Self-Harm
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How common is self harm and how therapy can help?
Self-harm is a coping strategy involving intentional and direct injuring of oneself when challenged by overwhelming emotional situations. Self-harm can come in many forms, including: cutting, picking, scratching, burning the skin, and hitting parts of the body. Less apparent forms of harm can also be classed as acts of self-harm, including: over and under-eating, substance abuse, asphyxiation, overdosing on prescription and non-prescription drugs, and wilfully placing oneself in dangerous situations.
What is self-harm?
Self-harm is a coping strategy involving intentional and direct injuring of oneself when challenged by overwhelming emotional situations. Self-harm can come in many forms, including: cutting, picking, scratching, burning the skin, and hitting parts of the body. Less apparent forms of harm can also be classed as acts of self-harm, including: overeating and under-eating, substance abuse, asphyxiation, overdosing on prescription and non-prescription drugs, and wilfully placing oneself in dangerous situations. The term of ‘deliberate self-harm’ (DSH) may be used to describe these behaviours. Self-mutilation or self-injury can also be used to refer to intentional acts like burning and cutting.
What compels someone to self-harm?
When someone self-harms, it may seem as if they are looking to commit suicide. This is often not the case, as self-harm is commonly used as a coping mechanism to help the individual regain a sense of control or a moment of relief when they are overwhelmed and wish to live. Some people find that the pain of self-harm replaces the emotional pain they may be experiencing. For others, the physical pain of self-harm can be a reminder that they exist despite feeling numb from emotional pain. Self-harm can also be used as a way to punish oneself. Self-harm may be triggered by the following:
Attempting to cope with difficult situations: This can include a number of challenging experiences such as relationship breakdown, financial worries, sexual identity issues, bullying, or difficulties at school or work.
Attempting to cope with negative feelings: These feelings can include stress, anxiety, sadness, disgust, anger, loneliness, guilt, frustration, emptiness, distress, failure, abandonment, emptiness, perfectionism, powerlessness, and low self-esteem.
Attempting to escape unwanted memories: This can include older memories, such as abandonment or childhood abuse, or more recent memories of an assault, breakup, or any other experience that has resulted in feelings of upset, failure, or shame.
Attempting to gain control over one’s life and/or body: Self-harm may seem to present itself as a way to take charge of your life if it is severely out of control. Individuals who have experienced severe bullying, neglect, or physical or sexual abuse may also turn to self-harm as a way of regaining control over their own body.
Attempting to communicate that help is required: Self-harm may be used as a call out for attention and assistance when an individual struggles to communicate their feelings in a conventional manner.
How common is self-harm?
Self-harm affects people of all ages and backgrounds. Adolescents aged from 12-24 years old and groups experiencing high levels of poverty are more likely to self-harm than others. Cutting, often using a knife or other sharp object to break the skin, is the most common form of self-harm. Females are regarded as more likely to self-harm than males. This may be due to a tendency in females to cut as a form of self-harm, where as males are more likely to punch walls or hit parts of their bodies. With at least 10 percent of young people in the UK reportedly attempting to hurt themselves and 150,000 recorded visits to accident and emergency departments relating to intentional self-harming, the UK stands out as having one of the highest levels of self-harm in Europe. However, it is difficult to acquire accurate figures due to the secretive nature of self-harm and the reluctance of sufferers to seek help. Many people are able to resolve their issues with self-harm before adulthood, but figures suggest that 10 percent of people continue to self-harm in adulthood.
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What are the signs of self-harm?
The most obvious signs of self-harm are often visible wounds including burns, cuts, scars, or other unexplained injuries. Many people who self-harm may keep themselves covered, even in hot weather, to conceal evidence of their injuries with clothing or jewellery. Substance bingeing and other forms of self-harm may not be as visible.
Self-harm is often triggered by poor mental health and may be accompanied by signs of depression, low self-esteem, mood swings, distress, anxiety, frustration, guilt, powerlessness, and loneliness.
Stigma surrounding self-harm
It can be difficult for those of us who do not feel driven to intentionally harm ourselves to understand those who do experience such feelings. This can lead to misunderstandings about why people self-harm.
There is a misconception that people ‘self-harm for attention.’ While some people may self-harm as a cry for help, most individuals hide the evidence of their self-harm as they do not wish for others to know. A sense of privacy regarding self-harm can help an individual feel in control. Not all people who self-harm do so because they are very unwell. Self-harm is behavioural rather than a condition, meaning that it often occurs as a sign of psychological challenges than as a symptom of a personality disorder.
Self-harm does not always indicate that a person is experiencing suicidal thoughts. Many people who self-harm do so because it helps them want to keep on living, providing relief and a way of managing their feelings when life becomes overwhelming. It is, however, true that many people who have committed suicide also self-harmed in the past. Research indicates that individuals who self-harm are 100 times more likely to die by suicide in the following year than the average person.
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Psychological conditions and self-harm
Self-harm can go hand in hand with psychological conditions like depression and anxiety. However, it may be possible that your self-harming is a symptom of a larger psychological disorder. These psychological disorders include: obsessive-compulsive disorder, post-traumatic stress disorder, borderline personality disorder, bipolar disorder, and schizophrenia.
Eating disorders can have a relationship to self-harm, with both commonly affecting adolescents and females while also being linked with a desire for control and symptoms of depression. Around 25 percent of individuals with an eating disorder may also be self-harming, with rates of self-harm higher in those who binge and purge rather than those who starve themselves.
Individuals with autism may also self harm, with research indicating that between 20-30 percent of autistic individuals self-harm. It is important to distinguish self-harm performed by an autistic person and other harming behaviours associated with autism, including punching, head banging, and skin scratching used as forms of stimulation with no obvious intent. Self-harm has also been linked to alcoholism, with one half of people presenting at accident and emergency following intentional self-harm found to have consumed alcohol. Ten percent of these individuals are recorded as alcohol dependent.
Treating self-harm
Medication is not usually prescribed as an intervention for self-harm, but may be used to treat other psychological conditions connected to an individual’s self-harm behaviours. Instead, psychological help is widely regarded as the best way to help individuals recover from self-harm. It is important to note that once an individual has stopped self-harming, the issues that likely caused the compulsion to harm can emerge. In order to continue on the healing journey, it is important to seek help from a mental health professional or support group.
Treatment can vary depending on the individual. A therapist can work with you to help reduce the number of self-harm incidents, reduce the risk of further harm, improve your well-being and social function, enhance your self-esteem, and assist you to work through negative emotions associated with anxiety and depression.
Talking therapies have proven to be effective in treating self-harm. These therapies can be conducted on a one-to-one basis, or family therapy can be explored. Effective talking therapies for self-harm include:
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Psycho dynamic therapy
Examines the way your past experiences may have contributed to distorted thinking in your adult life and created unhelpful patterns of behaviour that are no longer working.
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Dialectical behavioural therapy:
Created specifically to deal with borderline personality disorder, this involves examining the connection between your thoughts and actions as well as learning techniques sourced from ancient Eastern philosophy. This is highly recommended for self-harm, especially if you are challenged by sudden overwhelming emotions related to borderline personality disorder.
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Cognitive behavioural therapy
Helps individuals to recognise how their feelings, thoughts, and actions work together.
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Group therapy
Helps individuals to feel understood, while also realising that you are not alone and self-harm is not behaviour to be ashamed of.
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Self-help
Books and online resources can help individuals recognise triggers and patterns that lead to self-harm while also teaching self-care techniques, building self-esteem, and offering distractions through healthy choices.
Emotion regulation, mindfulness, occupational therapy, distress tolerance, risk management, mentalisation-based therapy, cognitive analytic therapy, and transference-focused psychotherapy can also be explored as further approaches to treat self-harm and associated conditions.
Tips for combating self-harm
If you experience the urge to self-harm, consider following some alternative behaviours:
· Call a helpline
· Search for self-help resources online
· Take a fast walk outdoors
· Mark yourself with a red felt tip pen on your skin where you might usually cut
· Let yourself scream into a pillow
· Busy yourself with a creative task
· Write your negative feelings onto a piece of paper and rip it into pieces
· Rub ice across your skin in places where you might usually cut yourself
· Flick elastic bands on your arms, legs, or wrists to experience pain without real harm
· Exercise to produce adrenaline that can positively affect your mood
· Write inside a private journal
· Call and talk to a friend
· Make noise with a musical instrument or by banging pots and pans together
Overcoming self-harming behaviours
A therapist can work with you to uncover issues that may be driving you to self-harm and support you in finding ways to tackle life's challenges in healthier ways. They may also be able to recognise if your self-harm is being exacerbated by a related psychological condition.
By building a trusting relationship with your therapist, you can grow in confidence to express your feelings and emotions. A therapist should be empathetic and open when listening to anything you wish to share and you should not be forced into following a particular course of action.w