Self-harm

Self-harm involves deliberately physically harming oneself. This definition does not include socially accepted self-harm such as smoking, tattooing, and body piercing. It is a broad range of behaviours, and it is not necessarily related to a mental illness or a disorder.

Self-harm is the result of overwhelming feelings such as pain, fear or anxiety that the person has not been able to cope with in more positive ways. It is performed because of its ability to modify psychological distress, a temporary release from these painful feelings and frustrations.

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
• People who have problems with impulse control
• 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 and feelings.

Reported self-harm is more common in women than men with the highest rate occurring among young women as young as 15. However, men also self-harm and their pain shouldn’t be overlooked.

Intentional Self-harm was the 4th leading cause of total injuries in the financial year 2003-04.

Common myths about people who self-harm

This is a suicide attempt

A person attempting suicide feels there is no way out of the pain they feel other than escaping it by ending their life. There is often no desire to die when self-harming. Self-harm can actually be a survival mechanism that allows the person to cope with difficult feelings that would otherwise not be expressed5.

They must like it and do not need help or understanding

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

They do it for 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.

They are impulsive

Self harm can sometimes be a planned activity and some people carry out a ‘ritual’ around their injuring behaviour. At other times, self harm may be carried out whilst in a distressed state.

Why do people self-harm?

Every person who self-harms is unique and their self-injury is a response to various psychological needs that are being unmet in healthier 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.
• 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.
• 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’.

Assessment and treatment

All persons who self-harm should be assessed by a mental health professional and a physical health professional. They should be offered psychological assessment to determine their mental capacity and the possibility of having a mental illness. The majority of people presenting after self-harm have a mental illness or a disorder2. Often treatment of the underlying condition with an antidepressant or other medication will be helpful.

Psychotherapy/counselling

Treatment of self-harm is based on the individual needs of the person.

Types of psychotherapeutic modalities which might be helpful are

• Dialectical Behaviour Therapy – teaches behavioral skills to help regulate distress and emotions.
• Psychodynamic Psychotherapy – focuses on identifying past experiences and interpersonal issues which might be at the bottom of emotional difficulties.
• Cognitive Behaviour Therapy – helps identify unhealthy beliefs and behaviours and replace them with positive ones.
• Mindfulness-based therapies – helps to live in the present moment.

Treatment NOT recommended

Recovery of past traumas are NOT recommended as this could escalate self-harm in some individuals.

Self-help

• Educate yourself as much as possible about self-harm. This may help you to understand the origins of your self injury, the reasons for it, advice on stopping and importantly – affirmation that there is support available to help you.
• .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.
• Support Groups are not considered helpful for self-harm, as members of the group might unintentionally encourage their self-harming behaviours. The only exception are groups for learning coping skills along with individual therapy or family therapy.

Family and friends

Advice on what how to help a person who is self harming.

Do’s

• Do reinforce that you love/like them but are concerned about the self-harming behaviour.
• Do educate yourself about self-harm.
• Do acknowledge the emotional pain of the person.
• Do 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. Share the load around.
• Do be supportive without reinforcing or colluding with the behaviour. Be willing to talk about the self harm and be open to hearing the person’s feelings or point of view.

Don’ts

• Don’t use emotional blackmail, such as ‘if you really loved me you wouldn’t do this’. .
• Don’t 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.
• Don’t 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.
• Don’t 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. 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 to seek help – providing support is more helpful than imposing limits.
• Don’t take it personally. Self harm is about the sufferer and not about you.

Refrences

1. Bardell, H. (2008). Cutting Edge: overcoming self-harm. North Sydney: Ark House
2. Walsh, B. (2006). Treating Self-Injury: A Practical Guide. The Guilford Press: NY
3. Self-harm and suicidal behaviours. Retrieved on 26 November 2015, from http://headspace.org.au/health-professionals/self-harm-and-suicidal-behaviours/
4. Berry, J. & Harrison, J. (2007). Hospital separations due to injury and poisoning, Australia 2003-2004. Australian Institute of Health and Welfare: Canberra. (p.x) Retrieved on 26 November 2015, from http://www.aihw.gov.au/publication-detail/?id=6442467934
5. (2015). The myths: Self-Harm and Suicide. Retrieved on 26 November 2015, from https://www.selfharm.co.uk/get-information/the-myths/self-harm-and-suicide
6. National Institute for Health and Care Excellence. (2014). Self-harm in over 8s: short-term management and prevention of recurrence. Retrieved on 27 November 2015 from http://www.nice.org.uk/guidance/cg16/chapter/1-recommendations#the-assessment-and-initial-management-of-self-harm-by-ambulance-services