Self harm: how can you help?

I have written before about self harm (see here) but today I want to write more specifically about what self harm is and how you can help someone who is self harming.

What is self harm?

The National Self Harm Network (NSHN) defines self harm as follows:

Self harm can take many different forms and as an individual act is hard to define. However in general self harm (also known as self injury or self mutilation) is the act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and/or self neglect. 

Image (c) LauraLewis23 2012 - Flickr Creative Commons

Nobody knows exactly what causes some people to start harming themselves, and the triggers may be very different in each case.  But for many self harming becomes a coping mechanism, for example, if someone is struggling to articulate how he/she is feeling.  For some self harming is a type of punishment, because they feel that they are bad, or not good enough.  Whatever the ’cause’ or trigger, it can be extremely difficult to cope with and of course it is very tough to witness someone you love causing themselves pain and physically harming themselves.

It is helpful to know what self harm is not.  It is rarely an attempt to commit suicide, and it also rarely leads to suicide,  but many people who witness a loved one self harming are afraid that their actions might lead to suicide.  However, self harm can still be dangerous to the health and may lead to death in extreme cases (most often due to complications).  Nor is self harming classed as a mental health disorder in itself, however it is a possible symptom of certain mental health conditions.  It is important to understand that it doesn’t necessarily mean that someone is mentally ill if they are self harming.

Self harming is most common among young people (both male and female), and is particularly prevalent in young LGBT (lesbian, gay, bisexual, transgender) people and among prison/young offender populations.  However it can affect anyone, of either sex, at any age.   Sometimes it can be triggered by peer pressure, or by seeing someone else who has done it.

Image (c) TheAlieness Gisela Giardino 2004 - Flickr creative commons

Self harming is often done in secret, and some who self harm are very good at keeping their activities, wounds or scars hidden.  Some who self harm do not disclose what they are doing to anyone, fearing negative reactions, and this can make them feel very lonely and unsupported.

Self harming can be an addictive behaviour.  The self harm cycle resembles that of an addiction: negative emotions cause anxiety which leads to the addictive act which causes temporary relief (in fact it is often merely the thought of the compulsive or addictive act that provides relief) however the positive effects are short-lived and are usually replaced by negative effects, negative thoughts and the cycle continues.

Most people think of self harming as involving cutting or burning oneself, which it predominantly does, but the range of behaviours is extensive and also can include:

  • scalding
  • hitting
  • deliberate bruising
  • head banging
  • pulling out hair
  • biting/nibbling/picking at skin
  • reopening wounds
  • swallowing dangerous objects or substances

And in very extreme cases:

  • bone breaking
  • castration
  • limb amputation

Some people believe that self harming extends to behaviours such as extensive tattooing or piercing,  self-starvation or eating disorders, substance abuse (alcohol or drugs), risk taking (reckless driving, unsafe sex) and there is evidence that some self harmers move on to more ‘acceptable’ behaviours such as these as replacement behaviours when they have stopped cutting/burning etc.  Self neglect or failure to care for oneself can also be considered self harming in some cases. It’s important to look at the whole picture of what someone is experiencing.

Image (c) logan-paig3(: 2013 - Flickr Creative Commons

How can I help someone who is self harming?

You  may know someone who is harming him or herself, perhaps regularly.  It may be someone in your family, so what can you do to help them?

Firstly, don’t judge them or be angry with them:  these responses are more likely to upset the sufferer more or may result in them becoming more secretive about what they are feeling or doing

Don’t act shocked or repulsed:  this may be challenging, but again this type of reaction may not be helpful

Don’t ask why:  they may not know or fully understand why themselves. Instead ask them what is going on for them right now.

Just listen: offer your ear and listen unconditionally (without judging or offering advice)

Empathise:  try to imagine being in their place

Remember that self harming in itself is probably not the problem – the problem is usually something that the person who is self harming is struggling with emotionally.  Offer an empathetic ear so that they can talk about what is troubling them. Being able to articulate feelings to someone else may reduce the need to self harm.

Offer to help find support:  check out the resources listed below, or resources local to you, and encourage the person who is self harming to seek support or help them to do so

Read my previous blog post for suggestions of alternative coping strategies you can suggest

Watch the video below for more insight and suggestions

In terms of treatment, cognitive type therapies such as CBT are very helpful with self harm, so you may want to encourage or help the person who is self harming to seek this type of help.

In some cases medication may help to treat severe anxiety or depression; a GP can advise and should also be able to refer on to more specialist services if necessary (such as psychological treatment or psychiatric assessment).

Resources:

Harmless – a user led support organisation

National Self Harm Network -information and advice

Young Minds – The voice of young people’s mental health and wellbeing

Mind Charity – About Self Harming

Samaritans – someone to talk to

Information for Young People from TheSite.org

Writer Cheryl Rainfield – who writes for young adults on subjects including self harm

NICE guidance on self harm

NICE pathways for treatment of self harm

Warning: this video contains images of simulated self harm and of real scars

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