Summary
The presence of adult self-injury is often listed as a descriptive indicator for a history of childhood sexual or physical abuse. The overlap between families in which both chemical dependency and sexual abuse occur is now accepted knowledge. A predominant dynamic for both problems is the shame, bound family system. The author presents a therapeutic perspective of adult self-injury as a coded survival response to childhood abuse in which shame, denial, and self-injury are intricately interwoven. Specific messages in self-injury and therapeutic responses to self-injury are discussed.