Self Harm

Self-harm occurs when somebody deliberately damages or injures their body. The National Institute for Clinical Excellence (NICE) describes it as ‘self-poisoning, or injury, irrespective of the apparent purpose of the act’. Rather than being an illness, self-harm is an expression of personal distress. Even though there may be the possibility of life-threatening damage, it is not usually an attempt at suicide, but more a way of expressing deep emotional feelings, such as low self-esteem, or even self-hatred.

What causes someone to self-harm

Self-harm usually occurs when someone is suffering from very distressing or overwhelming feelings.
Self-harm may be an attempt to cope with traumatic events or situations, such as the death of a loved one, or an abusive relationship. Other typical triggers for include:

• Bullying
• Abuse (sexual, emotional or physical)
• Neglect
• Pressures at school or work
• Financial difficulties
• Family problems
• Housing problems
• Relationship difficulties
• Bereavement
• Loneliness or isolation
• Eating disorder
• Drug or alcohol abuse
• Coming to terms with sexuality
• Any experience or event that causes negative feelings, thoughts and tensions

For some individuals, an episode of self-harm may be triggered by a significant life event, but for others the day-to-day fluctuation in their thoughts and feelings is just too much to bear. Simple stress such as breaking a glass, or running late for an appointment can be enough to create such overwhelming tension, that they self-harm to cope. Sometimes, even positive experiences can create overwhelming feelings that lead to self-harm.

What is the ‘purpose’ of self-harm

The sufferer may feel that self-injury is a way of:
• temporarily relieving intense feelings, pressure or anxiety
• being real and alive, or feeling something
• feeling pain on the outside instead of the inside
• taking control of and managing their pain – compared to the uncontrollable pain they are experiencing from physical or sexual abuse
• stopping their emotional numbness (the self-anaesthesia that allows someone to cut without feeling pain)
• drawing attention to their need for help
• manipulating others by trying to make them care, feel guilty or go away

Some people who self-harm are punishing themselves for having strong feelings that they were not allowed t express as a child. They may also be punishing themselves for somehow being bad and undeserving. These feelings may stem from abuse and a belief that the abuse was deserved.

What types of self-harm are there

Typically, self-harm involves cutting or burning the skin, or behaving in a destructive or dangerous manner, such as abusing alcohol or drugs. Some individuals go for months without harming themselves, while for others self-harm can become a daily habit: something they do routinely to survive on a day-to-day basis, because they don't know what else to do.

When is it right to seek help

Recovery is always possible, however lost and overwhelmed the person might feel. The starting point for recovery is for them to understand why they self-harm. Armed with this knowledge, they can learn to respond differently to their problems. A good way to achieve this understanding is by talking to a counsellor. A counsellor can help the sufferer to see the underlying emotional difficulties that are making them unhappy, and help them to work out why they are using self-harm to cope.

What treatments are available

One danger of self-injury is that it often becomes an addictive behaviour – a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help is usually necessary. A doctor should be able to referral the sufferer to a mental health professional specialising in helping those who self-harm.

Cognitive-behavioural therapy (CBT) may be used to help the person learn to recognise and deal with their feelings in a healthier way.
Because a history of abuse or incest may be at the core of an individual’s self-injuring behaviour, a therapy that addresses post-traumatic stress disorder, such as EMDR, may be helpful.

Hypnosis or other self-relaxation techniques can help in reducing the stress and tension that often trigger self-harm.

Group therapy may be helpful in combating the feelings of shame associated with self-harm.

Family therapy may be useful, both in addressing any family issues related to the behaviour, and also in helping other family members learn how to help.
In a case that involves moderate to severe depression or anxiety, an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress while other coping strategies are developed. In a severe case of self-harm, in-patient hospital treatment may be required.