Self Harm: Roots, Reasons and Response
Risk Taking Behaviour
There are many actions people undertake which can result in harm. These may include extreme sports, drinking too much, taking drugs, unprotected sex, driving at speed, and so on. These actions may be reckless or intentional and could well result in harm to the individual in the short term or long term, yet rarely is the plan to cause oneself harm; harm arises as a side effect of the experience or thrill.
Reckless behaviour may be dangerous, but is not of itself “self harm”. So what is self harm?
Definition of Self Harm
-- Self harm is a deliberate and intended action designed to cause harm to your own self. This usually takes the form of a physical self injury although can include emotional/psychological consequences.
-- Self harm is not an act of attempted suicide; there is no intention to kill oneself, although certain forms of self harm could unintentionally result in death. It is therefore not nihilistic – an attempt to end life
-- Self harm is usually not “just attention seeking.” It is commonly done in private, on parts of the body which can be covered by clothing. It is a personal act and not a public one, and often only comes to light by accident or if the individual panics about the depth of the cut or recognises they need help.
Who self harms?
-- Both men and women, although more women than men
-- Any age group, although most think of it as linked to the teens and twenties with people coping with the angst of youth
-- 1 in 10 teenagers self harm. Among young people, the ratio of female to male is 3:1
-- The UK has the highest recorded self harm rate in Europe
Why does a person start to self harm?
Many people stumble into self harming. Some might act initially out of anger or frustration, and hit something or cut themselves to express their pain, and, unexpectedly, when they cause injury they realise that they strangely feel better inside. Some may hear about self harming from others and copy it. Others may try to cut their wrists as part of a suicide attempt, but by cutting themselves they realise that they can get relief. Some are drawn to self harm through stress (school work is a major trigger for some teenagers). Yet others may find that self harm gives them a sense of control over something in their lives (which are usually controlled by events or others). Self harm can make “real” the emotional pain an individual cannot express, giving it an outlet.
Understanding Self Harm
Self harm is still somewhat of a taboo subject. Someone new to the subject can feel horror and shock, and be disturbed by the thoughts of self injury and the gory nature of the actions involved. They may well be bewildered as to why anyone would want to deliberately cause themselves hurt, pain and injury. These responses can lead to avoidance. However, when you know someone who is self harming then all of this is supplemented with a desire to help, to support, to come to the rescue, to care. The first task is not any of these. It has to be “to learn to understand.”
Self harm is not an attempt to end life but a means to live
It is a learnt coping mechanism that gives the individual a chance to relieve internal tension, pressure or distress and live their life.
Self harm is not a mental illness.
It is an unhealthy coping mechanism associated with powerful emotions, but is not of itself a mental illness. Some self harmers hide the activity from others as they are frightened that they are “mad.” It can be linked to disassociation – a psychological state where an individual separates themselves from things around them, often as a way to cope with overwhelming distress.
Self harm usually occurs as self-inflicted injury
Such as cutting, stabbing, burning, hitting hard objects, rubbing, scratching, or scraping. It may also include swallowing foreign objects.
The usual feature is that the action causes pain, injury to the skin, and often bleeding.
Self harm is a way to cope with inner feelings
If an individual feels intense hurt, frustration, tension, pain or anger inside and they find it hard to cope with these feelings, then instead of taking them out on someone else or just bottling them up they may look to self harming.
Self Harm can be a ritual of self punishment
Some individuals feel a need to inflict punishment on themselves; they feel that they have done something wrong or have had guilt put upon them and there is a need for retribution, and they are the ones to carry out the sentence on themselves. An extension of this involves the symbolism of blood letting which is seen as a purging or cleansing act releasing any evil from within, letting out the poison or pain inside.
Self harm deflects inner distress
Causing physical pain can deflect a person’s attention from their inner pain, albeit for a limited period of time. For a while it can feel easier to cope with the physical pain instead of the emotional or psychological. The pain can reassure the individual as it reinforces that they are real, still have feelings, that they are alive.
Self harm releases chemical defences in the body
When “attacked” the body goes into defence/self protection mode. There is a complex internal physical response to the injury. This response involves powerful chemicals produced by the body called endorphins. These work to enable the person to cope with their injury by giving a natural tranquilising effect to relieve the pain, thereby giving relief to both physical and emotional pain, and causing a calming effect on the person.
The endorphins also lift the mood, giving a high to enable the “fight or flight” response with a sense of “buzz” or energising effect. The high has been compared with that of certain illicit drugs and even sex.
As with other highs, once experienced there is a tendency to want to experience the effect again. This leads to the temptation to repeat the self harm when the internal emotional tension and pressure begin to build again.
Self harm is addictive
As can be seen, above, the release of endorphins can easily become addictive as the individual seeks to revisit the tranquilising effect and natural high they have achieved in the past. The sense of physical pain deflecting an emotional load is also powerfully addictive. A third type of dependency may arise from the emotional and caring responses of others to the person when they self harm.
Self Harm Cycles are hard to break
The natural effect caused by the endorphins complicates the issue. A person may start to self harm because of emotional and psychological feelings inside which they express in the self injury. To bring help in the long term these root causes need to be addressed along with the dependency on the effect of the endorphins, and other complicating behavioural habits.
Self Harm – dangerous yet attractive
Self harm is an abnormal coping mechanism which should never be encouraged and it is dangerous to the individual. It tends to escalate in the same way as other addictive behaviours, adding to the physical risk of major harm to the body, infection, anaemia, etc. Others may be tempted to copycat the behaviours out of need or curiosity, especially if encouraged to try out self harm by someone who thinks it is helping them. Those in emotional distress end up with two problems instead of one: inner turmoil coupled with addiction. Self harm cycles need to be replaced by healthier coping strategies.
Managing Self Harm
Responding to an incident of self harm
The response must be calm, matter of fact and practical. Most importantly, ensure the injuries are cleaned and treated. This may mean going to Accident and Emergency. Minor injuries can be dressed at home. Do not panic. This calm approach is the best way to keep the individual physically safe and well, but also reduces the risk of any emotional response feeding their desire to self harm. A secondary emotional gain can be psychologically addictive.
Responding day to day
The person needs to be “noticed” and cared for all the time, not just when they self harm. There should be no blame and no shame. They need opportunities to talk, and to learn how people express and deal with emotions in safer ways. Encourage the person to seek expert help. Be there for them, but do not allow them to become over dependent. They need to be helped by professionals. Seek advice and support for yourself if you are supporting someone who self harms.
Do not stifle self harm
If the underlying causes are not addressed, making an individual stop self harming may lead to even more destructive activities to relieve their unresolved emotions. These might include alcohol or drug abuse, promiscuity, or actual suicide attempts.
Practical alternatives for the self harming individual
There are activities that can be used as an alternative to self harming to break the habit/dependence. These include:
-- Pinging an elastic band to inflict pain without cutting the skin
-- Going through the motion with a blunt blade without breaking the skin
-- Putting ice on the arm
-- Drawing red lines on the arm (feeling of the ball point plus visual effect)
-- Releasing endorphins through exercise, sex, eating hot foods like chilli and curry or intense mints
-- Hot (not too hot) or cold shower
-- Doing something enjoyable as a distraction
-- Writing out feelings
-- Punching and shouting into a pillow
Although these strategies may work in the short term, there is still a need to get expert help: to talk to someone, to face the problems, and deal with the root. The person needs help to stop but this cannot be done without support. The distress inside is like a pressure cooker on boil where both the heat needs to be turned off and the weight or burden released.
Medical help should be sought to reduce the effects of scarring which could be upsetting to the individual years after ceasing to self harm.
Prayer for the person, with them, offer them hope, acceptance.