Ask a Psychologist: I Have a History of Self-Injury

How do I keep hiding the scars?

Q: Dear APW,

I’ve had a long history of recovering from mental problems, including cutting and bulimia. I very much appreciated the Ask a Psychologist post on eating disorders. It’s helped me manage my body image issues as I try and deal with trying on bridesmaid dresses for two upcoming weddings, as well as embarking on my own wedding planning.

My problem now is that even though it’s been a couple years since I’ve cut myself, I still have scars on my upper arms, with a few on the right arm that are large, discolored, and bumpy. You can’t miss them.

This has caused two wedding issues for me. The first is that one of the brides that has asked me to be in her wedding does not know about the scars. She lives in another state so I thought I’d be trying on dresses and just sending her pictures for her to choose from, so I could just make sure that the scars weren’t visible in the pictures. She is letting us choose our own dresses, and I don’t think she has a problem with me wearing a jacket or cover-up, so I thought I was set, although I believe that would make me the only member of the bridal party not going sleeveless. This week, though, she offered to fly me to her state so that I could go dress shopping with her. This is an incredibly generous and thoughtful offer, and I’d love to, except I don’t know to hide my scars from her while trying on the sleeveless dresses. She’s a nurse, so I think she’s bound to notice even the more minimal scarring.

I do not want to come off as a diva or like I’m being difficult by refusing to try on sleeveless dresses, but I don’t know how to tactfully get around it. I don’t want to make an excuse about me covering my arms because they’re too fat because 1) I am really trying to stop thinking about my body like that, and 2) She and one of her bridesmaids are a bit bigger than me, and I don’t want her to think I’m judging them negatively for wearing sleeveless/strapless dresses. I wonder if maybe I should have just not accepted her request for me to be a bridesmaid, but she’s offered to help me with travel expenses and everything to make sure I can be there, and I do feel incredibly honored that she wants me to participate. There is really no way for me to back out now without potentially ruining our relationship.

The second problem I have is similar. I plan on having my parents and a couple of other family members present when I try on my dress. Although most of my family know about some of my psychological problems, none of them know about the bulimia or the cutting. I’ve yet to try on a formal dress with sleeves that wasn’t incredibly restrictive/uncomfortable. I know I could probably find something to cover up to wear at the wedding itself, but I feel like it would be awkward and lead to more questions if, while shopping for my dress, I ducked back into the fitting room every time I wanted to try on a different jacket because I was too embarrassed to change in front of my family. It’s bad enough for me to have a permanent reminder of my past destructive behavior without letting everyone around me know just how crazy I used to be.

I feel like my options at this point are to elope, buy the dress alone (and both those thoughts make me extremely sad), or have such outlandish hair or makeup that people can’t help but stare at my head.

—Anon

A: Dear Anon,

Your question brings up concerns about body image, friendship, family relationships, and what Meg might refer to in her book as skeletons in the closet. You are in good company in the APW community, since we can all relate to your question on some level: How do we see ourselves in our bodies? Are we comfortable in them? How do others see us? How do we navigate relationships with friends and family members? How does our past inform our present and future, and how much of it do we choose to share with the people we love?

My first concern is how you are managing all of this. You mentioned that none of the people involved in shopping for your bridesmaid dresses or your own wedding dress know that you used to cut. Does anyone know, e.g. your partner, or have you kept it a total secret? If you have kept it a secret, that is a huge burden to bear. It’s already involved going to extremes to get around it, as well as thinking up new extremes to continue to do so. Even if you have told a few people, this is an important time to make sure you’re taking care of yourself by seeing a trained mental health professional: someone to help you sort through this stuff and help ensure that you don’t return to unhealthy ways of coping with stress.

You are wondering whether to show your scars, and if you do show them, how to explain how you got them. Here are some thoughts. You could continue to keep the scars hidden, but it seems like that has become increasingly difficult. There is the reality of the clothes we wear today: the often exposed arms in the dresses your friends want their bridesmaids to wear, or the dress that you may want to wear for your wedding. There is the difficulty, as you bring up, of going to extremes to hide your scars. Ducking into fitting rooms. Possibly threatening meaningful relationships.

Another thought is: if you do show the scars, you don’t have to disclose what they are. People may not realize that they are from self-injury. You are very attuned to your scars, and you know what they’ve looked like over the years. Other people may be less focused on them, and they may not ask. Also remember that just because people ask doesn’t mean that you’re required to fully answer. “It’s a long story,” or “I don’t want to get into it today,” will suffice, and will let you set appropriate boundaries for self-care.

Or, you can disclose what the scars are from. Keeping the scars a secret may ultimately be more burdensome and cause way more anxiety than just accepting that they’re there. It’s very difficult, because this was a private problem and a very challenging time in your past, but you’ve had the strength to move on. Clearly, the people who’ve asked you to be in their weddings care deeply about you and want to honor your friendship by having you be a part of their weddings. And you have a partner who has chosen to build a life with you, and you are preparing for your own wedding. These are really, really good things. Keep them in mind as you’re working through all of this.

You might have heard of Dialectical-Behavioral Therapy (DBT), a kind of psychotherapy developed and researched by the psychologist Dr. Marsha Linehan. DBT is often very helpful for people with histories of self-injury and difficulty managing stress, intense emotions, and relationships. DBT approaches recovery by teaching healthy coping skills and working to change unhealthy thought patterns and behaviors. It also incorporates mindfulness and acceptance techniques in “building a life worth living.” DBT is based on the dialectic between acceptance and change. We have to accept certain things about ourselves, and we also have to change them. Both of these things are true.

It’s true that your scars are a permanent reminder of the past. That can’t be changed. But they can also serve as a permanent reminder of the behavior that, based on your internal and external resources, you don’t have to go back to. That is the good news, and that is the part you can change.

The trouble with moving forward is that emotions get in the way. You are making a lot of assumptions about how things will go, and how people will react, based on your own, understandably, strong emotions about your scars and what they mean to you.  You wrote, “I feel like my options at this point are to elope, buy the dress alone (and both those thoughts make me extremely sad), or have such outlandish hair or makeup that people can’t help but stare at my head.” You feel like—key word being feel. Your feelings are totally valid and make sense. And they are very powerful, so they are also getting in the way of considering more perspectives. When we integrate, as DBT would suggest, a more rational, or “reasonable” perspective with your (totally understandable) emotional response, we realize that, fortunately, these are not the only options.

So, think about the larger picture: how you want to maintain and strengthen your relationships, how you can continue to take care of yourself and live a healthy, meaningful life, and how you’d like to do things differently in the future. As Meg wrote in her book (one of my favorite lines), “I can’t wait to see what you create.”

For more information and resources on DBT, or to find a therapist trained in DBT, visit The Linehan Institute Behavioral Tech website.

The information provided in Ask a Psychologist is intended by Dr. Brofman and APW to serve as general advice and guidance for all readers. The advice herein does not constitute a clinical recommendation or relationship, and Dr. Brofman and quoted mental health professionals do not take clinical responsibility for this information. Ask a Psychologist does not take the place of a confidential clinical consultation with a trained mental health professional. 

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