Self-harm refers to when a person deliberately inflicts physical injury on themselves. The most common forms include skin scratching or cutting, though burning, banging, hitting, or punching objects—or even oneself—are also frequent methods.
The arms, legs, and stomach area are the most commonly affected parts of the body.
Behaviours that could cause harm, such as substance use or excessive risk-taking, are only considered self-harm when the person fully intends to injure themselves.
Although self-harm and thoughts of suicide can sometimes occur together, the majority of people who engage in physical self-harm do not intend to end their lives. Instead, self-harm is often a coping mechanism, signalling emotional overwhelm, distress, or difficulties with emotion regulation.
Even though some of us can think of a glaring example of someone we once knew who had unsettling scars on their arms, most people keep their self-harm hidden from others.
The exact prevalence of self-harm can be difficult to establish because self-harm tends to be a hidden affliction. Most people who self-harm tend to experience shame or fear of being judged by others for their behaviour. As a result, most people who self-harm keep their behaviour a secret from others. It is often only when a person is being seen for other concerns such as anxiety, depression, substance use or trauma that the extent of their self-harm is uncovered.
Despite the often hidden nature of self-harm, there have been recent attempts within large-scale studies to identify how common self-harm is amongst individuals.
Taking a collection of studies into account, Swannell et al. (2014) estimated that approximately 17.2 % of adolescents engage in some form of self-harm, while 13.4 % of young adults self-harm and 5.5% of adults.
Some people tend to self-harm when dealing with intense negative feelings (often because of trauma) and/or a sense of a loss of control or overwhelm in their lives.
Although sometimes family members or loved ones can struggle to understand why someone they care about is self-harming, it’s important to know that behaviours (including self-harm) always serve a function or purpose. People need to be understood, not blamed, judged or criticized.
A person who engages in self-harm may be experiencing intense and distressing emotions such as sadness, fear, anxiety, anger, shame or numbness. The experience of these underlying emotions may or may not be evident to others.
Individuals who self-harm may have difficulty experiencing and coping with such painful emotions. This difficulty could be because the person was never taught how to notice, express and cope with feelings, or because they were shamed or blamed for their emotions or because they feel alone and/or unable to cope in other ways.
At a time in a person’s life when they felt overwhelmed by intense painful emotions, self-harm can show up as a part of self that engages in physical self-harm as a way to feel in control again of one’s body or mind and as a way to relieve stress or pressure.
Self-harm may also be a person’s way to express their emotions. Self-harm may also be an attempt to distract from painful memories or feelings such as anxiety, sadness, anger or other emotions.
In our clinical experience, some people activate with self-harm because of an underlying fear of their own anger. The inflicted self-harm allows a person to direct energy away from feeling angry and possibly hurting someone else and towards feeling shame and hurting oneself instead of another.
Self-harm is not a senseless act. The exact reason for self-harm can vary across people, but there is always a reason that makes sense. It’s important to explore and not to assume.
Regardless of the exact reason, to help someone who self-harms, it’s essential to understand and heal, not judge, panic or force alternatives on them.
For people who self-harm, there is often a risk that the person causes more injury than was actually intended. Self-harm with sharp objects while feeling intense emotions can be difficult to perform with exact precision.
Many individuals report experiences where they ended up with a more serious injury than intended, and this can lead to hospitalization, severe scarring, and even death. This is especially concerning because many people who self-harm may not seek medical attention because of the fear and stigma associated with self-harm.
Another reason to be concerned about self-harm is that self-harm can become more difficult to stop over time as the behaviour becomes habitual. Some individuals who engage in self-harm have described the addictive nature of their behaviour as, over time, they come to rely more and more on self-harm as a coping mechanism as a quick way or shifting intense emotional pain (Blasco-Fonerilla et al., 2016).
Therefore, it can be important to seek help as early as possible before more deeply entrenched habits and or patterns develop and then require more work to change.
In recent decades there have been increasing concerns that self-harm is becoming more common (Wester, Trepal & King, 2018).
Reasons for the increase in self-harm include: 1) the influence of people seeing more self-harm in the media, 2) social influences (youth copying behaviour of peers), 3) increases in stress and crisis amongst people, and 4) more people seeking mental health services and speaking about self-harm.
In short, we should be concerned about self-harm because people often cause more harm to themselves than intended, the injurious behaviour can be more difficult to stop with repetition and, increasingly people (especially youth) may be turning to self-harm when there is help available.
If you find yourself self-harming, it can be important to increase the quality of your support system. Consider seeking out peer support or speaking to a therapist or counsellor. A therapist can help you understand the root causes (and actual function) of your self-harming behaviours. Increasing your understanding will make it easier to establish a plan to address the reasons for your self-harm.
Although the exact plan can vary across individuals, in general, a plan to help with self-harm may involve first helping you to understand and appreciate the intent of the self-harm (often to try and protect from painful emotions or other feared outcomes).
The next steps may then involve enhancing your capacity to cope with emotions and/or self-regulate in the face of stress or distress.
Enhancing your coping can be achieved through strategies like mindfulness training, acceptance-based strategies, self-soothing and/or shifting negative internal dialogue.
Additional approaches may involve identifying concrete alternatives to self-harm, working to reduce stress and improving self-care. Trauma-focused therapy to help heal the impacts of previous experiences that continue to influence self-harming behaviours or urges may also be important.
In case these suggestions sound vague or overwhelming, let’s break things down in terms of what you can do starting right now:
Acknowledge that life can be challenging, and it isn’t easy sometimes to cope with things.
You are not alone. Many other people also self-harm. Don’t be hard on yourself.
Make a commitment to yourself. “Life can be difficult enough. I will strive to support myself through hard times. Instead of ______ (the form of self-harm you engage in) I will _______________” (see next step).
Identify 1-2 actions you will engage in instead of your usual form of self-harm. For instance, consider holding ice cubs or dunking your face in cold water or snapping a rubber band on your arm.
Keep your expectations realistic. Don’t expect the alternate action to equal your usual form of self-harm or completely ease your feelings. Initially, just look for a slight reduction in emotion intensity. Remember that the alternative action will be more effective with practice.
Think of your self-harm urges as being represented on a Thermometer, whereas the higher the temperature, the more intense the urge is.
Check-in throughout each day and see what the thermometer is saying. If the temperature is going up (the urges are stronger), be prepared to utilize your alternative action(s), OR:
Identify ways to self-soothe with your five senses. Examples of soothing include: listening to calming music, smelling a desirable essential oil, chewing gum, taking slower breathes, using a squeeze object etc.
Think of a wave metaphor- where you remember that all emotions pass and you just have to ride out this wave.
Reach out to someone to help you feel more supported, even if you don’t feel like it. People who reach out more often tend to make changes faster than those who withdraw. Talk to a friend or contact a counsellor or therapist. A therapist can help you solidify your coping plan and assist you in working on the underlying causes of your self-harm.
Don’t expect a straight road to recovery. Relapse is more common than not and can be seen as an opportunity to keep building alternative habits and building resiliency. Don’t give up because you are worth it, and change is always possible.
Even though it can be terrifying to see someone you care about engaging in self-harm, try not to panic. Strong reactions to self-harm may make the person shut down or withdraw from you. This could cause further distress or harm through shaming, which is counter-productive.
Try to find a balance between addressing the concern you have while remembering that most people who self-harm do not want to die or even cause serious physical injury to themselves. Do not make any assumptions. Try to gently explore the reasons the person feels they need to engage in the behaviour.
Even though you may not understand why the person is self-harming, try to remember that there is always a reason for a behaviour. With exploration and understanding, things always make sense.
If the person doesn’t want to talk about their self-harm, do not force them or take this personally. Gently let them know that you care and that you want to help them. Ask them what they need from you.
Let the person know that self-harm is not something to be embarrassed or ashamed about and may be more common than they think. At the same time, let the person know that their behaviour can become more serious than initially intended and that help is available. Encourage alternatives such as holding ice in their hands or self-soothing (see ideas above).
If the person is open to more information, direct them to a helpful website (see suggestions below) or to a counsellor or therapist.
If the person is not receptive to your concerns, consider whether anyone else would be able to talk to them. Be sure that person is supportive before suggesting they try to assist.
Don’t give up if you are struggling to get the person to consider additional supports or information. Gently check back in from time to time. Consider getting support for yourself in the meantime. It can be genuinely disheartening and disempowering to see someone you care about harming themselves.
Remember that acceptance, warmth and non-judgement is more likely to help your loved one come around than intense reactions or attempts to force help on them. In the meantime, continue to learn more about self-harm. Consider visiting other websites such as the site from Cornell University and also the Self-injury outreach & support (through Guelph & McMaster University).
If you or someone you care about is struggling with self-harm, seeking professional support can be a crucial step toward safety and healing. You can reach out through our contact page to explore confidential therapy and counselling options.
By clinical psychologist Dr. Jennifer Barbera C. Psych
References:
Blasco-Fontecilla, H., Fernández-Fernández, R., Colino, L., Fajardo, L., Perteguer-Barrio, R., & de Leon, J. (2016). The Addictive Model of Self-Harming (Non-suicidal and Suicidal) Behavior. Frontiers in Psychiatry, 7:8.
Swannell, S.V., Martin, G.E., Page, A., Hasking, P., & St. John, N.J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 2, 1-31
Wester, K., Trepal, H., & King, K. (2018). Nonsuicidal Self‐Injury: Increased Prevalence in Engagement. Suicide and Life‐Threatening Behavior, 48(6), 690-698.
International Society for the Study of Self-injury. (2018, May). What is self-injury? Retrieved from: https://itriples.org/about-self-injury/what-is-self-injury.
Important Websites/Resources:
Cornell University Self-injury & Recovery Resources (SIRR)
Self-injury Outreach and Support (Ontario): http://sioutreach.org
