What is deliberate self-harm?

by Rethink

Deliberate self-harm is any act by an individual with the intent of harming him/herself physically and that may result in some harm. For example, you may cut or burn yourself, with the intention to cause pain and injury to yourself, or you may poison yourself with drugs with the aim of making yourself ill or die. Taking drugs to self-harm is different to taking drugs for pleasure because the reason for doing it is to cause harm to yourself.

Some people think of self-harm as a continuum, with suicide at one extreme, and no self-harm at the other end while in between are serious harm, moderate and minor harm. However, other people think of self-harm as quite different from suicide or attempted suicide. This difference in approach seems to be because they think of the reasons for self-harm as different from the reasons for suicide, or perhaps that people who commit suicide have sought to end all feeling, while people who have self-harmed have just tried to make themselves feel better. For the purpose of this fact sheet we will consider self-harm as distinct from suicide; - we use the term self-harm to refer to deliberate harm to yourself but where the aim is not death.

Wso self-harms?

An estimated 1 % of people in developed countries self-harm. Some people are more likely to self-harm than others. This includes:

• Young people between 15 and 25 years
• Women
• People of Asian origin
• People who are dependent upon alcohol or street drugs
• People with psychiatric disorders including depression, bipolar disorder, personality disorder and schizophrenia
• People who have a strong dislike of themselves
• People who are very sensitive to rejection
• People who have a lot of pent-up anger
• People who tend to be impulsive
• People who have few effective coping strategies
• People who feel that their lives are out of control.

why do people self-harm?

The usual reason seems to be the need to seek relief from unbearable emotional distress. This is quite different from Munchausen's syndrome, where people with the condition cause harm to themselves in order to achieve a specific physical symptom and often to get hospital admission to a medical ward.

Each person who self-harms has his or her own reasons for doing it. Often it is a coping mechanism that helps you deal with the pain and distress caused by life's problems. The reasons for self-harm suggested by doctors and other professionals are often different to those put forward by service users. For example, many professionals believe that self-harm is often a cry for attention but many service users strongly disagree with this and say that the main reason is that self-harm is the only way they can express the distress they feel. Some reasons why you self-harm may include:

• Feeling it is the only way to express your distress
• Needing relief from strong emotions such as anger
• Finding that self-harm relieves tension and distress
• Wanting to escape from certain situations in life
• Wanting to escape from feelings of numbness
• Wanting to change something in life
• Wanting or needing attention
• Wanting or needing to manipulate other people
• Pressure from friends (e.g. to show how tough you are or to fit in with the crowd)
• To follow the example of role models (e.g. pop stars).

Some doctors and other professionals think of self-harm simply as a behaviour, resulting from other difficulties. However, others suggest that it is a psychiatric disorder involving problems with perception, thought, emotions and/or behaviour. Many people who self-harm have signs of other psychiatric disorders such as depression, psychosis or personality disorder. Some research suggests that low levels of a substance in the brain called Serotonin may be involved with self-harm (Winchel & Stanley, 1991).

Do people repeatedly self-harm?

Research suggests that if you have self-harmed before then you are likely to repeat some form of self-harm. One study found that within two years 11 % of patients who self-harmed went on to self-harm again (Isacsson, Wasserman & Bergman, 1995). They also found that 2 % of people who self-harmed went on to commit suicide within two years. Approximately 10 % of people who self-harm go on to commit suicide within ten years. So if you have self-harmed you are at risk for self-harming again unless you get appropriate support and treatment. Remember that there is support and treatment that will help you.

What help can I get from professionals?

Although you are at risk for self-harming again, many people who self-harm recover and don't self-harm again. Doctors, psychologists and other professionals can help in many ways. However, many professionals find self-harm difficult to understand and you may feel misunderstood and it may help if you are able to find an understanding professional or if you can educate people about self-harm. Professionals can help you by:

• Psychiatric assessment to identify mental health difficulties;
• Investigation of the circumstances around and motivation for self-harm;
• Evaluation of the short term risk of suicide;
• Treatment of mental health difficulties;
• Practical help to deal with the situations that led or could lead to self-harm;
• Follow-up appointments soon after episodes of self-harm;
• Antidepressant medications;
• Cognitive behavior therapy;
• Psychotherapy
• Problem solving therapy/training.

What can I do to help myself?

You may find that stopping self-harm is difficult. Even if stopping completely is too hard at the moment there is plenty you can do to increase your control over your self-harming behaviour. Everybody is unique and what works for one person may not necessarily work for another. Here are some suggestions of things you can do to help yourself gain control over your self-harm and in time these might help you stop completely. Most of these suggestions are based on the ideas that self-harm is usually a coping mechanism to express distress that you can't find another way of expressing and that self-harm is often a result of you feeling helpless and out of control over your life. By finding different ways to express distress and by exercising choice you are loosening the grip of self-harm. Try experimenting with different ideas to find things that help you. For example:

• Seek social support from friends and family;
• Talk to someone who understands what you are going through, this could be a friend, a relative or another person who self-harms;
• Find other ways to express feelings and relieve tension, such as hitting something, writing, drawing or doing sport.
• Do something that does not cause harm but does cause intense sensation, such as biting into ginger or squeezing ice (the important thing is that it causes intense sensations, perhaps even pain for a brief time, but does not cause lasting harm);
• Try to delay self-harming for a short time (e.g. start with 15 minutes and gradually increase this time).

If the need to self-harm is too great and you choose to do it then there may be things you can do to keep yourself safe, including:

• Not sharing cutting implements with other people - many diseases including HIV/AIDS can be transmitted this way;
• Trying to keep cuts shallow;
• Making sure you have first aid supplies and know some first aid;
• Making sure you know what to do in an emergency (e.g. dial 999 if you need an ambulance); and
• Before you self-harm set yourself limits - deciding how many cuts or burns or bruises and how big they will be - and set these limits so that they are just enough to relieve your distress but no more.

How do I tell other people about my self-harm?

Many people find self-harm difficult to understand and may react in negative ways. Try to explain it to them, give them time to think, be available and willing to talk to them about it and tell or give them as much information about self-harm as you can. Talk to the other people in a comfortable and safe environment where all your attention can be on the conversation. Try not to tell people in anger ("look what you made me do"), approach it gently and with respect for the person you are telling. When you first tell someone you may want to avoid giving details so that you avoid frightening them off.

What do I say if someone asks me about my scars?

There is no right or wrong thing to say. Sometimes you may feel it is best to be honest but often you may want to brush it aside by saying something like "it's a long story" or you may just want an excuse such as "I fell" or something more exotic that will puzzle them and perhaps make them feel awkward that they were nosy enough to ask.

How can I help somebody who self-harms?

You can help someone who self-harms by:

* Showing that you see and care about the person in pain behind the self-harm;

* Showing concern for the injuries themselves. Whatever "front" they may put on, a person who has harmed herself is usually deeply distressed, ashamed, frightened and vulnerable. It is usually counter-productive to "withhold attention". You have an opportunity to offer compassion and respect; to show them something different from the way they have been treated by most people in their lives;

Making it clear that self-injury is okay to talk about, and can be understood;

* Conveying your respect for the person's efforts to survive, even though this involves hurting him/herself;

* Remembering that you are not to blame and so you need not feel guilty;

* Being open about your feelings;

* Find out as much as you can about self-harm;

* Provide distractions, such as going for a walk with the person, to help the person avoid self-harming him/herself at that time;

* Helping him/her make sense of his/her self-injury. For example: ask when the self-injury started, and what was happening then. Explore how self-injury has helped the person to survive (physically and emotionally), in the past and now. Ask how he/she feels before he/she hurts herself, and how he/she feels afterwards. Retrace with him/her the steps leading up to an incident of self-injury - the events, thoughts and feelings which led to it;

* Acknowledging how frightening it may be to think of living without self-injury;

* Encouraging the person to use the urge to self-injure as signals of buried feelings, memories, needs. (These will be unfamiliar and frightening; go slowly and offer support.) Help him/her learn to express these in other ways, e.g. talking, writing, drawing or hitting something. Encourage him/her to ask for support and to care for him/herself;

* Helping the person to break down isolation and shame and to build up support networks. (e.g. groups);

* Not seeing stopping self-injury as the most important goal. A person may make great progress in many ways and still need self-injury as a coping method for some time. Self-injury may also worsen for a while when previously buried issues or feelings are being explored, or when old patterns and ways of living are being changed. This can be frightening but is understandable.

* It takes a long time for a person to be ready to give up self-injury. Encourage him/her and yourself by acknowledging each small step as a major achievement; Examples of very valuable steps might be: taking fewer risks (e.g. avoiding drinking if she thinks she is likely to self-injure); taking better care of the injuries; putting off hurting herself for a day or an hour; reducing the severity or frequency of the injuries even a little. In all cases more choice is being exercised the "hold" of self-injury is being loosened;

* Encouraging them to comply with their treatment program, which may include medications and cognitive behavior therapy;

* Helping the person to find other ways of dealing with stress.

About the Author

www.rethink.org
Rethink is the largest severe mental illness charity in the UK. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field.