“Other people are going to find healing in your wounds. Your greatest life messages and your greatest ministry will come out of your deepest hurts” – Rick Warren

Self-harm/harm is an extremely sensitive issue and a difficult one to discuss without becoming morbid yet it occurs more often than we realize with people from all walks of life. This kind of behaviour is often misdiagnosed and misunderstood but it keeps people alive in the face of unbearable mental anguish.

Because of the shame, secrecy and judgment surround self-harm, SIAD (Self-Injury Awareness Day) occurs on 1st March every year. It is an international event which aims to raise awareness and to educate people about self-harm so that we can better understand and empathise with those who struggle with this.

What is self-harm?

Non-suicidal self-harm, often called self-harm, is the act of deliberately harming the surface of your own body, often resulting in tissue damage. Behaviours such as cutting the skin with a sharp object or burning oneself, scratching, banging or hitting body parts, interfering with wound healing, hair pulling and ingesting toxic substances or objects all fall within the spectrum of this behaviour.

Self-harm without suicidal intent can be seen on a spectrum – just like many other disorders (substance abuse, gambling addiction). Just like these other disorders, once the self-harming behaviours cross a certain threshold, it then becomes classified as a mental health disorder.

What self-harm is not

According to the South African Depression and Anxiety Group (SADAG), self-harm is not a teenage fad, an all-female phenomenon, attention-seeking behaviour or manipulative behaviour. Nor is intended to hurt others. It is not an act that people necessarily want to engage in – some people feel compelled to hurt themselves. Self-injurers are, according to them, able to identify, communicate and/or release their emotions constructively.

Does the person who self-harms intend to commit suicide?

No, usually this is not their intention, however, self-harming behaviour may be potentially life-threatening and there is an increased risk of suicide in individuals who self-harm. Self-harm is found in 40–60% of suicides.

Which part of the population is most at risk of self-harm?

Current research suggests that the rates of self-harm are much higher among young people with the average age of onset between 12 and 24. Self-harm is more common in females than males with this risk being five times greater in the 12-15 age group.

Why do people self-harm?

People’s reasons vary but on the whole, for some, it is the only coping skill that they have when they feel overwhelmed as it provides temporary relief from intense feelings such as anxiety, depression, stress, emotional numbness, or a sense of failure. It can also be a means of communicating distress. Self-harm is often associated with a history of trauma and emotional and sexual abuse and it becomes a means of managing and controlling pain, in contrast with having had no control over pain experienced earlier in their life e.g through abuse.

A common belief regarding self-harm is that it is an attention-seeking behaviour and an attempt to manipulate others emotionally and this is one of the judgements that Self-harm Awareness Day would wish to dispel because, in many cases, this is inaccurate. Many self-harmers are very self-conscious of their wounds and scars and feel ashamed and guilty about their behaviour, leading them to go to great lengths to conceal their behaviour from others – either by hiding their scars or by offering different explanations for their injuries.

Some clients report that when they self-harm, they almost dissociate which means that they are capable of separating their mind from the feelings that cause them pain. They say that when they self-harm, they are overwhelmed by a sense of relief and do not experience the physical pain at that time. Rather the physical pain distracts them from the emotional pain which they are feeling and they can trick the mind into believing that the pain that they feel is being caused by the self-harm rather than by the emotional pain.

Often because of the trauma and pain experienced by the person, they feel numb or empty emotionally and the purpose of the self-harming behaviour is to let them feel something, anything – even if the feeling is unpleasant.and painful. For some, the release of beta-endorphins in the brain, when they self-harm, can provide relief because these chemicals act as natural painkillers and reduce emotional distress and induce feelings of pleasure. So even if it is hard to start cutting, the reward lies in the relief that will follow.

It is true that people who have some form of mental disorders are more prone to self-harm, although not everyone who self-harms has a recognized mental disorder. People who are on the autism spectrum, those who struggle with borderline personality disorder, bipolar disorder, depression, phobias, conduct disorders and schizophrenia, are more susceptible to self-harming behaviours than the rest of the population.

From a psychological perspective, a main social factor contributing to self-harm, according to the literature, is abuse during childhood. Bereavement and troubled parental or partner relationships are also factors to consider.

Genetics may contribute to the risk of developing other psychological conditions, such as anxiety or depression, which could, in turn, lead to self-harming behaviour.
Substance misuse, dependence and withdrawal are associated with self-harm because people who are addicted to benzodiazepine, when in withdrawal, tend to self-harm. Alcohol is also a major risk factor for self-harm.

How does one treat self-harm?

There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behaviour itself. It is important to have a multi-pronged approach to treating this behaviour and a combination of therapy and medication is the first line of defence.

When self-harm is associated with depression, anti-depressant medication and therapy may be effective. Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.

Cognitive behavioural therapy (CBT), Dialectical behaviour therapy (DBT) and Brain Working Recursive Therapy (BWRT) can potentially be used for those who exhibit self-harming behaviour.

People who habitually self-harm are sometimes hospitalised, based on their stability, their ability and especially their willingness to get help. A multi-pronged approach to therapy where treatments such as CBT, family intervention, interpersonal therapy, and various psychodynamic therapies were all shown to be possibly effective in treating self-injurious behaviour in children and adolescents.

Other techniques which are effective helping the person to structure their time well in order to keep them busy, helping them to express their feelings by journaling, participating in exercise or being around friends when the person has the urge to harm themselves. The removal of objects used for self-harm from easy reach is also helpful for resisting self-harming urges.

Where to get help

Contact a psychiatrist or a knowledgeable medical doctor
Contact a qualified, experienced psychologist
Support groups like SADAG can be contacted:

Tel: +27 11 262 6396 Fax: +27 11 262 6350
Zane1@hargray.com www.sadag.org

By Sharon Steyn
Educational Psychologist

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