What Is Self-Harm?

Self-harm is a deliberate act of harming the surface of the body through cutting or burning. But can also include destructive and dangerous behaviour such as misuse of alcohol or drugs.

It is more common for people to think of self-harm as cutting and although any life-threatening injuries may occur, they are usually not intended as acts of suicide. But can, of course, lead to fatal and serious injuries non-the-less.

Self-harm is usually a way of coping with emotional pain, anger and frustration and can bring a momentary sense of calm. But this is followed by guilt and shame and the return of the painful emotions that they were trying to be avoided in the first place.

Self-harm is common among teens.

Self-harm is much more common among girls usually in the 15-19-year-old age range. But can be seen in children as young as 11. Please don’t rule out adults or boys though when thinking about self-harm either because it is related to other mental health issues.

Shame and fear of discovery mean that people often keep self-harm a secret. As a result, a parent may not be the first person to notice this happening, it can be your GP during a medical exam.

Self-harm may be commonly associated with other mental health conditions such as eating disorder (start here), PTSD, depression(In Teens, Adults)and anxiety.

What Are The Signs And Symptoms?

In no particular order the signs and symptoms of self-injury may include:

1. Old or new scars
2. Fresh cuts, scratches, bruises or other wounds
3. Excessive rubbing of an area to create a burn
4. Keeping sharp objects on hand
5. Wearing long sleeves or long pants, even in hot weather
6. Difficulties in interpersonal relationships
7. Persistent questions about personal identity e.g. “Who am I?” “What am I doing here?”
8. Behavioral and emotional instability, impulsivity and unpredictability
9. Statements of helplessness, hopelessness or worthlessness
10. Misuse of drugs or alcohol
11. Burn marks on the skin (usually with cigarettes)
12. Scratching or picking at the skin
13. Hitting or punching either themselves or an object
14. Deliberately breaking of bones
15. Pulling out hair
16. Swallowing poisonous substances, such as glue or bleach
17. Taking an overdose of drugs, including prescription medication
18. Carving words or symbols on the skin
19. Piercing the skin with sharp objects

As I’ve said self-harm usually occurs in private and is done in a controlled or ritualistic manner. Any area of the body can be targeted but usually the arms, legs or front torso as these can be covered and hidden allowing for the self-harm to continue in secret.

Many people self-harm only a few times and then stop. But others will continue and it becomes a long-term repetitive behaviour.

The Causes and Risk Factors.

There’s no one single or simple cause that leads someone to self-harm. In general, though, it is thought that non-suicidal self-harm is usually the result of an inability to cope in healthy ways with psychological pain.

The person has a hard time regulating, expressing or understanding emotions. The mix of emotions that triggers self-harm is complex e.g. there may be feelings of worthlessness, loneliness, panic, anger, guilt, rejection, self-hatred or confused sexuality.

Certain risk factors may increase the risk of self-harm.

These may include:

1. Age.
2. Having friends who self-harm.
3. Life issues: neglect, abuse or other traumatic events.
4. Mental health issues: borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders.
5. Excessive alcohol or drug use.

Diagnosis and Treatment

Some people may ask for help but more likely it will be discovered by family members, their friends or a doctor.

There’s no diagnostic test for self-harm. But it is usually based on a physical and mental evaluation carried out by a psychiatrist or psychologist who has experience in dealing with and treating self-harm. They may also evaluate for other mental illnesses that may be linked to self-harm.

Treatments

There is no one treatment plan for self-harm. It is based on the needs of the individual being treated taking into account any other mental health-related issue.

Psychotherapy also known as talk therapy or psychological counseling can help the individual identify and manage the underlying issues that trigger self-harm.

Several types of individual psychotherapy may be helpful, such as:

1. Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
2. Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you tolerate distress, manage or regulate your emotions, and improve your relationships with others
3. Psychodynamic psychotherapy, which focuses on identifying past experiences, hidden memories or interpersonal issues at the root of your emotional difficulties through self-examination, guided by a therapist
4. Mindfulness-based therapies, which help you live in the present, appropriately perceive the thoughts and actions of those around you to reduce your anxiety and depression and improve your general well-being

In addition to individual therapy sessions, family therapy or group therapy also may be recommended. Dont forget  that as parents and a family you too need support so consider therapy for yourself and any siblings.

If the person injures themselves severely or repeatedly, the doctor may recommend that they be admitted to a hospital for psychiatric care. Hospitalization, often short-term, can provide a safe environment and more intensive treatment until they get through a crisis. Day treatment programs also may be an option.

How to help yourself after diagnosis.

1. Stick to your treatment plan and keep therapy appointments and take prescribed medications as directed.
2. Recognize the situations or feelings that might trigger your desire to self-injure. Make sure you have worked out a plan with your therapist to help you soothe or distract yourself or to get support, so you’re ready the next time you feel the urge to self-injure.
3. Ask for help. Keep a list of supporters  and their numbers handy so you can ask them to help you if you feel like self-harming and keep your doctor or therapist’s phone number handy, and tell him or her about all incidents related to self-injury.
4. Take care of yourself. Learn how to include physical activity, eat healthily and relaxation exercises as a regular part of your daily routine. Ask your GP/Therapist for help if you have sleep problems, which can significantly affect your behavior.
5. Avoid alcohol and recreational drugs. They affect your ability to make good decisions and can put you at risk of self-harm.
6. Take appropriate care of your wounds if you injure yourself or seek medical treatment if needed. Don’t share instruments used for self-injury — that raises the risk of infectious disease.

Coping skills and support for family and friends

1. Get information. Learning more about self-harm can help you understand why it occurs and help you develop a compassionate but firm approach to helping your loved one stop this harmful behavior.
2. Know the strategies and relapse prevention plan your loved one has developed with the therapist so you can encourage it.
3. Try not to judge or criticize. Criticism, yelling, threats or accusations may increase the risk of self-harm behaviour. Offer support, praise efforts to express emotions in healthy ways and try to spend positive time together.
4. Let your loved one know you care no matter what. Remind the person that they are not alone and that you’re available to talk.
5. Recognize that you may not change the behaviour, but you can help the person find resources, identify coping strategies and offer support during treatment.
6. Support the treatment plan. Encourage your loved one to take prescribed medication and stress the importance of keeping therapy appointments.
7. Remove or limit access to matches, knives, razor blades or other items that may be used for self-harm.
8. Share coping strategy ideas. Your loved one may benefit from hearing strategies you use when feeling distressed. You can also serve as a role model by using appropriate coping strategies, set healthy boundaries and stress reduction techniques.
9. Find support and get therapy yourself. Consider talking to people who’ve gone through what you’re going through. Share your own experiences with trusted family members or friends. Ask your GP or therapist if there are local support groups for parents, family members or friends of people who self-harm.
10. Take care of yourself, too. Take some time to do the things you enjoy doing and get adequate rest and physical activity.
11. Suicide Risk: If at any time you feel there may be a risk of suicide then don’t hesitate to call 999 or 112 immediately.

Work With Me.

Remember you are allowed to ask for support. No woman is an island. In fact I would strongly advice you make sure you create a positive support system before you start to make any changes in your life.

If you need extra support then you can also work with me. We all struggle with stress and overwhelm from time to time. If you find this has become a problem for you and you’d like some support then schedule an appointment with me.