What is self-harm? Simply put, self-harm is any act where one physically harms their body in an effort to alleviate mental pain. People refer to self-harm in many different ways: self-injuring, self-mutilation, non-suicidal self-injurious behavior. A common misconception about self-harm is that people who hurt themselves are actively suicidal. Statistically, a third of young adults who have self-harmed will do so only once, and most acts of self-harm are considered “superficial,” meaning that they are not considered medically serious.
It is really important to remember that even if people aren’t suicidal or severely damaging their bodies, self-harm is a clear indicator that they’re really struggling internally and need additional support.
Why do people self-harm?
Everyone self-harms for different reasons, but all of these reasons are rooted in emotion. Some people self-harm because they feel overcome by emotions such as anger or sadness, others self-harm because they feel totally disconnected emotionally. Whatever the reason, know that emotions are temporary, can be worked on, and recovery from self-harm is possible. Here are some of the most common reasons young people choose to self-harm:
To cope with emotional pain, frustration or intense anger
A sense of release to bottled emotions
To feel something after a period of emotional numbness
As a distraction from emotional pain
As a means of self-expression
To punish oneself
Self-injury may seem to bring a sense of calm and a release of tension in the moment, it’s usually followed by guilt and shame and the return of painful emotions.
Types of Self-harm
Equally varied are the ways in which individuals choose to self-harm. Oftentimes, self-harming is synonymous with cutting, but self-harm can take many forms, including but not limited to:
Cutting
Burning
Excessive skin picking
Pulling out hair
Headbanging
Deliberately starting a fight with someone in order to be injured
Hitting something repeatedly with the intent to hurt oneself
Purposeful mismanagement of medical care, such as diabetes.
Whatever the reason or method, know that emotions are temporary, can be worked on, and recovery from self-harm is possible.
Who is most likely to self-harm?
Media can really distort our perceptions about social issues, especially self-harm. Most of the time a storyline often includes a cis-straight, white girl character, who lives in a upper middle class suburban area with her two parents and siblings who is self-harming. The truth is, people from all different backgrounds and demographics are at risk for harming themselves.
Self-harm is increasingly common among preteens and teenagers from all walks of life. Most researchers believe this is because of “social-contagion.” Social-contagion is basically when we mimic the behaviors of others, which is easier than ever with social media. Approximately 17% of all adolescents and 15% of all college students engage in self-harm (Muehlenkamp et al. 2012). Some research suggests that these numbers may be inaccurate because of stigma and shame associated with self-harm.
Also, many masculine-identifying people’s self-harm goes unreported as it can look quite different from the traditional presentation of self-harm. Some examples of more masculine specific self-harming behaviors are intentionally instigating a physical altercation to be hurt by another person or striking something repeatedly in an attempt to deliberately hurt oneself.
One group of people who are more likely to self-harm are LGBTQ+ identifying youth. LGBTQ+ identifying youth are more likely to engage in self-harming behaviors than their cis-straight peers. One identity group within the LGBTQ+ community that is particularly susceptible to self-harming behaviors are cis-female adolescents who are bisexual – approximately 43% engage in self-harming behaviors.
However, risk of self-harm seems to be less determined by identity and more about what is going on in a person’s life. Loss of a parent, chronic medical conditions, parental substance use, childhood neglect or abuse, a history of trauma, a lack of strong familial attachment, a lack of impulse control, and low self-worth are all factors that may make someone more likely to engage in self-harm (Briere and Gil, 1998; CSP, 2014). It is super important not to assume that someone does or doesn’t engage in self-harm because of how they identify.
Signs of self-harm
Scars, often in patterns
Low mood, or sadness
Irritability, impulsivity and unpredictability
Showing less emotion/smiling less
Disinterest in old hobbies or activities
Poor academic performance
Ending friendships/relationships unexpectedly
Being more socially isolated
Wearing clothes that are more concealing than usual
Fresh cuts, scratches, marks, bruises, or other inexplicable wounds
Excessive rubbing of an area to create a burn
Frequent reports of an injury resulting from an “accident”
Statements of feeling hopeless, helpless, or worthless
What if I need treatment?
#1 – Tell Someone!
Remember that people care about you and are invested in your recovery. If you do not have a trusted adult that you can confide in, you can also access some of the resources below. Remember, self-harm is always an outer example of inner pain. It is much easier to stop self-harming if you are also working on other aspects of your mental health. Many people who recover from self-harm say that a real turning point for them was when they started seeing a therapist. There are so many different kinds of therapists out there, so it is important to find one who specializes in treatment of self-harm. Two of the most effective treatment modalities for self-harm are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT).
Cognitive Behavioral Therapy primarily focuses on learning to identify and gradually modify thought patterns in order to generate behavioral changes.
Dialectical Behavioral Therapy incorporates components of cognitive behavioral therapy with additional strategies like mindfulness, acceptance, and emotion regulation. If you are seeking a provider, it is important to ensure that they specialize in an evidence-based modality that is proven to address the treatment concern.
Do I need emergency help?
If you have injured yourself severely, believe the injury may be life-threatening, or an attempt at suicide, call 911 immediately. If you can’t reach someone, get yourself to the nearest Emergency Room.
4,3,2,1: Identify 4 things you can see, 3 things you can hear, 2 things you can feel, 1 thing you can smell.
Are you angry? Sad? Figure out how you feel and make a list of all of the synonyms that you can think of to describe that word.
Square breathing: breathe in slowly while you count to four, hold your breath a second, breathe out slowly while you count to four.
Wear an elastic band to snap against your wrist when you want a more adaptive physical distraction.
Rubbing ice cubes on the skin can be another way to soothe your needs.
Freeze an orange and take it out of the freezer when you are feeling checked out or overwhelmed. Hold it, rub it on your skin, and smell it. The texture, temperature, and smell can be super grounding.
Call a friend.
Write a letter that you don’t have to send, expressing why you are so upset.
Remember – recovery is possible!
The first step to becoming well is letting someone that you trust know that you need help, and making the commitment to yourself to seek that help!
Be an Ally: What should I do if a friend is hurting themselves?
Written by Katilyn Dalton-Wise, LCSW
If you discover that a friend is self-harming, the most important action that you can take is to stay calm. It is really alarming and upsetting to learn that someone that we love is in enough pain to hurt themselves. Try to focus on the feelings that your friend is telling you about instead of the behavior itself. If you listen to why they are doing what they are doing, you will be able to have a clearer understanding of how to help. You also may not be able to relate to the self-harm, but can probably relate to feelings of being in pain. When we can have empathy for what someone is going through, we are able to be more helpful.
Step #1 – Tell a Trusted Adult
Step #2 – Crisis Text Line- Pass 741741 On To A Friend
Step #3 – If your friend has injured themselves severely, believe the injury may be life-threatening, or an attempt at suicide, do NOT leave them alone and call 911 immediately.
Other Ways to Help
Be clear and kind. It is important to have an honest and non-judgemental conversation with your friend or loved one about staying safe:
Tell your friend that you really appreciate their honesty.
Tell them that you wish they weren’t having such a hard time.
Tell them you understand they’re struggling but you are really worried about them.
Encourage them to reach out to a trusted adult (parent, teacher, school counselor, coach, medical professional or another adult they trust) to help navigate these feelings and get the help that is needed to ensure they are safe and cared for.
If you are concerned at all about their safety, let them know that even though you appreciate them trusting you, their safety is the most important thing to you and that you are going to have to notify a caregiver/school counselor/coach.
