Names have been changed. All quotes are based on true lived experience.

Unlike other mental health difficulties, self-injury can leave permanent scars. It is important to keep in mind however that scars do not always form from self-injury^{1, 2}. The appearance of scars differ with the method used to injure oneself. For instance, cutting generally leaves a line-shaped wound whereas burning with the tip of a cigarette creates a circular pattern³.

The meaning of self-injury scars

Self-injury scars often carry meaning. Some people see their self-injury scars as a mark of their journey and feel pride in being a survivor⁴. Indeed, for some, scars tell a story and are a visual evidence of the suffering endured⁵, which could explain why some individuals are upset by the fading of their scars: as the scar disappears, the visual mark of their suffering and story disappears as well⁶. More simply, scars are healed injuries. They are a visual sign of recovery, which can be motivating for people who are trying to stop harming themselves.

I really think when you have only scars it’s more difficult to start [self-harming] again, because the difference seems huge. Whereas when you already have a lot of fresh cuts it’s just one more. – Emily, 20

For others however, scars and self-injury overall are a sign of weakness³, and they feel shame and disgust toward them⁴. This negative perception of scars does not always last, and a process of acceptance can occur, with a gradual switch from shame to a more neutral perception⁴. Some people also interact with their scars, observing or touching them⁷.

I’m not the kind of person who romanticizes [scars]. Scars are just scars. I would feel differently with fresh wounds obviously. – Emily, 20

Stigma and concealment

Scars are sometimes visible and therefore can make individuals vulnerable to the judgment of others⁵. Indeed, they can be stigmatizing for people who self-injure⁶ and there is some social expectation that self-injury scars should be covered, from fear they could generate contagion and encourage others to mimic the behavior⁸. Hispanic or African-American people also tend to conceal their scars more, perhaps because they face higher stigma, either within their communities, or from non-Hispanic and non-African American people⁹. Many people who self-injure cover their scars, avoid situations when they are visible, and find socially acceptable reasons to explain their presence when they are noticed^{1, 4}. Despite such care at hiding them, scars can sometimes cause unwanted disclosure of their self-injury when noticed².

I think it’s not worth the risk and stress of having to hide. I’m fed up with having to choose my clothes so that scars on my arm don’t show. Now I see the aftermath and it’s not worth it. I’ll have scars for years. – Leah, 21

Research has found that people who self-injure suffer from lower opinion on their body image, regard their self-inflicted scars more negatively than scars resulting from an accident or surgery, and perceive them as more noticeable^{7, 10, 11}. It could be because self-inflicted scars are a reminder of trauma, or because of stigma¹¹. Furthermore, people who are ashamed of their self-injury scars report more likelihood for future self-injury¹⁰.

Conclusion

Self-injury sometimes leaves permanent scars which can be an additional source of lingering suffering for individuals. As little can be done to improve their appearance, it is essential that people learn to regard them positively, particularly as those who see their scars as growth report less likelihood for future self-injury¹⁰. Scars can be addressed through Acceptance and Commitment Therapy (ACT) or compassion-focused therapy to reduce shame^{2, 4}.

References

[1] Lewis, S. P. (2016). The Overlooked Role of Self-injury Scars: Commentary and Suggestions for Clinical Practice. The journal of nervous and mental disease, 204(1), 33-35. https://doi.org/10.1097/nmd.0000000000000436

[2] Lewis, S. P., & Hasking, P. A. (2021). Self-injury recovery: A person-centered framework. Journal of Clinical Psychology, 77(4), 884-895. https://doi.org/10.1002/jclp.23094

[3] Seko, Y. (2013). Picturesque Wounds: A Multimodal Analysis of Self-Injury Photographs on Flickr. Forum Qualitative Sozialforschung Forum: Qualitative Social Research, 14(2). https://doi.org/10.17169/fqs-14.2.1935

[4] Lewis, S. P., & Mehrabkhani, S. (2016). Every scar tells a story: Insight into people’s self-injury scar experiences. Counselling Psychology Quarterly, 29(3), 296-310. https://doi.org/10.1080/09515070.2015.1088431

[5] Shaw, C. (2013). Living with Scars. Asylum, 20(2), 4-6.

[6] Sternudd, H. T. (2012). Photographs of self-injury: production and reception in a group of self-injurers. Journal of Youth Studies, 15(4), 421-436. https://doi.org/10.1080/13676261.2012.663894

[7] Stacy, S. E., Lear, M. K., & Pepper, C. M. (2017). The importance of origin: Differences in interpretation of self-inflicted versus environmentally-inflicted scars. Personality and Individual Differences, 116, 92-95. https://doi.org/10.1016/j.paid.2017.04.035

[8] Gunnarsson, N. V. (2021). The scarred body: A personal reflection of self-injury scars. Qualitative Social Work, 21(1), 37 – 52. https://doi.org/10.1177/1473325021990868

[9] Burke, T. A., Ammerman, B. A., Hamilton, J. L., Stange, J. P., & Piccirillo, M. (2020). Nonsuicidal self-injury scar concealment from the self and others. Journal of psychiatric research, 130, 313–320. https://doi.org/10.1016/j.jpsychires.2020.07.040

[10] Bachtelle, S. E., & Pepper, C. M. (2015). The Physical Results of Nonsuicidal Self-Injury: The Meaning Behind the Scars. The Journal of Nervous and Mental Disease, 203(12), 927-933. https://doi.org/10.1097/nmd.0000000000000398

[11] Dyer, A., Hennrich, L., Borgmann, E., White, A. J., & Alpers, G. W. (2013). Body image and noticeable self-inflicted scars. The Journal of nervous and mental disease, 201(1), 1080-1084. https://doi.org/10.1097/nmd.0000000000000057