Self-harm is a way of expressing very deep distress. It's a means of communicating what can't be put into words or even into thoughts and has been described as an inner scream. Self-injury can be understood as a coping mechanism so that an individual harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation. For those that self-injure the physical pain is often easier to deal with than an emotional pain because it causes ‘real’ feelings. Afterwards, people feel better able to cope with life again – for a while. However it’s not unusual for the person not to understand why they self-harm, nor for them to know what deeper feelings they are connected to.
People self-harm in many ways including:
- Injuring themselves by scratching, cutting or burning the skin
- Poisoning themselves
- Hitting themselves against hard objects
- Taking drug overdoses
- Swallowing or putting other things inside themselves
- Hair pulling
Self-harm may also take less obvious forms including taking unnecessary risks, staying in an abusive relationship, developing an eating disorder (such as anorexia or bulimia), becoming addicted to alcohol or drugs or even simply not looking after their own emotional or physical needs.
Typically people who self-harm will try to conceal what they are doing rather than draw attention to it, as they feel ashamed, afraid or worried about how other people will react.
It is worth remembering that most people behave self destructively at times even when not realising it to avoid being alone with their thoughts and feelings. They may smoke, drink, eat or work too much.
Why do people self-harm?
Self-harm is a coping strategy that helps people to manage their emotional hurt or stress. It is important to remember that it is not attempted suicide, but it is something that people do in order to survive. Often people self-harm to try and feel as if they have more control over their emotions, or to get immediate relief from high levels of distress. Sometimes people harm themselves because of self-hate, or because they want to punish themselves.
There are more young women than men who self-harm, although the numbers of young men is currently on the increase. Often the person will have gone through or is going through a very painful or difficult experience, are under a number of stresses from families, friends or school, or are having to make demanding life decisions. It’s not unusual that these people are also depressed or anxious, although not all self-harmers show any other mental health symptoms.
A person who self-harms is likely to have gone through very difficult, painful experiences as a child or young adult. At the time, they probably had no one they could confide in so didn’t receive the support and the emotional outlet they needed to deal with it. The experience might have involved physical violence, emotional abuse, or sexual abuse. They might have been neglected, separated from someone they loved, been bullied, harassed, assaulted, isolated, put under intolerable pressure, made homeless, sent into care, into hospital or to other institutions. Experiences like these erode self-esteem. Emotions that have no outlet may be buried and blocked completely out of awareness. If a trusted adult betrays or abuses them, and there are no other witnesses, children will often blame themselves. They turn their anger inwards. By the time they become adults, self-injury can be a way of expressing their pain, punishing themselves, and keeping memories at bay.
There is often an absence of pain during the act of self-injury, rather like the absence of sensation that often occurs during abuse or trauma. The body produces natural opiates, which numb it and mask the emotions so that little is felt or realised consciously. A badly traumatised person may end up feeling quite detached from their feelings and their body. Some may injure themselves to maintain that sense of being separate, and to convince themselves that they aren’t vulnerable. Others may injure themselves in order to feel something and know that they are real and alive.
If experiences were so painful they forced you to deal with your emotions by hurting yourself, you may now seriously doubt whether you can deal with them in any other way. However, people do move forward and can grieve over past events or a lost childhood and work through the fear and confusion surrounding them. With plenty of support, they learn that they can cope with the pain, anger and rage which need to surface.
The important thing is to find ways to start talking to someone you trust. It could be to a friend, a family member, a professional counsellor, a psychologist or a psychotherapist.
A professional should have the training to listen to you and help you reach your feelings and manage them in a different way. Problems in the present and from the past all need to be addressed. If you can, find someone who specialises in treating people who self-harm, who have eating problems or who have been abused.
For all individuals the starting point for recovery is to become aware of their reasons for, and drivers to, self-harm. It is armed with this knowledge that they can learn to respond differently to their difficulties. Recovery is always possible, however lost and overwhelmed the person feels.
It is important to remember that you have choices. Remember it is not your fault, you are not to blame for having strong negative feelings, they are a normal response to what has happened to you. Your self-injury is a way of surviving this.
The following tips may help you in overcoming self-harm:
- Get informed about your own behaviour: What is happening, what are you feeling, what are you thinking when you feel the need to self harm? It is useful to keep a daily diary to record how you cope with powerful emotions.
- Talk with someone you trust about how you feel. You do not need to suffer in isolation. There are others who can understand your pain and distress and help boost your strength and courage to manage.
- Join a support group.
- Build your self-esteem by writing positive statements about yourself, telling yourself something affirming, listening to songs or reading poems that have soothing or positive words.
- Reduce the stress in your life by working less, eating healthily, sleeping well, and taking regular exercise.
- Remind yourself that you deserve good things in life and treat yourself with something you enjoy.
- Keep in touch with friends or helpful organisations when you hit a crisis point.
- Think about your emotions especially anger, hate and rage. List the people who have hurt you or that you have strong feelings towards.
- Hitting or kicking cushions that represent these people is a safe way to give expression to feelings that you have kept inside. Tell them how they hurt you and that you don’t deserve punishment. Try to do this with a trusted friend or counsellor so that you do not hurt yourself.
- Another way to give expression to your difficult feelings is to draw them with crayons / paints. Some people find it helpful to draw on their bodies with bright body colours.
- Find a creative alternative that shows how you feel perhaps dancing, music or writing poetry.
- Stay within safe limits if you do need to self-harm, your GP should be able to advise you on minimising and taking care of your injuries.
Supporting someone who self-harms
The most constructive way to deal with self-harm is to stay calm, try not to be alarmed or show your fears. It may be that the individual needs structured therapy from a mental health professional, or that the compassionate support of family and friends is enough to aid their recovery. The most helpful treatment for people who self-harm is any talking therapy that usually takes place over a number of months or years.
Supporting someone who self-harms can be very difficult and challenging. Knowing that someone you care about is in emotional distress can create many feelings including fear, anger, frustration, helplessness and sadness. Try to make sure you have a way of dealing with your own feelings as the person you are supporting is going to need all the patience, understanding and support you can give.
Remember that the individual you are supporting is in distress, their actions are not intended to make you suffer. Try to imagine how desperate you would have to be feeling to cause actual physical harm to yourself. Many people who self-harm feel completely ashamed and isolated by their difficulties. The best source of support you can give is to reduce this shame and isolation by providing an unconditional relationship. Allow the person to express their feelings whatever these may be as this might be fundamental to their recovery.
- MIND – Leading charity MIND publish case studies, symptoms, causes, treatment options, further reading and useful links. They also have a useful resource, ‘About Self-Harm: A Guide for Young People’.
- Self-Harm.org.uk – A resource for people who self-harm, their friends and families and professionals working with them.
- Harmless – Harmless is a user led organisation that provides a range of services about self-harm including support, information, training and consultancy to people who self-harm, their friends and families and professionals.