Self-Harm: What it is and Why it Happens

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This article is not intended for the purpose of diagnosis or treatment of any mental health issue. If you or someone you know is struggling with self-harm or other mental health issues, please call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) for free, confidential treatment referrals and information available 24/7, 365 days a year.

My cat is very rambunctious and bites and scratches, probably more frequently than the average cat. Since I work in the mental health setting, these scratches are sometimes misinterpreted as attempts at self-harm by both fellow colleagues as well as patients. My defensive response to a patient who asked about a scratch one time made me feel ashamed and caused me to reflect on the stigma associated with self-harming behaviors, also known as non-suicidal self-injury (NSSI). The stigma behind NSSI often leads to shame and secrecy that makes it hard for people to seek treatment, feel better, and find more effective coping skills so that they can stop hurting themselves.

Usually when people think of self-harm, they think of cutting – when someone breaks their own skin with a sharp object. However, self-harm can present in a lot of different ways. Sometimes, people burn themselves or engage in behavior that can lead to broken bones. But what is behind self-harm? What leads someone to hurt themselves? Self-harm is a coping skill to manage negative, intense, or difficult feelings (APA, 2015). Since NSSI is not an area of expertise for me, I looked at some recent studies as well as personal accounts so that I could learn more about what underlies these behaviors from the people who suffer.

What is most noteworthy is that that the general public and professionals alike have preconceived notions about who engages in self-harming behavior and why they do it. To reveal some of my own biases as a clinical psychologist, the “portrait” of someone who self-harms that immediately comes to mind is a young (teens or twenties), white female who has a diagnosis of borderline personality disorder secondary to an abusive childhood in which sexual abuse is usually involved. According to the American Psychological Association (APA), some of these perceptions line up with who is most commonly seen for this issue, but as with any psychiatric disorder or unhealthy behavior, it does not discriminate and can present a variety of ways across populations (APA, 2015). One of highest at-risk populations for self-harm, which my “portrait” did not identify, is among bisexual individuals, both men and women. Rates of NSSI among teenage are indeed quite high as well and should be taken seriously and not viewed as “just a phase” (Monto et al., 2015; Townsend, 2019).

Of long-standing concern are the increasing instances where non-suicidal self-injury ends up leading to death, regardless of the intent (Rockett et al., 2018). People with intellectual disabilities may also use NSSI as a means of communicating distress (CDC, 2021). There is concern that the isolation due to the COVID-19 lock-down is increasing instances of self-harm, especially among students, although specific information about how the pandemic is affecting people’s mental health is still forthcoming (Hasking et al., 2021; AP, 2020).

Interestingly, much of the qualitative literature and personal accounts from people who self-harm were from the United Kingdom – perhaps this is because the prevalence is higher than in the United States, the stigma associated with discussing mental health issues is lower, or other factors that play a role (British Psychological Society, 2012; Edmondson et al., 2018; Time to Change, 2021). Some key themes that arose in the literature regarding reasons for self-harm include self-punishment, protecting oneself, and finding a method of communication with the outside world. NSSI can also be used to gain a sense of mastery or feelings of empowerment related to a painful situation (Edmondson et al., 2018; Time to Change, 2021). 

Of the personal accounts that I read, some people reported perfect childhoods, but many said that they had experienced abuse throughout their lives and especially in childhood. A most important common theme was that depression made people feel burdensome, so reaching out to communicate painful feelings to someone through their words did not feel like an option. These individuals would communicate through their wounds/later scars or would release their emotions by inflicting harm on themselves (Edmondson et al., 2018; Time to Change, 2021). In one post, a person with a history of NSSI said that if someone were to ask about their history of self-harm, they would want to be asked if it was okay to ask about their scars and not be shamed for having engaged in self-harm. They would also want someone to offer a listening ear if they found themselves struggling with the same issue in the future (Time to Change, 2021).  

Speaking broadly, people with NSSI can seek psychotherapy that aids in improving emotional regulation, distress tolerance, and healthy communication to help decrease the instances of self-harm. In addition to psychotherapy, they can also seek help from a psychiatrist, who may recommend medication to help decrease distressing symptoms. If you are an ally, friend, or loved one, you can be part of the solution by being a source of empathy and understanding and by avoiding further stigma of someone’s self-harm behavior. As listed at the beginning of this article, the SAMHSA National Helpline is a great resource to help someone get started (1-800-662-HELP). If someone is in immediate crisis, please call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

References

Associated Press. (2020, August 7). Increased student harm, suicide tips reported during COVID. U.S. News & World Report. Retrieved from https://www.usnews.com/news/best-states/pennsylvania/articles/2020-08-07/increased-student-harm-suicide-tips-reported-during-covid

Centers for Disease Control and Prevention. (2021). Safety and children with disabilities: Self-injury. Retrieved from https://www.cdc.gov/ncbddd/disabilityandsafety/self-injury.html

DeAngelis, T. (2015, July/August). Who self-injures? American Psychological Association Monitor on Psychology, 46(7), 60. Available from https://www.apa.org/monitor/2015/07-08/who-self-injures

Edmondson, A.J., Brennan, C., House, A.O. (2018). Using photo-elicitation to understand reasons for repeated self-harm: A qualitative study. BMC Psychiatry, 18(98), 1-11. https://doi.org/10.1186/s12888-018-168-3

Hasking, P., Lewis, S.P., Bloom, E., Brausch, A., Kaess, M., Robinson, K. (2021). Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources. School Psychology International, 42(1), 57-78. https://doi.org/10.1177/0143034320974414

MentalHealth.gov. (2021). How to get mental health help: Get immediate help. Retrieved from https://www.mentalhealth.gov/get-help/immediate-help

Monto, M.A., McRee, N., Deryck, F.S. (2018). Nonsuicidal Self-Injury Among a Representative Sample of US Adolescents, 2015. American Journal of Public Health, 108(8), 1042-1048. https://doi.org/10.2105/AJPH.2018.304470

National Collaborating Centre for Mental Health (UK). Self-Harm: Longer-Term Management. Leicester (UK): British Psychological Society; 2012. (NICE Clinical Guidelines, No. 133.) 4, EXPERIENCE OF CARE. Available from: https://www.ncbi.nlm.nih.gov/books/NBK126796/

Townsend, E. (2019). Comment: Time to take self-harm in young people seriously. The Lancet Psychiatry, 6(4), 279-280. https://doi.org/10.1016/S2215-0366(19)30101-4

Time to Change: Let’s End Mental Health Discrimination. (2021). Blogs and stories about self-harm. Retrieved from https://www.time-to-change.org.uk/category/blog/self-harm/

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