Self-injury has existed for nearly all of recorded history. Although it has been defined and regarded in various ways over time, its rise in the 1990s and early 2000s has taken a specific, although contested, form and meaning. We focus in this book on the deliberate, nonsuicidal destruction of one’s own body tissue, incorporating practices such as self-cutting, burning, branding, scratching, picking at skin (also called acne mutilation, psychogenic or neurotic excoriation, self-inflicted dermatosis or dermatillomania), reopening wounds, biting, head banging, hair pulling (trichotillomania), hitting (with a hammer or other object), swallowing or embedding objects, breaking bones or teeth, tearing or severely biting cuticles or nails, and chewing the inside of the mouth. Our goal here is to discuss the form of this latest incarnation of self-injury, now often regarded as a typical behavior among adolescents, describing and analyzing it through the voices and from the perspective of those who practice it. We call these people the “practitioners.”
Referring to self-injury as “tender” in the title of this book carries with it a distinct purpose, especially since previous treatments have often used harsher words, such as “mutilation,” “scarred souls,” and “a bright red scream.” It may seem oxymoronic to refer to cutting oneself intentionally as tender. By this term we intend to convey what the individuals we studied thought about this behavior, which was accepting. Nearly all of these people regarded this behavior as a coping strategy, perhaps one they wished they did not need (and might someday be able to quit), but one that functioned to fill needs for them nevertheless. Several referred to it as a form of “self-therapy,” noting that when things were rough and they had nowhere else to turn, a brief interlude helped them to pull themselves together. People felt better after injuring than they had before. Many used terminology to describe it such as “a friend” and “my own special thing.” We dedicate ourselves here to representing their perspectives and providing a nonjudgmental voice for their experiences.