were extensively updated in 2005. See pages 266–267 for details of accessing the revised guidelines online. Important material retained from the appendices of Edition 2 has been incorporated into the main text in Edition 3.

Who will benefit from reading this book?

To date, Healing the Hurt Within is the only book on self-injury published in a third edition. It weaves together a rich tapestry of information presenting the truth about self-injury – explaining why it happens and clarifying what it achieves. Importantly, it demonstrates that recovery from self-injury and preventing the external wounds requires healing the hurt within. Moreover, it unequivocally demystifies and de-stigmatises self-injury, showing the behaviour exactly for what it is – an effective (albeit unorthodox) coping mechanism for dealing with difficult feelings, emotions, and circumstances – in other words – an insurance policy to safeguard survival, rather than an act designed to end one’s life. As one respondent clarifies:

‘SI [self-injury] is a coping mechanism that has many bad sides, but it works. It is a way to deal with extreme emotional distress, a way to survive.’

Writing this third edition has increased my knowledge and understanding of self-injury. I trust this additional learning is reflected in the book.

It is my sincere hope that it will provide inspiration and help to those who battle with self-injury, and support and guidance to family members and friends striving to help a loved one that self-injures. For those faced with the challenging behaviour of self-injury during the course of their work, my hope is that the book will provide direction on appropriate interventions as well as encouragement to look beyond the wounds and non-verbal language of self-injury. In sum, the book will be of value to anyone wishing to enhance their comprehension about this perplexing and widely misunderstood issue.

Notes

Contributions integrated into this book come from people from different parts of the globe. In the main, for purposes of clarity and consistency, British English spellings have been applied throughout the text.

To avoid stereotyping, wordiness, and awkward phrases, feminine and masculine pronouns are applied interchangeably throughout the text where possible. The terms ‘therapy’ and ‘counselling’, also applied interchangeably, essentially refer to the same practice. Further, although the predominantly used term is ‘client’, the term ‘patient’ could equally be applied.

Cautions

• 1.Self-injury is a sensitive issue, which can be upsetting to read or think about. While the aim of this book is to offer those of you who use self-injury as a coping strategy, hope, help, and support, it is possible you will feel triggered to self-injure by some of the material, particularly if you are new to studying the topic. Please read with caution and keep yourself safe – put the book down if you begin to feel anxious, vulnerable, or start to lose focus (feel ‘detached’ or ‘spaced out’). If you are in the early stages of healing from self-injury it may be advisable to read the book with support from a friend, loved one, or your therapist or counsellor if you have one.
• 2.This book contains some strong language as well as sexual content. It is therefore unsuitable for young children.

Disclaimer

Whilst every effort has been made to provide accurate information concerning the subject matter covered in this book, the publisher and author expressly disclaim responsibility in law for negligence or any other cause of action whatsoever. Moreover, inclusion of material does not necessarily imply endorsement of information, nor agreement with the views expressed.

The diagnosis and treatment of psychiatric disorders requires a doctor or qualified mental health professional. The information provided in this book, intended for informational purposes only, should not be used as a substitute for the diagnosis of mental illness – if help is required, the services of a health professional should be sought.

Contributors’ personal testimonies, poems, stories and artwork

The personal contributions included in this book have been offered voluntarily and willingly in the hope that it will help readers gain a better understanding of self-injury. Apart from where specifically requested, names have been changed or omitted to protect the contributors’ identities.