In a calm manner, the counselor communicated understanding, empathy and caring for Catherine, thus establishing trust. The counselor asked questions to determine that the cuts were not physical child abuse by an older person, but self-inflicted. She avoided shaming Catherine by stating that she was not a bad person for hurting herself. When Catherine was unable to describe her behavior, the counselor asked if she could write down or draw what she does to herself when she is upset. The counselor's goal was to not criticize or coerce her into stopping because intimidation usually leads to increased self-hurting behavior, but to find the help she needed.

Self-injury means deliberately hurting yourself without the intent to commit suicide. Other names for self-injury are cutting, self-harm, and self-mutilation. Most self-injurers feel ashamed of what they're doing and try to hide it from adults and friends. Since self-harm is done in private, it often goes undetected or is explained as being accidental.

Though uncommon, children as young as preschool age have intentionally hurt themselves. Self-injurers come from a broad spectrum of social, economic and racial groups. They can range from being perfectionists to school dropouts. However, as young children, they usually have experienced abuse, neglect, violence, or trauma such as the death of a loved one or involvement in a car accident. They can be males or females, although most are females in their teens or older. A reason for this may be that males tend to display their aggression towards others or inanimate objects. Girls, on the other hand, tend to turn that hurt and pain inward toward themselves.

Self-injurers often lack social skills and may be victims of teasing or bullying. In order to distract themselves from painful emotions, they inflict physical harm upon themselves. Self-injurers may begin with only scratching an insect bite or accidentally cutting their skin, but due to the sense of relief it brings, they continue to injure themselves. Some researchers theorize that the release of endorphins, the body's natural painkillers, can contribute to continued self-injury. What young children have in common with older children and adolescents who hurt themselves is an inability to verbally express their feelings and needs.

Individuals inflict pain upon themselves to:

• Rapidly reduce the tension in their body and mind
• Relieve their emotional pain caused by feeling worthless, angry, fearful, abandoned, depressed, anxious, or trapped
• Feel pain that tells them they are "alive" thus warding off emotional detachment
• Regain control since turning mental and emotional pain into physical pain is easier for them to handle
• Punish themselves for real or perceived offenses like being bad, fat, ugly, stupid, or guilty (for example, a boy who feels guilty over the death of his brother may challenge a bigger boy to fight because he knows he will get hurt)
• Express anger/rage when words or outward actions are unacceptable or when the pain is too severe to put into words (for example, children may have been told that expressing an emotion is wrong, or they may have been severely punished for expressing certain thoughts or feelings)