What is self harm?
'Self harm' is a term which is used to describe a variety of harmful actions which people deliberately carry out in order to hurt themselves, from scratching at their own skin to non lethal overdosing. The World Health Organization defines self harm as:
‘An act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes which the subject desired via the actual or expected physical consequences’
How do people self harm?
People often associate self harm with cutting, but in reality there are many different ways in which people may hurt themselves. Some of the most common methods of self-harming include:
Cutting yourself
Poisoning yourself
Over-eating or under-eating
Biting yourself
Picking, scratching or bruising your skin
Burning your skin
Inserting objects into your body
Hitting yourself/hitting parts of your body against a wall
Non-lethal overdosing on drugs, alcohol, solvents etc.
Exercising excessively
Pulling out your hair
Getting into physical fights where you know you will get hurt
What are some of the common myths about self harm?
Self harm is usually a very private issue and it can be a really difficult subject for the person who self harms to talk about, as well as for those around them. The behaviour and the reasons for it are therefore often misunderstood, which generates myths and stereotypes around it. These misunderstandings in turn make it even more difficult for those affected to be open about and to ask for support. They may fear people will make assumptions, be judgemental, lack empathy and generally react negatively. So what are some of the common wrongly held opinions about self harm?
People who self harm are attention seeking
People who self harm are suicidal
People who self harm are mentally ill/have a specific mental health condition
People who self harm will grow out of it
People who self harm can stop if they want to
If the wound isn't that bad, the problem can't be either
None of these opinions are factually accurate, so...what really is the truth about self harm?
What is the underlying cause? Why do people self harm?
Research has shown that many people who harm themselves are struggling with intolerable distress or unbearable situations and that self harm can be a way of coping with this distress. Self harm can be described as:
‘...an act which we know does us physical or psychological damage but gives us temporary respite from difficult feelings.’
This 'respite from difficult feelings' is often what drives people to self harm. Some people do it because they don’t know how else to cope with the pressures of life. Difficult feelings such as fear, anger, guilt, shame, helplessness, self-hatred, depression or despair can get worse over time. If these feelings become unbearable, self-harm can be a way of dealing with them. People who self harm say that some of the reasons why they do it are:
When the level of emotional pressure becomes too much to cope with, it acts as a way of relieving the tension
Cutting makes the blood take away the bad feelings
Feeling physical pain can make you feel more alive when feeling numb or dead inside
It's a way of punishing yourself for something you've done wrong/something you've been accused of doing (it's in response to feelings of shame or guilt)
When it’s too difficult to verbalise feelings, it’s a way of communicating unhappiness as well as a way of acknowledging the need for help
It's provides a sense of control over one aspect of your life (that may be missing elsewhere)
It feels like an escape from experiencing emotional pain
It provides a way of showing on the outside how you are feeling on the inside
Some people self harm with the intention of ending their life, others may just be unsure about whether they want to live, therefore in taking an overdose they are leaving it to fate to decide the outcome.
A person will often struggle with mental health difficulties for some time before they begin to self-harm. Once a person begins self harming, it can become a compulsion. When a person self harms, chemicals are released into their brain which can very quickly become addictive, making the behaviour even more difficult to reduce or stop.
The diagram below shows the cycle of self harm. Self harm often begins as a way of relieving the pressure from built up emotions. It might give the person relief from the emotional pain that they're feeling, but it’s only temporary because the underlying causes for the behaviour are still there. Afterwards, feelings of guilt and shame often follow, which leads to the cycle continuing.
Some of the most common problems which people have experienced before self harming behaviours emerge are:
Experience of a mental health disorder e.g. depression, anxiety, borderline personality disorder or an eating disorder etc.
Being a young person who is not being cared for by their own parents, or a young person who has left a care home
Being part of the LGBT community
Having been bereaved, particularly by suicide
Having difficulties at home
Having arguments or problems with friends/friendship groups
Experiencing school pressures
Experiencing bullying
Having low self-esteem
Going through transitions and changes, such as changing school/moving home etc.
Alcohol and drug use.
Experiencing physical or sexual abuse
Having relationship problems with a partner or family members
Being unemployed, or having difficulties at work
You may also be more likely to harm yourself if you feel:
People don’t listen to you
You have no one to talk to
Hopeless
Isolated or lonely
Out of control
Powerless – it feels as though there's nothing you can do to change anything.
Who self harms?
Current research suggests that around 10% of young people self harm. Most people report that the self harming behaviour began around the age of 12. Those more likely to self harm are:
Girls and young women
Prisoners
Asylum seekers
People with learning difficulties
Veterans of the armed forces
People who are dependent on alcohol and/or drugs
Gay, lesbian and bisexual people (this seems at least in part, due to the stress of experiencing prejudice and discrimination)
A group of young people who self-harm together: having a friend who self-harms may increase your chances of engaging in this behaviour
People who have experienced physical, emotional or sexual abuse (particularly if it is in childhood)
What are the risks associated with self harm?
Although self harm is often felt to be the person's only way of coping, it has the potential to cause both short and long term physical and psychological damage. The most common side effects and consequences of self-harm (particularly when injuries are left untreated) are:
Broken bones
Social isolation and poor relationships
Increased feelings of shame, disgust and guilt about the behaviour
Poor self-esteem and self-image
Permanent scarringInjuries to tendons, nerves, blood vessels and muscles
Permanent weakness or numbness in certain areas of the body
Loss of limb or appendage
Multi-organ damage and/or failureInfections at the site of self-injury
Septicaemia
Increased risk of suicidal thoughts and behaviours
Accidental death
What are the alternatives, help and treatment for self harm?
While it's important to acknowledge that people who self harm often feel it's the only way they know how to cope with their situation, it is possible to live without self harm...there are safer and less harmful coping strategies which can be used as an alternative.
The following actions may help to distract you from your self-destructive emotions and thoughts which might otherwise lead to self harm:
Instead of hurting yourself, hold an ice cube in one hand and squeeze it. The sensation from the cold ice is numbing and very distracting.
Write on yourself with a red felt-tip marker instead of cutting. Draw exactly where you would cut. Use red paint or nail polish to make it look like you’re bleeding. Then draw stitches with a black marker. If you need to make it even more distracting, squeeze an ice cube in the other hand at the same time.
Snap a rubber band on your wrist each time you feel like hurting yourself. This is very painful, but it causes less permanent damage than cutting, burning etc.
Dig your fingernails into your arm without breaking the skin.
Draw faces of the people that you really dislike on balloons, and then pop them
Write letters to the people that you hate/those who have hurt you. Tell them what they did to you and tell them why you hate them. Afterwards you might want to throw the letters away, burn them etc. or save them to read later.
Throw foam balls, rolled-up socks, or pillows against the wall as hard as you can
Scream as loud as you can into a pillow or scream some where you won’t draw attention from other people e.g. at a loud concert or in your car.
Stick pins in a voodoo doll instead of hurting yourself. You can make a voodoo doll with some rolled-up socks or a foam ball and some markers. Or you can buy a doll in a shop for the specific purpose of sticking pins in it.
Cry... Sometimes people are afraid that if they start to cry they’ll never stop. This never actually happens. In fact, the truth is that crying can make you feel better because it releases stress hormones.
Therapy offers people an opportunity to explore the underlying causes and the impact of self harming behaviours, as well as a chance to build self esteem and find healthier ways of managing difficult feelings, regulating your emotions and coping with life. With the right help and support most people who self harm can and do fully recover.
Consider talking to a qualified therapist if you are concerned about your own mental health or anything else mentioned in this blog.
You can also contact the Samaritans on: 116 123 for free confidential support 24/7.