Self-harm

Information about:

What is self-harm?

Self harm involves deliberately physically harming oneself. Common injuries include cutting with a knife or scissors, burning the skin with matches or cigarettes, picking at existing injuries to prevent them healing, self-inflicted bruising or bone fracturing and taking low-level drug overdoses. This definition does not include socially accepted selfharm such as smoking, tattooing, body piercing etc.

Self-harm is done intentionally and is usually the result of overwhelming feelings such as pain, fear or anxiety that the person has not learned to deal with in other, more positive ways. Many people find that the negative emotional state they are trying to avoid disappears quickly when they self-harm. The person then learns through experience that this is an effective way of reducing distress. However, the stress is only reduced temporarily and self injuring prevents the person from finding more helpful and healthy ways to express and process difficult emotions. Some people who self harm report that they feel little or no pain whilst injuring whilst others feel the pain fully – they may experience this pain as a positive or negative thing.

Self-harm is a destructive coping mechanism, not unlike smoking, workaholism, drug use, alcoholism, overeating or anorexia – however it is not understood or accepted as much by society.

Who self-harms? – Higher risk groups

It should be noted that none of the factors below provides a complete explanation for self harm – i.e. not everyone who self harms has been sexually abused or has borderline personality disorder. Self-injury has many symbolic meanings.

  • Abused children and adult survivors of physical, emotional or sexual abuse
  • People with Borderline Personality Disorder
  • Women
  • Angry, impulsive, anxious, aggressive or very stressed individuals
  • People with eating disorders
  • People with a mental illness such as schizophrenia or depression
  • People abusing alcohol or drugs
  • People who were raised in an environment that invalidated them – discouraged
  • or punished for their opinions, feelings, or personality

There were 22,950 cases of hospitalised intentional self-harm in the financial year 2003–04. This includes suicide and attempts of suicide, as well as cases where people have intentionally hurt themselves, but not necessarily with the intention to kill themselves e.g. self-mutilation.

Common myths

That self-harm is a suicide attempt

A person attempting suicide feels there is no way out of the pain they are feeling other than escaping it. There is often no desire to die when self-harming. The aim is more to express unbearable emotional pain. Self harm can actually be a survival mechanism that allows the person to cope with difficult feelings that would otherwise not be expressed. However, the self-harming person may miscalculate and die by accident. A person who is self-harming may also become suicidal. However, the dynamics behind
this are often quite different to the self-harm.

That this problem is self-inflicted therefore the person does not require help or understanding

The person is often feeling enormous overwhelming pain and self injuring is the only way they know to express it. This level of emotional distress is always serious and should be taken seriously.

Self-harm is done to gain attention

Many people hide their injuries, so the self-injury is carried out only for their own
‘benefit’. Accusing a person of attention-seeking often trivialises their suffering. The person may be seeking care, understanding, kindness or acceptance rather than just attention.

Self harm is always carried out on the spur of the moment and is impulsive

Self harm can sometimes be a planned activity and some people carry out some kind of ‘ritual’ around their injuring behaviour. The person has learned that self harming is a way of coping with their emotions and come to rely on it. At other times, self injury may be carried out whilst in a distressed state.

Why do people self-harm?

Every person who self-harms is unique and self-injury is a response to various
psychological needs that are being unmet in more healthy ways. The following are some of the reasons people have given for self-harm.

  • To externalise unbearable emotional pain that is difficult to express. The person often feels unbearable tension or distress that only self-harming seems to alleviate. Emotional pain can be difficult to talk about or even acknowledge to the self but it needs to be expressed somehow.
  • Physical pain can be easier to cope with than emotional pain – cutting or burning transforms the emotional pain into something visible. The person is often unaware why they are doing this but they have learned from past experience that self-harming has a regulating effect on their feelings. Self harm is an attempt to alter an emotional state. Physical pain is more socially acceptable than emotional therefore the person is converting it into physical pain.
  • Injuries and scars can serve as ‘war wounds’ – the person has something physical to show for all their emotional pain. Wounds are tangible, external and treatable whereas emotional pain is confusing and hidden.
  • A few people do use self-harm as a means of manipulating others. This is likely to be a very difficult situation for family and friends that leaves them feeling angry, frustrated, hurt or afraid.
  • Some people who self-harm do so to ‘ground’ themselves or ‘bring themselves back to reality’. This may be particularly true in people with dissociative disorders.

Treatment

Biochemistry

Along with several other disorders, a decrease in levels of the neurotransmitter
serotonin in the brain may contribute to self-harm. Drugs that increase serotonin levels to the brain seem to have some positive effects on self-harming behaviour. These drugs are often the same as ones prescribed for depression. Selective Serotonin Reuptake Inhibitors (SSRIs) are anti-depressant drugs which address neurotransmitter imbalances in the brain. Medication may be prescribed to treat any diagnosed mental illness that is present.

Psychotherapy/counselling

The general aims of ‘talking therapies’ are to:

  • Help treat any associated mental illness
  • Prevent or minimise future self harm
  • Learn new coping skills to deal with difficult feelings
  • Reduce levels of emotional distress
  • Provide support and encourage insight into the behaviour.

Various modes of therapy are used and the following are some of the most common:

  • Cognitive Behavioural Therapy - CBT teaches the person to identify and challenge unhelpful thoughts that lead to self-harming behaviour.
  • Dialectical Behaviour Therapy - DBT is a method of teaching the person skills in coping with extremes of emotion which they did not learn in earlier life.
  • Interpersonal therapy/counselling - There are many forms of psychotherapy and counselling. In general these help the person to explore the reasons for their self-harm and to find positive ways of ways of coping with difficult feelings.

Self-help

Educate yourself as much as possible through websites and books. This may help you to understand the origins of your self injury, the reasons for it, advice on stopping and importantly – affirmation that you are not ‘crazy’ and you are not alone. Reading about how other people have struggled and coped with self harm may give you some hope.

Find a therapist you are comfortable with and make a firm commitment to attend sessions.

Nurture other parts of your life, yourself and your relationships. You are not defined by your self-injury. You are a complete person with interests, strengths, faults, talents and goals of your own.

Unfortunately, relatively few self-harm support groups exist. Try searching the internet for the many web sites and chat rooms focused on self harm. These can provide advice, information, support, and reduce isolation and stigma.

Family and Friends

Do

  • Reinforce that you love/like them as a person but dislike the self-harming behaviour. This reassures the person that they are loved but also lets them know that others will not collude in the self-harming.
  • Educate yourself about why people self-harm. This will help you to understand why it is happening and help address the fear you may be feeling.
  • Acknowledge the emotional pain the person is feeling. This is the origin of most self-harm and acknowledging its existence and severity may be one of the most important things you can do to assist.
  • Get professional support for yourself if you need it but don’t expect to be able to ‘cure’ the person – only they can do this for themselves. Coping with someone you love self-harming is difficult – don’t try to go it alone or be the person’s only support person – share the load around.
  • Be supportive without reinforcing or colluding with the behaviour. Be willing to talk about the self injury and open to hearing the person’s feelings or point of view.

Don't

  • Use emotional blackmail, such as ‘if you really loved me you wouldn’t do this’. Guilt will only add to the person’s mental turmoil and will not ease the self-harming behaviour.
  • Give ultimatums such as ‘if you don’t stop cutting yourself, I am going to leave you’ – they do not work. Punishment such as this feeds the cycle of low self esteem and self hatred and maintains the self-harming behaviour.
  • Accuse them of attention-seeking. If the person is going to these extremes to get attention, they probably need it. Encouraging proper help will provide them with the right sort of attention.
  • Physically force someone to stop self-harming; this will not help in the long-term. Self-harm is the only way the person knows how to express emotional pain and they need to learn more appropriate coping methods before this one is taken away from them.
  • Physical restraint could be traumatic and make the problem worse. Although it may be extremely painful for you, try not to discourage the self injury until the person is ready – providing support is more helpful than imposing limits.
  • Take it personally. Self harm is about the sufferer and not about you. 

Where to go for help

As self-harm is a symptom rather than a diagnosis all by itself, treatment depends on the reasons behind self-harm and any co-existing disorder. In general terms, treatment might include medication and/or some form of psychotherapy.

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