Chapter 1 – Then and Now: A Survey of Self-Injury (p.
1. The majority of self-injurers cut because they
a. are seeking attention.
b. are suicidal.
c. seek relief from seemingly
uncontrollable pain or deadening numbness.
d. want to punish themselves for wrongdoing.
2. Which is NOT true?
a. The author prefers to use the phrases self-harm
and self-injury rather than
b. In the Old Testament, God commands His people to not cut their
bodies ritually, as their pagan neighbors did.
c. Many people of many different religions injure themselves to gain favor
with their deity.
d. People who have never intentionally harmed themselves are unable to
empathize with cutters.
Chapter 2 -- What Words Cannot Explain (p. 33-60)
3. Which is NOT true?
a. Many people who injure themselves have little or no idea how they got
b. Removing all sharp objects is not helpful to a cutter because he will
find something else to cut with.
c. Cutters use seclusion and privacy to establish routines of cutting
themselves in the same locations and at the same times of the day.
Therefore, being with them and supportive during a difficult part of their
day could decrease the likelihood of self-inflicted violence.
d. Once a cutter, always a cutter.
4. Which is TRUE?
a. The author, a non-cutter, began experiencing genuine compassion for
cutters when she realized that all of us choose some type of coping
b. Self-injury is more of a problem for women than for men.
c. Teenagers who injure themselves usually grow out of this habit and stop
d. Self-injurers enjoy the pain they cause themselves.
5. Which was NOT one of the reasons given for why people cut themselves?
a. To release my emotional pain when I cannot cry.
b. To make my unending emotional pain a temporary physical pain.
c. Because I feel so overwhelmed or alone.
d. To punish my parents.
e. Because I can't express my emotions any other way.
f. Because I need to control something.
g. To quiet my racing thoughts.
h. To show how tough I am.
i. To feel love (because after my father punished me he would comfort me).
Chapter 3 -- Misery Loves Company: Environmental and Physical Conditions
that Often Accompany Self-Injury (p. 61-89)
6. Which is TRUE regarding depression?
a. Moods disorders exist on a continuum, ranging from people with
chemical imbalances and/or severely disturbed family functioning to those
who have circumstantial hopelessness.
b. After long periods of toxic thought patterns and of experiencing intense
feelings of sadness, grief, or rage, it's possible for one's limbic system,
the area of the brain that helps control mood, to actually shut down.
c. Depression is best treated by a combination of medication and therapy for
changing, for example, negative thought patterns.
d. All of the above.
7. Which is TRUE about cutters and Borderline Personality
a. All cutters have BPD.
b. All people with BPD harm themselves.
c. Some cutters have BPD.
d. The Diagnostic and Statistical Manual of Mental Health Disorders
specifies self-injurious behavior as a possible symptom of
Obsessive-Compulsive Disorder (OCD).
8. Which is NOT true?
a. It is possible for a cutter to change from a momentary impulse to cut
to doing something else that is a healthy alternative, such as walking a
b. With eating disorders, people attempt to manage and control psychological
longings by converting them to physical sensations of hunger, fullness, or
the temporary extinction of either.
c. No matter what sex-abusers said to their victims, and no matter what
pleasure the victims may have experienced, the abuse was not and never will
be the fault of the victim.
d. SPECT scans of self-injurers will appear "cool." Their brains also
produce lower levels of cortisol.
9. Which is NOT true about dissociation?
a. Dissociation is when your mind goes blank until the threatening
b. Since dissociation serves as a psychological defense against traumatic
memories, it is rarely dangerous or destructive when used by a cutter.
c. Sometimes self-injury can halt a cutter's descent into
dissociation by increasing her awareness of what she is doing to her body.
d. Sometimes a cutter can use dissociation to space out during acts of
self-injury in order to block out the pain of hurting herself.
Chapter 4: Is It All in Their Head? -- The Undeniable Influence of
Physiology in Self-Injury (p. 91-113)
10. Which is NOT true?
a. Cutting releases the body's natural painkillers -- endorphins,
dynorphins, and enkephalins -- which are 8 to 10 times stronger than
morphine. Some cutters actually crave the release of these chemicals because
they make them feel happy, content, and normal.
b. Initial cutting produces euphoria, but can ultimately produce numbness,
as the brain builds up tolerance to the body's natural painkillers. This
explains why some cutters must cut themselves more often and more severely
to produce the same effects as when they first began cutting.
c. A score of 5 or more on the Amen Brain Subsystems Checklist indicates
cingulate malfunctioning and would explain why it is difficult for some
cutters to "let go" of self-destructive thoughts.
d. If a cutter answers "very frequently" to just one of the one hundred
questions on the Amen Brain Subsystems Checklist, this person should seek
Chapter 5: How Will You Know? -- Understanding the Messages Self-Injurers
Send (p. 115-135)
15 POSSIBLE SIGNS OF SELF-INJURY
1. Frequent cuts, burns, or bruises are "explained away."
2. Clothing seems ill-fitting or ill-suited for the climate or season.
3. The person demonstrates a reluctance to change or try on clothes in
front of someone else.
4. The person appears to have strong body dissatisfaction.
5. There is intense resistance to routine doctor visits or to seeking
medical attention for wounds that clearly need treatment.
6. The person wears accessories to cover the skin.
7. There are clusters of similar markings on the body.
8. The person's friends self-injure.
9. A normally outgoing person withdraws from family and friends.
10. Dramatic mood swings occur in a short time frame. Anxious or
11. The person continually uses language that expresses low self-worth
or the need to be punished.
12. The person displays continuous outbursts of anger, tears, or extreme
13. The family has a history of mental health issues.
14. You find hidden stashes of gauze, bandages, sharp instruments, or
other implements that could be used to self-injure or soothe a
15. Someone else tells you that your friend/spouse/student/child
11. One San Diego therapist recommends that parents of
“notice me” self-injurers take their child to ________, where self-inflicted
violence is NOT a cool or fashionable thing but rather a sign of
b. the emergency room
c. the school principal
Chapter 6: What Can I Do? – The Crucial Role You Can Play
in a Self-Injurer's Recovery (p. 137-156)
12. Which would be least helpful to a cutter?
a. Validating her feelings of anger, fear, guilt, or hurt.
b. Teaching her how to endure uncomfortable emotions – like loneliness,
loss, rage, remorse, and disillusionment – without acting upon them.
c. Telling a cutter that if she forgives the person(s) who hurt her, her
need for cutting would probably go away.
d. Refraining from using any shame or guilt messages.
e. Learning to listen to the meaning the cutter affixes to their
self-inflicted violence rather than demanding they stop it.
f. Being empathetic.
g. Helping the cutter to make her environment less compatible with cutting,
such as asking her if she would lock her razor blades in a box.
h. Offer to help a cutter with chores or accompany her to an appointment,
knowing that being with her offsets loneliness.
13. Self-injurers benefit from seeing all of the following
thoughts and behaviors modeled EXCEPT
a. Having a healthy self-worth.
b. How, when, and why to articulate feelings.
c. Patiently enduring difficulties.
d. Accepting that we cannot control everything.
e. Establishing and maintaining healthy boundaries.
f. Occasionally having the freedom to
scream or yell, validating one's passionate emotions.
g. Giving and receiving appropriate physical affection.
Chapter 7: Dressing the Wounds – Methods of Treatment and Why They Matter
14. The author says that “therapy is almost always crucial to a
What does individual therapy help a cutter accomplish?
a. To identify and express her feelings.
b. To learn non-destructive ways of managing stress, such as exercise,
reading, hobbies, or prayer (instead of destructive ways such as sexual
promiscuity, drinking, drugs, or self-injury.
c. To limit self-examination so it doesn't lead to narcissistic thinking.
d. All of the above.
15. In a typical ______ session, the therapist facilitates the movement of
the client's eyes while the client focuses on a destructive event. Sets of
eye movements are controlled until the memory becomes less disturbing and is
associated with positive thoughts and beliefs about one's self.
a. Dialectical Behavioral Therapy (DBT)
b. Theophostic Prayer Ministry (TPM)
c. Eye Movement Desensitization Reprocessing (EMDR)
Chapter 8: When the Body is Ravaged, the Soul Cries Out – Exploring the
Spiritual Implications of Self-Injury (p. 179-207)
16. When did Gretchen realize she no longer needed to cut
a. When she read “The Book of God” by Walter Wangerin, Jr.
b. When she realized that no cut she made would ever satisfy the ache within
c. When she discovered that Jesus bleed (died) one time for every reason she
“needed” or “wanted” to cut.
d. All of the above.
17. Which is NOT true about shame?
a. When we feel shame, we should do
something to make us feel better.
b. Shame makes us feel disgusted with ourselves.
c. When we internalize a shame message, we make wrong conclusions about
ourselves based on that message.
d. Shame and contempt are an assault
against the glory God intends His children to bear.
18. How does God's grace help a cutter?
a. Grace overcomes shame by accepting the cutter fully and irreversibly.
b. Grace takes away a cutter's rejection and abandonment and imparts worth
c. Grace gives a cutter power to face fear and pain.
d. All of the above.
19. Which is NOT true?
a. Cutters should express to God what they truly feel, think, and
desire, even their fear, rage, self-contempt, and doubt in God.
b. Christ truly understands cutters because He Himself experienced
unimaginable pain, emotional grief, and abandonment.
c. One of the benefits for cutters who learn the disciplines of prayer and
meditation is endorphin release.
d. There are no examples of self-injurers in Scripture
20. The author says, "I would love to share with every self-wounder this
a. Psalm 103:10 "He [God] is grieved
when we...fail, but He quickly draws us to His forgiving heart and accepts
us just as if it never happened."
b. II Corinthians 10:4 "The weapons of
the war we're fighting are not of this world but are powered by God and
effective at tearing down the strongholds erected against His truth."
c. Hebrews 4:15 "For Jesus is not some high priest who has no
sympathy for our weaknesses and flaws. He has already been tested in every
way that we are tested; but He emerged victorious, without failing God."
d. Isaiah 53:5 "But He was hurt because of us; he suffered so. Our
wrongdoing wounded and crushed Him. He endured the breaking that made us
whole. The injuries He suffered became our healing."