A Therapist’s Guide to Self-Harm
It is Self-Harm Awareness Month in March and while the topic of self-harm and self-injury is a sensitive one, it is also an incredibly important topic to understand and to dispel some misconceptions about, especially given that the urge to self-harm, particularly with young people, is not uncommon. Recent studies show that “about 17% of adolescents and 15% of college students have engaged in some form of self-injury on at least one occasion.”
While this is an important issue to have knowledge and awareness of, reading about it here might also elicit uncomfortable thoughts and feelings in you, so please take care of yourself as you continue on in this blog and pay attention to what you might need in the moment or after reading, whether it’s getting some fresh air, talking a friend or support, or drinking a cold glass of water.
Having a better understanding of the complexities of self-injury can ultimately help you consider what you personally might need if this is a behavior you’ve engaged in but can also help you to support loved ones who might be struggling.
What Is Self-Harm (and what ISN’T it)
Self-harm, also known as self-injury (and used interchangeably here) is the act of hurting oneself on purpose, potentially as a way to release or relieve distress. Some examples of self-injury are cutting with a sharp object, burning, hitting oneself, skin picking or intentionally breaking bones. Self-harm is not a mental illness, but actually a symptom or behavior that one might engage in to manage difficult feelings as well as an attempt to have some control over their experience.
Many who engage in self-harm are not intending to end their life and wounds are often considered superficial, but it is important to recognize that some can hurt themselves more severely and require medical attention. Self-harm is not the same as attempting suicide but those who engage in self-injury are at higher risk of attempting suicide or dying by suicide if they don’t get help. Given this, it’s even more important to understand the complexities of self-injury and how to respond to those in need.
There may often be a misconception that a person who self-injures is seeking attention from others. A majority of people who self-harm are in a state of emotional distress and not looking for attention. In fact, while self-harm provides temporary relief, it also can increase a person’s feeling of shame or guilt and it is a behavior that is often hidden or kept secret. When feelings of shame or guilt are felt, then an individual might engage in other behaviors to manage this, ultimately creating a cycle that is difficult to break.
Self-harm is a way to manage overwhelming feelings and negative emotions. Many young people who I have worked with in therapy have shared personally that they engage in self-injury because it provides relief and “it is easier to show someone that I’m in distress by cutting than by saying out loud to someone that I’m hurting.” Engaging in self-harm provides a feeling of “release” and can produce a calming effect because of the release of endorphins that occurs, ultimately soothing an individual temporarily.
Why Someone Might Have Urges to Self-Harm
The urge to hurt oneself deliberately may likely be part of a larger mental health concern such as depression, anxiety, or trauma. Self-harm is a way to provide temporary relief from a number of feelings and experiences such as anger, sadness, isolation, intrusive thoughts but the key word here is temporary, and without more support, it might be difficult for someone to stop self-harming.
Self-harm can be a way of communicating distress without using words.
It is considered to be a coping strategy that might feel helpful in the moment but has deeper impacts on an individual.
Self-injury has also been linked to experiences of self criticism or self loathing, resulting in a person harming themselves because of the negative thoughts they have about themselves and seeking a sense of calm.
Some might engage in self-harm due to seeking out some “feeling” to replace the experience of numbness that might be a result of trauma response or the nervous system being in a hypo-aroused state. If an individual has uncertainty with how to deal with emotions or hasn't been allowed to express emotions or been invalidated this might also be a root cause of self-injury.
Six ways to support someone who might be self-harming
While self-injury can be difficult to think about, the care and response an individual experiences from others around it is critical. Responding in a nonjudgmental, supportive way and inviting space for someone to share about what they are experiencing is important. Here are six things to keep in mind when supporting someone who is practicing self-harm:
Take self-harm seriously. It is crucial to take things seriously, be attentive to and respond to an individual experience. Do not be dismissive.
Remain calm. Approaching in an overly reactive and activated manner won't be helpful. While your instinct might be to react due to your own worries and anxieties, remaining calm and inviting communication convey that you are there, regardless, and that you can tolerate and handle their pain. It is imperative to figure out ways to manage your own feelings and not judge or be critical.
Listen to understand without judgment. Openly listening to what they are experiencing and feeling and supporting them to understand what might have triggered them to engage in self-injury.
Discuss and offer support options. Accessing help from a professional and developing a network of support to help a young person explore other coping strategies that are just as effective but not harmful–working to replace a destructive act with a more constructive strategy will be key.
Encourage medical attention. Gently encouraging receiving treatment and acknowledging that self-harm is not uncommon can be helpful in reducing stigma around self-injury. Additionally, encouraging medical attention for a physical wound if it is needed/warranted, will be important, even if they aren’t ready to stop self-harming.
Seek out your own support and education. Whether it’s for you or someone you love, it’s important to be able to process your feelings and gain understanding of self-harm. While you might want someone to stop self-harming, it is important to recognize that it is a process and work they will need to do for themselves, but you can support them in this.
These ideas and recommendations can not only be helpful for an individual who is engaging in self-harm but also for someone who is supporting a child or young person who might self injure. Conveying a message that there is support available and tools for relief and coping is crucial.
A crisis line (998) or local emergency services provider can be helpful for ongoing assessment and determining the need for medical care and intervention. If you feel like you or someone you know needs non-emergency support, please consider a consult with therapist.