Understanding Self Harm

What is self-harm?

Self-harm is a direct and deliberate physically damaging form of bodily harm, which is intentionally not life-threatening, often repetitive in nature and socially unacceptable (Walsh & Rosen, 1988). Self-harm is used to cope with difficult and overwhelming feelings; and is chosen by the person to carry on living, rather than choosing to die.

The most common form of self-harm is wrist and body cutting. Other forms include scratching, burning, branding, punching, picking skin, hair pulling and hitting oneself against things. The severity of the self-harm varies with individuals, ranging from relatively minor through to causing serious damage.

Often the practice of self-harm is difficult to understand and anxiety-provoking for others. We need to understand and gain some level of comfort around these behaviours, to be able to effectively help those who self-harm. People who self-harm are struggling to cope and if they don't get help and support, problems may get worse and they may even harm themselves more seriously.

How common is self-harm?

This is hard to determine as most people who self-harm keep it private and do not seek help from professionals.

Generally self-harm begins in early adolescence and for some young people this continues into early adulthood.

Some people continue to have a chronic problem with self-harm in their adult years. This may indicate that their self-harm is a symptom of a more severe mental disorder, e.g. borderline personality disorder (see SIEC alert #43 www.suicideinfo.ca/csp/assets/alert43.pdf)

Why do people harm themselves?

Theories suggest it may be to do with:

Biological differences i.e. pain from self-harm causes the production of endorphins, which reduce dysphoric feelings. Therefore a cycle is formed where habitual self-harmers hurt themselves to feel better.

Social/Cultural factors i.e throughout time, self-harm has been performed in various religious and cultural practices, to create healing and stability within the community.

Psychological factors i.e. self-harm is learned and reinforced; the act of self-harm consistently reduces a state of heightened tension and is therefore reinforced. The reaction of others can also reinforce this behaviour. Or self-harm is seen as a symptom of underlying problems and is an attempt to cope with stressors in the person's life.

Risk factors for self-harm

Studies have shown that there are a number of risk factors in the backgrounds of young people who self-harm.

Childhood risk factors include:

• Physical and or sexual abuse
• Serious childhood illness and/or surgery
• Loss of a parent (through death/separation)
• Family violence or severe conflict within the family
• Impulsive and self-destructive behaviours in the family

Adolescent Risk Factors include:

• Eating disorders and body disconnection
• Recent significant losses
• High impulsivity
• Peer isolation and alienation
• Family violence or severe family conflict
• (Walsh & Rosen, 1988)

At a personal level, when young people are asked why they self-harm, the majority responded that they self-harmed to:

• "release intense, overwhelming, negative emotions "
• "gain temporary relief "
• "regain control over themselves and/or their life situation "
• "help them cope"
• "prevent suicide"
• "provide a temporary escape"
• "help themselves - form of self-help"
• "get rid of self-hatred or guilt - used as a punishment"

A smaller number of young people stated that they also used self-harm to:

• Deal with impulsive or compulsive thoughts and feelings
• Communicate their distress, feelings and/or needs to others
• Express their identity, to gain a sense of acceptance and belonging

A common myth is that people who self-harm do it for attention. Although a small minority of young people may hope to communicate their needs and influence others in this way, most people who self-harm do so in private and hide their scars. They fear being considered as 'freaks- and are usually ashamed of their behaviour. Seeking attention is a normal human need; and perhaps we would respond better by trying to figure out why a person needs to go to such lengths to get the attention they need.

Self-harm and Suicide

The underlying characteristics of self-harming and suicidal behaviour differ in their intention, method, potential to be fatal and frequency.

Characteristics	Self-harming behaviour	Suicidal behaviour
Intention	To relieve emotional pain; to live and feel better	To put an end to unbearable 'pain-; to die
Method	Thought to be non-lethal i.e. shallow cutting, burning etc.	Lethal or thought to be lethal
Potential to be fatal	Unlikely and perceived by the person as not fatal	Highly likely or seen by the person as likely to be fatal.
Frequency	Frequent, daily-weekly-monthly; repeated over time	Most likely to be a single or occasional attempt

People who self-harm hurt themselves to cope, gain relief and control. Whereas those who attempt suicide seek to put an end to a feeling of unbearable pain, the purpose of their behaviour is to die.

It is very important to understand the purpose or intent of any self-destructive behaviour. Do not assume that you can determine what the behaviour represents by its presentation. You need to ask the person about their motivation and intention i.e. do not assume that shallow cutting is self-harm, as the intent may be suicidal.

You need to find out if the behaviour is motivated by intent to die; if so, you need to take immediate action to ensure the safety of the person. Remember that people who self-harm are at greater risk of suicide.

What can you do to help?

When responding to a person who has self-harmed remember:

• Don't panic or overreact
• Make sure the person gets medical attention if needed.
• Try to respond neutrally (to prevent reinforcing the behaviour). Acknowledge what the person has done in a matter of fact way. Being angry or punitive can reinforce the behaviour; as can being overly caring or concerned.
• If other young people are present, take the person away from a situation where they might attract unnecessary attention. This helps to prevent contagion.
• The motivation to reduce or stop self-harming behaviour must come from the individual; ultimatums do not work!
• Help the person to access appropriate counselling or mental health support.
• Removing a coping strategy (without replacing it with more adaptive ones) can leave the person vulnerable if they have no other way of coping with their distress.
• Make yourself available to listen. Encourage them to come and talk out their feelings instead of self-harming. Cheerlead them when they do share their feelings.
• Take their problems seriously and model effective problem solving.
• Find ways to enhance self-esteem and recognise their positive qualities.
• Develop effective communication, coping and social skills.

Many people stop or reduce their self-harming behaviour as they learn better coping skills

Specialist help

There are different treatment approaches depending on what is causing the problem. Treatment often involves individual and family work. Individuals learn how to cope with overwhelming and difficult feelings that lead to self-harm. They also learn effective problem-solving skills; relaxation and stress management and how to deal with intrusive thoughts. If the person has an underlying problem (i.e. dealing with trauma in their background; depression or anxiety) this will also need treatment. Families often need help in how to best support the person.

References

Education Department of WA & Health Department of WA. (1998). Youth suicide prevention: Gatekeeper training manual. Perth, WA: YSAC

Jones, J. (1999). Self-harming behavior: A study of young people's explanations for their experiences. Unpublished Masters thesis, Curtin University.

Keith Hawton, Karen Rodham, Emma Evans, Rosamund Weatherall. Deliberate self-harm in adolescents: self report survey in schools in EnglandBMJ 2002;325:1207-1211 ( 23 November )

Nadine Jodoin, A Closer look at self-harm SIEC Alert, January 2001, No 43.

Walsh, B.W., & Rosen, P.M. (1988) Self-Mutilation: Theory Research and Treatment. New York: Guildford Press.