What is Self-Harm & How to Deal with it?
The US government’s mental health website, MentalHealth.gov, puts it succinctly. The website explains that self-harm is when an individual intentionally harms themselves. According to the brief description, 5% of the population engages in self-harm, and more women than men harm themselves. Although a person who hurts themselves does not mean to kill themselves, they may be at a higher risk of attempting suicide if they do not receive help.
Most people cut or harm themselves because they claim it gives them a sense of relief — as a maladaptive coping mechanism. Others harm themselves to seek help or attention from those who are important to them, sometimes due to impulse control issues. Indeed, a variety of psychological conditions can cause one to harm themselves.
To paraphrase the same website, self-harm includes:
- Cutting yourself
- Punching yourself
- Burning yourself with a cigarette
- Pulling your hair
- More serious injurious behaviors like sticking objects through body openings
- Breaking one’s bones or bruising oneself.
As you can see, the list of self-harm behaviors on the website is not comprehensive, and they may greatly vary depending on the severity of the mental disturbance and socio-cultural factors. The repertoire of self-harm behaviors is vast, and the severity can vary depending on several factors.
In this article, we look at self-harm in detail and understand how to manage this maladaptive coping mechanism.
What is self-harm?
Self-harm consists of a range of behaviors that involve deliberately causing pain or harm to one’s body. Most people associate self-harm behaviors with cutting, head-banging, beating oneself up, and other behaviors that inflict apparent external injuries to one’s body.
However, self-harm can be more insidious and complex. It can include harming oneself emotionally, remaining in an abusive relationship, binge-drinking alcohol or using illegal substances, and deliberately having unprotected sex with random strangers. Consuming too much sugar when you have diabetes can be a form of self-harm, although most wouldn’t recognize it that way.
Types of self-harm
There are two essential kinds of self-harm behaviors:
- Non-suicidal self-injury (NSSI)
- Suicidal self-injury.
Non-suicidal self-injury (NSSI)
Halicka and Kiejna explain that approximately 10% of the population worldwide engages in NSSI. You may notice this figure is higher than the government estimates mentioned above. This is because what we consider self-harm behavior can significantly vary depending on who is diagnosing and who is being diagnosed.
If we include harmful use of alcohol, drugs, unprotected sex, and choosing to remain in abusive relationships, the rate of NSSI dramatically increases. NSSI has long been understood as an adolescent phenomenon. However, clinicians and therapists now know that adults engage in it equally, if not more. Halicka and Kiejna explain that current research shows that adults engage in self-harm behaviors as much as adolescents do.
Suicidal self-injury, on the other hand, has a different motive. While a person who engages in NSSI may or may not have a death wish, suicidal self-injury is goal-directed — the person participates in self-harm to kill themselves. A variety of psychiatric conditions can cause suicidal thoughts and behaviors. These include mood disorders such as major depressive disorder and bipolar disorder, schizophrenia, and personality disorders such as borderline personality disorder.
Non-psychiatric causes of suicidal self-harm are common too. Many people who otherwise do not meet any psychiatric diagnostic criteria reveal that they feel “dead inside” or “don’t see a point in living anymore.” Several people engage in suicidal self-harm when overwhelmed by circumstances and do not see an escape route. A third category of people who engage in suicidal self-harm is those with physical illnesses that cause immense pain, including terminal illnesses.
It is difficult to predict which self-harm behavior is a red flag for suicide. Indeed, the variety of self-harm behaviors may overlap in non-suicidal and suicidal self-injury. Hence, it is essential to take every act of self-harm seriously and provide access to psychiatric care and suicide helplines.
Know the warning signs
Self-harm can be notoriously difficult to detect. People who cut themselves often wear long-sleeved shirts, or they may use concealers to hide the scars. They may also convincingly explain away wounds and cuts, which an untrained person may believe to be true. Moreover, it becomes difficult to detect if the non-suicidal self-injury does not involve apparent physical injuries. However, there are certain red flags that you can watch out for if you suspect your loved one is engaging in self-harm:
- Unexplained wounds, scars, and cuts on wrists, chest, thighs, etc.
- Keeping oneself fully covered even during warm weather
- Patchy hair loss
- Binge drinking, eating too much or too less, using drugs
- Devaluing oneself or expressing chronic emptiness
- Excessive sleep or lack of sleep
- Inappropriate emotions, especially when confronted with abuse.
Almost every kind of psychological disturbance can hint at self-harm, both suicidal and non-suicidal. Hence, it is difficult for untrained people to identify warning signs for self-harm. A more practical and helpful approach is to look for signs of emotional disturbance and offer unconditional support while recommending that they seek therapy or counseling. Even if the person does not engage in self-harm, a visit to the psychiatrist or clinical psychologist can clear away many things.
How to deal with self-harm
If you are engaging in self-harm behaviors, know that help is available. A clinical psychologist or psychiatrist will help you understand the underlying beliefs that drive you to inflict self-harm. Psychiatrists may also prescribe medications that help alleviate symptoms of psychopathology that may cause self-harm behaviors. For example, Borderline Personality Disorder (BPD) is notorious for non-suicidal self-injury. People with BPD are also at high risk for suicidal self-injury.
If your loved one or someone you know is engaging in NSSI or suicidal self-injury, it is time to alert their caregivers. If you are the caregiver, gently approach the topic in a non-confrontational manner, and get them to speak to a counselor or therapist. A registered social worker (in some jurisdictions), a mental health nurse, or a clinical psychologist can all be good options. Please do remember you cannot talk away either NSSI or suicidal self-injury. Both require professional help.
Why do people self-harm?
People engage in non-suicidal self-injury (NSSI) and suicidal-self injury for various reasons. In most cases, professionals can find an underlying psychiatric or psychological cause. Common mental health conditions associated with NSSI are personality disorders such as Borderline Personality Disorder, psychotic conditions such as schizophrenia, mood disorders such as major depressive disorder and bipolar disorder (especially during a hypomanic or manic state), and autism spectrum disorder (ASD). Substance abuse disorders, eating disorders, and obsessive-compulsive disorder (repeated hand washing until the skin starts to peel off or compulsively pulling hair) may also result in non-suicidal self-injury.
Suicidal self-injury, on the other hand, may or may not be due to an underlying psychiatric condition. Although depression, schizophrenia, borderline personality disorder, and other mental health conditions significantly increase the risk of suicide, many people who are otherwise mentally healthy choose to die by suicide as well.
Consequently, it is hard to predict why individual instances of self-harm occur. Some feel a sense of comfort or relief from emotional disturbance, while others may use self-harm as a distraction technique. Others may punish themselves with injuries because they think “they deserve it.” The bottom line is whether you engage in NSSI or suicidal self-harm, or someone you know seems to be engaging in it, professional mental health care helps.
What to do when someone self-harms
When someone self-harms, it can be alarming to those around them. Here is what you can do:
- Remember that self-harm cannot be talked away, and most people do not do it to seek attention.
- Approach the person who self-harms in a non-confrontational and gentle manner.
- Give them time to understand that help is available, and they can start feeling better.
- Once they are open to seeking help, guide them to the professionals.
- Try to find out the nearest mental health care unit and have a word with a professional.
- Fix an appointment for your loved one so that they are attended to by those who are trained to do so.
Effects of self-harm
The effects of self-harm depend on the degree and the kind of injury one inflicts upon oneself. If the non-suicidal self-injury involves cutting, bruising, burning, etc., the short-term effects include excruciating pain, infections, skin damage, and even gangrene. Long-term effects include scars, tissue damage, and nerve damage. For instance, cutting oneself in the wrists can cause numbness and permanent weakness in the arm.
Other kinds of self-harm, such as alcohol abuse and binge eating, can affect internal organs and cause damage to the liver and kidneys. Suicidal self-injury, at worst, can cause death. If the attempt is unsuccessful, it causes debilitating effects that may persist throughout one’s life. In addition, self-harm also has psychological effects ranging from low self-esteem to depression and anxiety. Consequently, it is essential to seek mental health care at the earliest.
MYTH: ‘Self-harm is ‘attention-seeking.”
Very few people inflict injuries on themselves to seek attention. Most people who engage in non-suicidal and suicidal self-harm do so because of an underlying psychiatric or psychological disturbance that needs to be treated professionally.
MYTH: ‘Self-harm is a goth thing.’
While the gothic subculture may superficially appear preoccupied with darkness, self-harm is not one of the features of the subculture. Goth subcultures emphasize appreciating specific kinds of music, literature, art, and fashion. All of these have got nothing to do with self-harm. On the other hand, many people have felt accepted by goth communities and noticed a significant improvement in their social lives.
MYTH: ‘Only girls self-harm.’
Previously, people believed self-harm was a feature of adolescent rebellion, but researchers have shown that adults engage in it equally. Both men and women are at risk of self-harm. Similarly, men, boys, girls, and women are all equally at risk of self-harm.
MYTH: ‘People who self-harm must enjoy it.’
Although some people engage in self-harm to cope with emotional distress or as a maladaptive distraction technique, most suffer from depression, anxiety, and low self-esteem due to self-harm behaviors. Many professionals believe self-harm is a cry for help.
MYTH: ‘People who self-harm are suicidal.’
Not necessarily, and not always. Self-injury is classified into non-suicidal self-injury (NSSI) and suicidal self-injury. However, NSSI must be taken seriously as it is difficult to predict when a psychologically disturbed person may turn suicidal.
Frequently Asked Questions
How to cover self-harm scars
In the short term, you can use concealers and makeup to cover your self-harm scars if your wounds have healed. However, dermatologists and plastic surgeons (if your skin damage is severe) can help achieve lasting results.
Why does self-harm feel good
Self-harm may distract you from traumatic memories and abusive environments, and you may paradoxically feel good when the physical pain reduces. However, self-harm also causes severe depression, anxiety, and low self-esteem. In addition, the physical consequences outweigh the momentary pleasure you may feel from the pain you experience.
Why is self-harm addictive
The National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) does not consider self-harm behavior an addition. It is also not listed as an addiction in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). However, as mentioned above, it is a feature of many psychiatric conditions. Hence, treating the underlying causes of self-harm is essential.
The following resources are helpful for those who engage in non-suicidal self-harm and suicidal self-harm:
National Alliance on Mental Illness (NAMI), Massachusetts, has resources for people who use self-harm.
Cornell University’s Self-injury and Recovery Resources (SIRR) help you understand how to cope with self-injury.
The National Health Service (NHS) has a valuable list of resources for anyone who self-harms in the United Kingdom (UK).
The Suicide Prevention Resource Center has various programs and resources for those at risk.
The American Foundation for Suicide Prevention has several resources for people at risk of dying by suicide. They have specific resources for LGBT individuals as well.
The CDC’s suicide prevention page is handy too.