Deliberate self-harm (also known as self-injury) is the act of harming one's body without the conscious intent to die (i). It is often carried out in secret with most people not knowing that a person is self-harming (ii).
Although most people who self-harm have no intent to die, they can sometimes take the behaviour inadvertently too far and accidentally suicide.
Deliberate self-harm and suicide are not the same. Suicide involves the conscious intent of ending unbearable pain with lethal methods. The act of deliberate self-harm involves not having the intent to die, and is acted out to relieve emotional distress via non-lethal methods (i).
The reasons for a person deliberately self-harming are complex and subjective. This tendency can serve several functions for the individual (ii), including:
- a way to express difficult feelings;
- a way of communicating to people that they need help;
- a way of proving to themselves they exist;
- a feeling of control; and
- an immediate sense of relief.
The feelings that are felt during an episode are unable to be dealt with internally via effectively functioning coping mechanisms and are therefore projected externally onto the physical self in order to relive the pain. Many people who self-harm recall feelings of calm and piece after an episode of harming.
Deliberate self-harm is a risk factor for suicide, however not everyone who self-harms is at risk. Self-harming is not an attention seeking ploy, it is a genuine act of dealing with emotions externally as they cannot be dealt with adequately internally.
Common Forms of Deliberate Self-harm
There are a number of ways in which self-harm can manifest in a person. The most widely used example of self-harm in the media is that of cutting. Cutting involves a person inflicting patches of his or her skin with small superficial cuts. The number of cuts can range from one to many. A person usually cuts on a section of skin that can be hidden by clothing. Aside from cutting the skin, a person can also bite and scratch at the skin, as well as burning the skin. Head banging and punching is also a common manifestation of deliberate self-harm.
Two other common forms of deliberate self-harm which may not automatically be thought of as such are hair/eyelash pulling and destructive behaviour. Although these things may not automatically be thought of as self-harming behaviour they can be just as destructive.
Risk Factors for Deliberate Self-harm
There are several factors that have been associated with this self-destructive behavior. These risk factors include societal factors and personal attributes, which include the following:
- poor coping mechanisms;
- low self-esteem;
- mental health issues;
- being a young person;
- being an indigenous person;
- being a person who identifies as being gay, lesbian, bisexual or transgender;
- being an elderly person;
- being a person with a mental illness;
- being a person in custody;
- being a person from a culturally and linguistically diverse background; and
- being a person living in a remote and/or rural community.
Societal risk factors that may increase a persons risk of self-harming include:
- disempowerment;
- migration and refugee experiences;
- homophobia;
- physical isolation;
- emotional isolation; and
- challenges with aging.
Protective Factors Against Deliberate Self-harm
Conversely, there are several qualities and factors that are exhibited by individuals who do not engage in self-harming behaviors. These protective attributes include:
- high self-esteem;
- good coping mechanisms;
- quality life-skills;
- strong support network (family, friends, community);
- a sense of self-empowerment;
- access to adequate health care;
- strong cultural identity;
- strong family identity; and
- strong sexual identity.
Responding to a Person Who is Deliberately Self-harming
There are several ways that family members and friends can respond when it's learned that an individual is engaging in self-harming behaviours. Providing emotional support and encouraging the person to seek help is the first and most important step in responding to a person who is deliberately self-harming. Whilst providing this emotional support, it is ideal to maintain a calm and non-judgmental attitude. Doing this will help the person open up and talk about what is bothering them.
Linking a person who is deliberately self-harming to informal and formal supports is an important step in responding. Discuss with the person who is available in his or her social network to provide emotional support. Explore with the person options available for more formal supports, such as a local doctor, counsellor or hospital.
Supporting someone who is self-harming can be stressful and emotional. Making sure you, as a person responding has someone to debrief with is important for your own self-care.
If you feel that a person you know who is self-harming may be at risk of suicide, my article on Suicide Intervention and Prevention will provide you with more information on how to approach the topic with them.
If you feel the threat of suicide is very serious and/or imminent contact appropriate resources immediately.
Self-care For People at Risk of Deliberate Self-harm
There are several strategies that can be utilized by individuals who are prone to potentially dangerous self-harming behaviors. Some of these self-care tactics include the following:
- look after yourself;
- get enough sleep;
- eat healthily;
- get some exercise, try something relaxing like yoga, walking or swimming;
- take time out to relax;
- acknowledge your emotional and physical reactions;
- keep a journal, or express yourself artistically in a way you feel comfortable;
- don't be afraid of saying 'no' to people;
- spend time with family and friends;
- get involved in activities that you like;
- develop a hobby;
- listen to music you like, or that you find relaxing; and
- watch a favourite movie.
Alternatives to Deliberate Self-harm
These are NOT solutions to the complex problem of deliberate self-harm. They are just a few examples on where to re-direct the external expression of emotion (ii):
- screaming into a pillow;
- punching something soft (pillow, bed, or a punching bag);
- draw or write on your body instead of cutting;
- have a cold shower; and
- jump up and down on the spot.
Self-harm is often viewed by society as an attention seeking ploy. This is not the case. Deliberate self-harm is a serious issue involving a persons inability to appropriately express such feelings as anger and sadness. Although cutting is the media's favourite way to illustrate self-harm, there are other potentially more dangerous ways in which people exhibit self-harming behaviours. If you know of someone who is deliberately self-harming it is advised to provide emotional support and a calm and non-judgemental attitude. Providing the person with informal and formal supports and with alternatives to self-harming will get them one step closer to being able to dealing with the behaviour successfully.
Sources:
(i) Responding to People at Risk of Suicide
(ii) Deliberate Self-harm
(iii) Headspace
Amy Clare Macdonald - Bachelor Behavioural Science (Psychology) Graduate Certificate of Arts (Writing)
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