March 1st is self-injury awareness day. Self injury or self-harm is defined as any form of intentional act to damage one’s own body. (Curtis et al., 2018). It may seem as though self-harm has become more common or media may have just exposed the reality and prominence of the issue. In fact, a study showed that Instagram users who are accidentally or intentionally exposed to self-harm content are at an increased risk of self-harm and suicidality-related outcomes (Arendt, Scherr, & Romer, 2019). Approximately 5% of the general adult population and 15% of youth have self-harmed (Klonsky, et al., 2011)
Common forms of self harming behaviour includes cutting oneself or sticking oneself with sharp objects (razor, tacs, knife, fingernails), self-poisoning (over-consuming drugs, alcohol, medications, toxic substances), hitting oneself (with fists, slapping, or hitting body on wall/hard objects), burning oneself (lighter/fire, intentionally leaving body part on something hot), to interfere with their body’s healing process and cause pain (picking at skin/nails/scabs)(Cipriano, Cella & Cotrufo, 2017).
Just found out your loved one is self harming? It can be very concerning when you find out that a loved one is harming themselves on purpose. Friends and family of those close to this person may experience their own feelings of shame, guilt, and fears about their loved one’s behaviours. Also, minds may make assumptions that our loved one is suicidal and attempting to take their own life in this way. Whilst these behaviours are linked to a heightened risk of suicide, not all people who engage in self-harm are suicidal. (Curtis et al, 2018). This type of harm is called Non-Suicidal Self-Injury (NSSI) and is most prevalent amongst adolescents and young adults, with age of onset occurring between 12 and 14 years (Cipriano, Cella & Cotrufo, 2017).
Then why do people self harm if it is not to ultimately end their life? Self harming is most commonly used to temporarily reduce or eliminate intense negative emotions (Klonsky & Muehlenkamp, 2007). Other reasons people self harm are to numb and trigger bodily sensations, “express self‐directed anger or disgust, influence or seek help from others, … and help resist suicidal thoughts” (Klonsky & Muehlenkamp, 2007). There are other factors that may increase the risk of engaging in NSSI behaviour which includes being female gender, identifying as LGBTQ2S+, experiencing childhood trauma, and having co-occurring disorders (PTSD, Depression, Anxiety, OCD, Borderline personality disorder, eating disorders) (Cipriano, Cella & Cotrufo, 2017).
Is it true that some people engage in self harm for attention? Absolutely – but this should not be interpreted as a negative reason or reason for dismissal. They are seeking out attention in order to get some help. Sometimes people are ‘crying out for help’, by attempting to communicate with their physical body that they are not doing well internally. If someone is sharing that they are harming themselves, listen to them. They are trying to reach out. Respond to their cry for help. Do not just dismiss it as “attention seeking” behaviour. They are needing your attention. Let them feel heard by validating their experiences. Let them feel valued by really taking the time to listen to them and their struggles/fears. Often, people have resorted to self-harm because they do not know what else to do, who to talk to or where to find supportive help. Since mental health is not easily seen and is not always taken as seriously as physical health needs, mental health often goes unnoticed, invalidated and unheard. Sometimes people with depression, anxiety, and other mental illnesses are advised to just “get over it”, “grow up”, “suck it up”, “just exercise”, and “smile more”. These comments often make people feel less understood, ignored, and embarrassed that they pointed out their mental health struggles in the first place.
There are also many situations where people try to self-harm in private, and in discrete/hidden places on the body in hopes that no one will ever see. They may resort to wearing clothing that covers their wrists, forearms, arms, thighs, hand, stomach or feet regardless of the weather. Though it might not look like traditional attention seeking behaviour. Please pay attention. Notice if your loved one is always wearing long sleeves or pants in the middle of summer. Notice if razors, lighters, knives, or other self-harming tools are always missing or in their room/backpack/purse. Also pay attention to loved ones’ interactions with others. Are they withdrawn from friends or events, easily irritable, feeling hopeless or believing there is no reason for them to attend school/work? This is when family and friends need to reach out. Ask the hard questions. Show that you notice. Show that you care. Show that you are there for them.
Should you force your loved one to stop their harmful behaviour? If you know that the purpose of their self harming behaviour is to cope and not suicidal, it may not be critical to have them stop the behaviour immediately. In fact, abstinence may not always be realistic or the safest option. Though you may not be able to help stop their behaviour immediately, it is important to you address this issue from a harm reduction stance. Essentially meaning that abstinence may not be the goal; instead, efforts should be made to reduce the harm and risk of the destructive behaviour (Dickens, G., Hosie, L., 2018). We use harm reduction strategies in daily life including wearing seat belts in cars or helmets while riding bikes. It is important to remember that many people engage in unhealthy and destructive coping mechanisms (ex. Overeating, indulging in desserts/carbs, drinking alcohol, substance use, shopping, etc.) to deal with emotions and stress but they have just been more normalized. We need to recognize that their self-harming behaviour has been serving a purpose – a way to cope. It has potentially allowed them to restrict themselves from engaging in other riskier behaviour, feel some bodily and emotional sensation, distract themselves from their trauma or possibly even helped to keep themselves alive.
What do you need to be aware of when your loved one is self harming? Some consequences of this coping mechanism are that it is destructive to the mind and body – sometimes leaving life-long physical and emotional scars. People can become self-conscious of their physical scars which in turn can affect their body image and self-esteem. Feelings of embarrassment or shame from bodily marks can make people feel even more alone and isolate themselves so they do not have to risk other people seeing these scars. Also, the release and relief coming from self harm can become addictive and can accidentally lead to increased risk and harm unintentionally (ie. Cutting deeper than intended, wounds becoming infected, concussions, etc.). In addition, relief from self-harm is temporary and only short-lived. Negative feelings usually resurface. Self-harm is a destructive coping mechanism that robs people of opportunity to actually address the underlying issues fuelling this behaviour.
How can you help your loved one? To ensure your loved one feels safe and supported, it is important to have an authentic conversation around how they are doing. Your attention should be focused on supporting your loved one’s emotions and reasons why they are self-harming – not punishing the behaviour. The behaviour is a secondary symptom of their distress. However, there are some necessary and direct discussions that need to be had to reduce the risk of the behaviour.
1. Gently acknowledged that you noticed/know they are hurting themselves
2. Tell and show them how much you love/care for them
3. Listen without judgement
4. Ask them what has been going on to lead to this way of coping
5. Ask them how long they have been doing this behaviour
6. Ask if they are having suicidal thoughts and if they have created a plan. ** If they have a plan to take action immediately or in the near future, you should seek immediate emergency mental health services through your nearest hospital/health authority.
7. Ask if you can see any scarring, fresh cuts, or injuries to assess need for medical attention
8. Ask how they know when medical attention is necessary
9. Ask what they do to prepare tools and tend to their injuries (ie. Ensuring tools are clean and cleaning/covering wounds to prevent infection)
10. Ask if they have someone who they talk to about these things
11. Ask them if they are open to talking to a counsellor – privately, in schools, community/provincially funded and subsidized programs.
12. Provide them with self-help resources including online interactive apps (like Calm Harm or What’s Up) and therapeutic CBT/mindfulness/healthy coping workbooks.
13. Provide following list of coping mechanisms and ways to self-soothe
· (Tip 3: Finding new coping techniques): https://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm
· https://www.themix.org.uk/mental-health/self-harm/self-harm-coping-tips-and-distractions-5696.html
14. Try to engage in safety planning so there is always a written plan in case something escalates, requiring further medical attention (ie. Physical or psychological medical intervention).
From my experience working as a crisis counsellor, social worker, and therapist with children and adults, often times when people have an empathetic, non-judgemental connection, who validates their feelings and make them feel heard, the self-harming behaviour tends to decrease in frequency and severity. Having someone they can talk to encourages them to practice healthier coping mechanisms by reaching out for support, talking about their emotions, and learning other ways to soothe their internal struggles.
Online Toolkits and Additional Resources:
Canadian Mental Health BC
Kelty Mental Health
BC Schools Suicide Prevention Toolkit for Parents
Suicide Info Self Harm Toolkit
Help Guide – Cutting and Self Harm
References
Arendt, F., Scherr, S., & Romer, D. (2019). Effects of exposure to self-harm on social media: Evidence from a two-wave panel study among young adults. New Media & Society, 21(11-12), 2422–2442. doi: 10.1177/1461444819850106
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal Self-injury: A Systematic Review. Frontiers in Psychology, 8. doi: 10.3389/fpsyg.2017.01946
Curtis, S., Thorn, P., Mcroberts, A., Hetrick, S., Rice, S., & Robinson, J. (2018). Caring for Young People Who Self-Harm: A Review of Perspectives from Families and Young People. International Journal of Environmental Research and Public Health, 15(5), 950. doi: 10.3390/ijerph15050950
Dickens, G., & Hosie, L. (2018). Self-cutting and harm reduction: Evidence trumps values but both point forward
Klonsky, E., & Muehlenkamp, J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology, 63(11)1045-1056. doi:10.1002/jclp.20412
Klonsky, E., Victor, S., & Saffer, B. (2011). Nonsuicidal self-injury. CanJ Psychiatry, 59 (11), 565-568. doi 10.1177/070674371405901101
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