About Self Harm

• Deliberate self-harm, also known as self-injury, refers to people intentionally inflicting physical harm on their bodies in an attempt to cope with distressing feelings. This is most often done in secret and without other people knowing.
• People who self-harm may not necessarily want to die.
• Self harm often begins in the teenage years and is more common in young people aged between 11 and 25 years.

Types of behaviour suggestive of self-harm

The most common forms of direct self-harm include:

• Cutting areas of the body, such as the stomach, arms and thighs.
• Burning the skin with cigarettes or a lighter.
• Overdosing on prescription or illegal drugs. For example, taking more medication than prescribed.
• Other forms of direct self-harm include piercing, hitting, biting, pulling out hair, scratching, and picking at sores.

Indirect self harm occurs when the person’s behaviours result in physical damage to the body in a more ‘roundabout’ way. Such as:

• Neglecting to manage an illness as advised or not seeking help for a disorder.
• Binge-eating or starvation.
• Abuse of alcohol or drugs.

Self-harm is distinguished from risk-taking behaviour, which involves repeatedly putting oneself in dangerous situations. For example, driving at high speeds or train surfing. There is a high risk of severe harm occurring to the person, or even death as a result of such behaviours.

Why do people self-harm?

Self-harm is usually a response to distress. People self-harm as a way of coping with the distress and emotional pain connected with difficult life events or circumstances. That is, the person is trying to relieve, control or express distressing feelings. These distressing feelings include: hopelessness, anxiety, rejection, anger, despair, and guilt.

• For some people, self-harm is a means of trying to make themselves feel better. It provides relief from psychological distress, as it decreases tension or pressure, releases intense, overwhelming negative emotions, and therefore provides brief escape. Although it brings immediate relief, it is a temporary solution.
• Some people view self-harm as giving them a sense of control over the pain and their lives. It may help them to cope with emotional numbness, as when they self-harm they can feel something; it proves they are not invisible. Some people also report using self-harm to control or drive away suicidal thoughts.
• Others use self-harm as a form of self-punishment – to deal with strong feelings of guilt, shame or self-hatred.
• Sometimes people who self-harm find it hard to explain their feelings to others or to communicate to others that they are struggling. Self-harm provides a way for the person to express difficult or hidden feelings such as emptiness, anger, sadness, grief and hurt. Self-harm becomes a way of telling other people about his or her emotional pain and letting people know he or she needs support.

The frequency of self-harm varies with the individual. Some people use self-harm regularly; others do it 1-2 times and then stop. It can become a coping mechanism that the person uses in response to all difficult life circumstances or it may be related to a specific problem.

Factors contributing to self-harm

• Experience of abuse in childhood or adolescence – emotional, physical, or sexual.
• Loss of a parent in childhood due to death or separation.
• Significant losses as an adolescent. For example, the death of someone close to the person.
• High impulsiveness
• Poor body image and low self-esteem, eating disorders and body disconnection.
• Serious illness or major surgery in childhood.
• Serious illness or disability – this may have an adverse effect on the person’s self-esteem.
• Peer isolation and alienation in adolescence, including being bullied or discriminated against.
• Relationship break-up.
• A stressful or critical family environment; family violence or severe family conflict; witnessing impulsive, self destructive behaviours within the family as a child.
• Distressing symptoms of an underlying mental illness such as depression, PTSD, or anxiety disorder.

Suicide and deliberate self-harm

Self harm should always be taken seriously. One of the risk factors for suicide is previous self harm or a prior suicide attempt.

Whilst engaging in self-harm sometimes suggests the person is thinking of suicide, not everyone who self-harms is suicidal. In general, someone who self-harms isn’t trying to suicide. With suicide, the person is desperate never to feel anything again, whereas with self-harm, the person usually wants to feel better. In fact, sometimes a person who self harms is actually trying to drive away suicidal thoughts. Nonetheless sometimes people accidentally die as a result of their self-harming behaviour.

The following table may be used as a general guide to understand the differences between suicidal behaviour and self-harm:

Adapted from the Ministerial Council for Suicide Prevention (2005).

Although people who self-harm do not necessarily want to die:

• Common feelings underlying both self-harm and suicide attempts could be feelings of overwhelm or loss of control, and hopelessness. If self-injury fails to ‘work’ to cope with these feelings, the person may increase the severity of harm, or start to believe that he/she cannot control pain and contemplate or attempt suicide.
• Repeated self-injury could lead person to believe he/she cannot stop, which might lead to feelings of hopelessness and possibly suicidal thoughts.

Response from health professionals to self-harm

Anecdotal evidence from people who self-harm suggests that many health workers do not understand self-harm. Some may have formed a mistaken belief that the person is engaging in self-injury ‘just to get medical attention’. Others may feel resentful, as they believe that the person is wasting valuable time and resources that could be given to others in ‘genuine need’. As a result, many health workers often react in negative ways to the person. This may include:

• Outwardly showing horror or revulsion in response to seeing the person’s injuries.
• Treating the person in a demeaning manner.
• Deliberately delaying treatment or giving insufficient treatment, such as administering very little or no pain medication.
• Showing the person where he/she should cut the wrist next time in order to ‘successfully suicide’.