What is self-harm? I’m not talking about accidental injuries or extreme sports. I’m specifically interested in the intentional, non-lethal infliction of pain or injury to oneself. Can you define it in clinical terms? What are the different types of self-harm, like cutting, burning, scratching, hitting, or head-banging? Are there less obvious forms of self-harm I should also be aware of? How does it differ from a suicide attempt? And what are the underlying psychological reasons people might engage in self-harming behaviors?

Answer

Self-harm, also known as non-suicidal self-injury (NSSI), is a deliberate behavior involving direct injury to one’s own body tissue, most often without conscious suicidal intent. It’s a coping mechanism, not a suicide attempt, although it can increase the risk of suicide.

Common Forms of Self-Harm:

• Cutting: Using sharp objects (razors, knives, glass) to make cuts on the skin. This is one of the most commonly recognized forms.
• Burning: Using heat sources (lighters, cigarettes, hot objects) to burn the skin.
• Scratching: Using fingernails or other objects to scratch the skin, often to the point of drawing blood.
• Hitting/Punching: Hitting oneself or objects, often resulting in bruises or welts.
• Head Banging: Repeatedly hitting one’s head against a hard surface.
• Picking/Pulling Skin or Hair: Compulsively picking at skin, scabs, or pulling out hair.
• Carving: Cutting words or symbols into the skin.
• Poisoning/Overdosing (Non-Lethal): Taking substances in amounts that are harmful but not intended to be fatal.
• Interfering with Wound Healing: Picking at wounds to prevent them from healing properly.
• Bone Breaking: Intentionally breaking bones.

Motivations Behind Self-Harm:

Self-harm is typically a way to cope with intense emotional pain. Some common reasons include:

• Emotional Release: To feel something when feeling numb or empty. The physical pain can provide a temporary distraction from overwhelming emotional pain.
• Coping with Overwhelming Feelings: To manage intense emotions like anger, sadness, anxiety, shame, guilt, or emptiness. The act can provide a sense of control or relief from these feelings.
• Punishment: To punish oneself for perceived wrongdoings or feelings of worthlessness.
• Self-Soothing: Ironically, to calm down or comfort oneself during times of distress. The act can release endorphins, which have a calming effect.
• Feeling Alive: To feel real or grounded when feeling disconnected from oneself or reality (dissociation).
• Seeking Attention: While not the primary motivation for most, sometimes self-harm can be a way to communicate distress to others and seek help.
• Exerting Control: To feel in control when feeling powerless in other areas of life.
• Dealing with Trauma: A response to past trauma, abuse, or other difficult experiences.
• Peer Influence: In some cases, particularly among adolescents, self-harm can be influenced by peers who engage in similar behaviors.

Who is Affected?

Self-harm affects people of all ages, genders, races, and socioeconomic backgrounds. However, it is more common in:

• Adolescents and young adults: This is a period of significant emotional and social change.
• Individuals with mental health conditions: Such as depression, anxiety disorders, borderline personality disorder, eating disorders, and post-traumatic stress disorder (PTSD).
• Individuals with a history of trauma or abuse: Past experiences can significantly increase the risk.
• Individuals who have experienced bullying or social isolation: These experiences can lead to feelings of worthlessness and despair.
• Individuals who struggle with emotion regulation: Difficulty identifying, understanding, and managing emotions.

Important Considerations:

• Secrecy and Shame: Self-harm is often done in secret due to feelings of shame, guilt, and fear of judgment.
• Not a Suicide Attempt: While self-harm is not typically intended as a suicide attempt, it is a significant risk factor for suicide. Individuals who self-harm are at a higher risk of attempting suicide in the future.
• Underlying Issues: Self-harm is usually a symptom of underlying emotional distress or mental health issues that need to be addressed.
• Cycle of Self-Harm: Self-harm can become a repetitive behavior, creating a cycle that is difficult to break. The initial relief it provides is often followed by feelings of guilt and shame, which can then trigger further self-harm.
• Contagion/Copycat Behavior: Exposure to self-harm, especially through online platforms, can sometimes lead to copycat behavior, particularly among vulnerable individuals.

Seeking Help:

Self-harm is a serious issue, and it’s essential to seek professional help if you or someone you know is struggling with it. Treatment options include:

• Therapy: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and other forms of psychotherapy can help individuals develop healthier coping mechanisms and address underlying emotional issues.
• Medication: Medication may be prescribed to treat underlying mental health conditions, such as depression or anxiety.
• Support Groups: Connecting with others who have similar experiences can provide a sense of community and support.
• Crisis Intervention: In cases of immediate danger, crisis intervention services can provide immediate support and help ensure safety.

Early intervention and appropriate treatment are crucial for breaking the cycle of self-harm and improving long-term mental health.