The phone rang at 12:30 a.m. It was 17-year-old Maggie. She’d cut herself again and thought she needed stitches. Because she lives more than a thousand miles away, I didn’t know how to help her. Finally, she woke her mom to take her to the hospital. I was worried, because I intimately knew the pain Maggie was in; for six years, I’d been a self-injurer, too.

What, How, Where, Who, Why?

Self-injury is any action by which people inflict physical harm on their bodies in order to achieve an emotional benefit. Self-injurers may use any number of tools to hurt themselves: knives, razors, scissors, pins, paperclips, nail clippers, their nails or even pieces of paper. They may use cigarette lighters or matches to burn themselves, or they may resort to hitting or punching themselves, even banging parts of their body against a hard surface until they bruise. Self-injurers most often will cut or burn their arms and legs, but no area of the body is off-limits, even the torso, breasts and genitals (the latter two often occur when a person has been sexually abused, which is reported by more than 50 percent of self-injurers).

Although self-injurers usually are careful to conceal their self-harm, a good sign that someone is self-injuring is if she wears long sleeves and long pants all year around, even in very warm weather, to hide fresh cuts and old scars.

Although it was somewhat unusual for me to start cutting (a term for a common form of self-injury) as late as I did—in my early 20s—I had struggled with eating disorders in high school, which commonly co-occur with self-injury (estimates range from 35 to 80 percent of self-injurers also battle eating disorders). Maggie is a more typical picture of a self-injurer: She’s a teenager (90 percent of self-injurers begin hurting themselves in adolescence, and more than 10 percent admit to having harmed themselves); she’s female (60-70 percent are female); she suffers from low self-esteem; and there appears to have been, at least, verbal abuse in her family.

Since Maggie’s dad died in late 2007, she’s been in the hospital almost once a month. Even before her dad died, though, she struggled to cope, alternately starving herself or binging and purging, and cutting herself. Her dad had a great sense of humor, which she loved, but he often used it to cut her down, calling her names like slut (even though she was a still virgin).

Maggie’s self-injury was likely a way of punishing herself in lieu of all the hurtful adjectives her dad ascribed to her. When Maggie felt bad about herself, due in part to the way others treated her, she experienced a sense of shame—as though she really were a bad person deserving of negative treatment.

Self-injury has many functions and features besides self-punishment. While feeling shamed, Maggie also might have felt anger at people for treating her poorly. Anger is a scary emotion, and girls especially aren’t taught how to deal with it appropriately. Worse, in Christian circles, anger is frowned on as a gateway to sin. But feeling angry isn’t a sin; acting in anger is.