counsellingMental HealthpsychotherapyHow can I help someone who is self harming?

What Is Self Harm And How Can You Recognise It In Those Around You?

While engaging in self-harm behaviours does not significantly indicate suicidal intent, however, research shows that individuals who engage in self- harm are at a higher risk of developing suicidal thoughts or engaging in suicidal behaviour. In fact, self- injury surpasses other suicide risk factors.It has been found that suicidal death is strongly associated with any previous self- injurious thoughts or behaviors. Therefore, a history of previous self-injurious behaviors can predict potential suicide attempts. Additionally, research has shown that among individuals who engage in self-harm, a notable 26% may progress to attempting suicide. This should have implications as to how medical practitioners view self- harm. It is crucial that self-harm is not merely seen as superficial wounds like cuts or burns, but rather as a gateway to increasingly harmful behaviors over time. It’s not just a cry for help, it’s an attempt to feel something before the overwhelming desire to feel nothing at all takes over, especially if they don’t get the help they need!

What is self harm?

It is a deliberate attempt to inflict physical pain upon oneself to relieve serious emotional distress. There is no conscious intent to commit suicide, but rather the intent lies in giving oneself a physical outlet to express an emotional wound. By engaging in behaviors such as cutting, burning, or hitting oneself, individuals seek temporary relief from overwhelming emotional pain or numbness. It’s a way for them to regain a sense of control over their emotions or to actively channel their internal turmoil that feels too intense to keep inside. In essence, self-harm functions as an unsustainable, unhealthy coping strategy for individuals who face severe emotional difficulties and perhaps, don’t know how to deal with them. Furthermore, Research has also shown that unlike what might be the general view, rates of individuals who engage in self harm behaviours has increased over time. One study examining self-injury in over 40 countries discovered that:

  • Approximately 17% of individuals will engage in self-harm at some point in their lives.
  • The typical age of the first instance of self-harm is 13 years old.
  • Cutting is the chosen method of self-injury for 45% of individuals.
  • Roughly half of individuals, or about 50%, seek assistance for their self-harm, predominantly turning to friends rather than professionals for help.

Onset of self harm

The habit of self harming to cope with difficult or intense emotions is not something that forms overnight. The inability to handle and communicate intense emotions and the uncertainty of how they will be received by others are at the core of self harming behaviours. Perhaps, this is why self harm begins at an early age, where one lacks the emotional intelligence and the adequate communication tools required to proceed in healthy expressions of emotions. Studies have shown that self harm can begin as early as the age of 11. In a study from India, self harm behaviours amongst adolescents and young adults were found to be 33% of the total population of 1571 students. Even in childhood, self harm can take many forms including cutting, scratching, burning, bruising, puncturing, embedding objects, hitting oneself, and more. One might view the act of inflicting harm to oneself as a way of communicating what one cannot express verbally or doesn’t know how to.

Self harm is not a way of seeking attention and is usually done in private and kept as a secret as one attempts to conceal their injuries or even self- medicate.

Self Harm can be categorized as Deliberate self harm (DSH) and Nonsuicidal self injury (NSSI). Deliberate self harm is characterized by purposeful self-infliction of injury or ingestion of harmful substances, irrespective of the underlying motive or the level of suicidal intent. It serves as an important precursor to suicide. On the other hand, Non suicidal self injury is defined as the act of inflicting physical harm to oneself without any intention to end their life, it can include cutting, scratching, carving on one’s skin using sharp objects, punching into the wall, and more. While they may vary in certain aspects, both deliberate self-harm and non-suicidal self injury serve as significant indicators of potential suicidal attempts and therefore, deserve our attention and awareness.

The diagnostic and statistical manual of mental disorders (DSM) has laid out definite criteria for assessing and concluding the condition of non suicidal self injury. It is not yet assumed to be a disorder but it is considered as one of the “Conditions for Further Study” in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and perhaps might be classified as a disorder in the upcoming versions of the text.

Non suicidal self-injury involves symptoms like:

  • Committing self-harm on five or more occasions in the past year
  • Injuring oneself to alleviate unpleasant emotions, resolve conflicts in relationships, or achieve a desired emotional state
  • Unwanted feeling like depression, anxiety or anger, an intense focus on completing the behavior and frequent thoughts of self-injury

What are the different methods used to inflict self harm?

  • Cutting oneself
  • Pinching or scratching on one’s skin
  • Carving on skin using sharp objects
  • Ripping old unhealed wounds
  • Self Burns
  • Impeding healing

Who all engages in self harm behaviour?

  • Adults: Except for very young children, adults demonstrate the lowest tendency to engage in self-injury. Only approximately 5% of adults have admitted to self-harming during their lifetime.
  • Teens: Adolescents exhibit the highest prevalence of self-injurious behaviors, with roughly 17% acknowledging self-injury at least once in their lifetime.
  • College Students: Research indicates that around 15% of college students disclose involvement in self-harm.
  • Sexual minorities: Queer population is at a high risk of engaging in self harm behaviours. A study found that nearly half of the bisexual women have engaged in self harm atleast once in their life.

What are the Risk factors for self harm?

  • Having friends or family members who self-injure
  • Mental health conditions, like depression, anxiety and personality disorders.
  • Substance use and addiction
  • Experiencing pain as a “ positive sensation”, viewing it as a reinforcer.
  • Other factors associated with self harm include poor socioeconomic status, history of bullying, loneliness and weak family/ social relationships.

Research has also shown that women engage in self harm at a higher rate than men, even though men are at a higher risk of dying by suicide.

What are the warning signs of self-harm?

  • They have cuts, burns or bruises on their wrists, arms, & legs.
  • They usually wear baggy or loose clothes (e.g., wearing hoodies or long sleeves during hot days to conceal the wounds).
  • You mostly find them making excuses for having cuts, marks or wounds on the body.
  • They stock razors, scissors, lighters or knives in strange places (i.e., the nightstand drawer or under the bed).
  • They spend long periods locked in a bedroom or bathroom.
  • They self isolate and avoiding social situations.

How is self harm different from suicide?

The main difference between suicide and self-harm lies in the intent behind the actions. People who attempt suicide are dealing with overwhelming life challenges or mental health issues that cause unbearable suffering, leading them to seek an end to their pain. Suicide attempts typically stem from feelings of hopelessness, despair, and worthlessness. In contrast, individuals who engage in self-harm do so as a way to manage their overwhelming emotions and cope with stressors. For some, the pain resulting from self-injury serves as a reminder of their existence, particularly when they feel emotionally numb or disconnected from the world. Also, the physical act of cutting or burning activates pain receptors in the body, triggering a rush of adrenaline in the brain. This sensation can become addictive and pose significant risks to one’s well- being.

Although the two are quite different, they have many overlapping risk factors. These include:

  • History of trauma, abuse, or chronic stress
  • High emotional perception and sensitivity
  • Few effective mechanisms for dealing with emotional stress
  • Feelings of isolation (this can be true even for people who seem to have many friends/connections)
  • History of alcohol or substance abuse
  • Presence of depression or anxiety
  • Feelings of worthlessness
  • Because of these and other risk factors, the presence of non-suicidal self- injury is, in and of itself, a risk factor for suicidal thoughts and behaviours.

What are some barriers to seeking treatment?

  • Stigma: There is often a social stigma surrounding self-harm, which can lead individuals to feel ashamed or embarrassed about their behaviors. Fear of judgment from others may prevent them from seeking help.
  • Lack of awareness: It is possible that one may not be aware how urgent and important it is to assess these self inflicted injuries, and what the implications might be if such behaviour goes unchecked.
  • Fear of consequences: People who self-harm may fear negative consequences, such as being hospitalised involuntarily or facing repercussions in their personal or professional lives, which can impede with their ability to seek help.
  • Minimisation of symptoms: Some individuals may minimise the severity of their self-harm behaviours or may not recognise them as a sign of underlying mental health issues, leading them to delay or avoid seeking help
  • Limited access to resources: Access to mental health services, including therapy and support groups, may be limited or unavailable in certain communities. Financial constraints or lack of transportation can also pose barriers to seeking help.

How can you support someone who engages in self harm?

  • Acknowledge their emotions: Self- harm often results from serious emotional distress. By showing genuine care for one’s wellbeing by simply asking “how are you feeling?” can make a huge difference to them. Avoid asking them “why are you doing this” or preaching instantly that there are other, better ways to deal with stress. They probably know that.
  • Be non- judgmental: There is a lot of stigma around self- harm and it can cause one to feel ashamed or embarrassed to speak up about it. Let them know, they need not apologize to anyone.
  • Just listen: Listen to them as intently and compassionately as possible so you can increase the likelihood of them expressing their emotion by talking instead of acting out on them in the future.

Please do not forget take care of yourself in the due process of being there for someone who engages in self-harm. You do not need to have all the answers. You just need to be kind and listen well.

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You might also want to read about breaking free from societal expectations.

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