Understanding self-harm

Self-harm is a term used to describe any act of self-injury or self-poisoning that may be used by a person, irrespective of their motivation (NICE 2013). It may take the form of cutting, burning or overdosing on medication. Self-harm can be related to a number of different mental health conditions and adverse life experiences, and is also associated with feelings of low self-esteem. It affects men and women of all ages, and there has been a significant rise in the number of young people attending A&E with self-harm related injuries over the past few years (selfharm UK).

Rates of reported self-harm are found to be higher among women than men (NICE 2013) and this may be due to women being more likely to internalize feelings of anger and inflict injury upon themselves, whereas men tend to externalise anger on to objects or others (Motz, 2002). However it is important to acknowledge that men also self-injure, but may feel less able to seek help or speak openly about it.

Self-harm can often seem confusing and overwhelming for those who come into contact with it. This may be through the work environment, or through personal relationships with family and friends. It can be difficult to make sense of why people would want to hurt themselves, and may lead to feelings of fear and powerlessness that nothing can be done to help. It may drive a desire to stop the person from harming themselves, resulting in feelings of frustration if they do not. Understanding some of the reasons why people self-harm may help to manage these feelings and overcome some of the stigma that surrounds it.

Self-harm as a means of coping with emotions

When people experience overwhelming emotions, such as acute anxiety or intense anger, self-harm can be used as a means of coping and distraction. Depending on the individual, self-harm may either “release” the distress, or help them to shift their focus from emotional pain to physical pain, which feels easier to understand and manage.

Physical pain also causes a physiological reaction by releasing endorphins, the body’s natural opiate. This provides the sufferer with a temporary period of calm, as it resets the balance between the body’s flight and fight responses and offers a feeling of euphoria.

For those who experience feelings of chronic emptiness, the pain associated with self-harm may awaken the senses, allowing them an opportunity to feel connected to something physical, if not emotional.

Self-harm as a means of communication

Sometimes people who self-harm can be viewed as “attention seeking”. This can have a very negative impact on those who have already experienced adverse life experiences and suffer from low self-esteem.

For some people, self-harm is not about gaining attention from others and has a very private function. However for others, it may be possible they are “seeking “something but are unable to ask for it in a direct way. In these instances self-harm may be a way of someone communicating how distressed they are, or that they need support from others in order to feel safe.

It is also important to understand that self-harm is not always an attempt at suicide, but can be a way of asking for help at times of great need.  So what can help? Self-harm is likely to be unique to each individual, with methods and motivations being personal to them. It may not be possible to prevent someone from harming themselves; however, there are some general approaches which can be tried to support the person to manage their distress.

• Be collaborative. Some people may prefer to keep their self-harm private, but for those who seek help ask them what they need.
• Remain calm and retain neutrality. It can be upsetting to witness self-harm, but try to offer support without panicking or being angry.
• Ask if the person feels able to manage their own self-care and if not, seek appropriate first aid/treatment.
• Validate how the person is feeling.  This is not about agreeing with the act, but listening to the person’s distress and offering them some understanding.
• Allow time to talk. Reflecting on the motivations or triggers will help to understand why people self-harm, and perhaps identify other ways that someone may cope with their emotions.
•  Support people to access talking therapy if they feel ready. Dialectical Behaviour Therapy (DBT) has been shown to support people to better manage and tolerate distress.

Motz, A. (2002) The Psychology of Female Violence, Crimes Against the Body. Brunner-Routlidge.

National Institute for Clinical Excellence (2013) Support for commissioning for self-harm. Commissioning guides. Available at www.nice.org.uk/guidance/cmg50

Emma Turner

For further advice and guidance please visit www.selfharm.co.uk, the NHS Choices self injury information page andhttp://www.lifesigns.org.uk