I belong to a women's self-harm support group. The group was the start of changing my life. The encouragement and support from both has given me the strength and courage to continue my life, and I now value myself. I still self-harm, but nowhere near as much as I used to. By talking about it, I am learning to deal with my feelings.
What is self-harm?
Self-harm is a way of expressing very deep distress. Often, people don't know why they self-harm. It's a means of communicating what can't be put into words or even into thoughts and has been described as an inner scream. Afterwards, people feel better able to cope with life again, for a while.
Self-harm is a broad term. People may injure or poison themselves by scratching, cutting or burning their skin, by hitting themselves against objects, taking a drug overdose, or swallowing or putting other things inside themselves. It may also take less obvious forms, including unnecessary risks, staying in an abusive relationship, developing an eating problem (such as anorexia or bulimia), being addicted to alcohol or drugs, or someone simply not looking after their own emotional or physical needs.
These responses may help someone to cope with feelings that threaten to overwhelm them; painful emotions, such as rage, sadness, emptiness, grief, self-hatred, fear, loneliness and guilt. These can be released through the body, where they can be seen and dealt with. Self-harm may serve a number of purposes at the same time. It may be a way of getting the pain out, of being distracted from it, of communicating feelings to somebody else, and of finding comfort. It can also be a means of self-punishment or an attempt to gain some control over life. Because they may feel ashamed, afraid, or worried about other people’s reactions, people who self-harm often conceal what they are doing rather than draw attention to it.
It's worth remembering that most people behave self-destructively at times, even if they don't realise it. Perfectly ordinary behaviour, such as smoking, eating and drinking too much, or working long hours, day after day, can all be helping people to numb or distract themselves and avoid being alone with their thoughts and feelings.
Why do people harm themselves?
A person who self-harms is likely to have gone through very difficult, painful experiences as a child or young adult. At the time, they probably had no one they could confide in, so didn't receive the support and the emotional outlet they needed to deal with it. The experience might have involved physical violence, emotional or sexual abuse. They might have been neglected, separated from someone they loved, been bullied, harassed, assaulted, isolated, put under intolerable pressure, made homeless, sent into care, into hospital or to other institutions.
I am a survivor of both sexual abuse and self-injury. I no longer self-injure, but it has been a long struggle to try to acknowledge and work through emotions that once felt overwhelming in their power.
Experiences like these erode self-esteem. Emotions that have no outlet may be buried and blocked completely out of awareness. If a trusted adult betrays or abuses them, and there are no other witnesses, children will often blame themselves. They turn their anger inwards. By the time they become adults, self-injury can be a way of expressing their pain, punishing themselves, and keeping memories at bay.
There is often an absence of pain during the act of self-injury, rather like the absence of sensation that often occurs during abuse or trauma. The body produces natural opiates, which numb it and mask the emotions, so that little is felt or realised consciously. A badly traumatised person may end up feeling quite detached from their feelings and their body. Some may injure themselves to maintain that sense of being separate, and to convince themselves that they aren't vulnerable. Others may injure themselves in order to feel something and know that they are real and alive.
There can often be myths and negative attitudes surrounding self-harming, even within the healthcare industry. Professionals can often make assumptions as to why someone is self-harming and therefore how to treat them. There can be instances of healthcare professionals with an unsympathetic attitude to someone who comes to them with injuries; for example, believing that people who are cutting themselves are causing their own injuries and therefore wasting the time of the nurse who has to stitch their wounds. NICE (the National Institute for Health and Clinical Excellence) produces guidelines on the treatment of self-harm, explaining the need for exploring the underlying reasons someone may be self-harming, rather than just the self-harming behaviour itself.
Who is most likely to self-harm?
According to research, the majority are young women, although the percentage of young men seems to be on the increase. Self-harming behaviour is also significant among minority groups discriminated against by society. Someone who has mental health problems is more likely to self-harm. So are those who are dependent on drugs or alcohol, or who are faced with a number of major life problems, such as being homeless, a single parent, in financial difficulty or otherwise living in stressful circumstances. A common factor is often a feeling of helplessness or powerlessness with regard to their emotions.
Self-harm involves all of us on some level. We may all punish, distract or numb ourselves as a way of dealing with difficult feelings or situations.
Recent research focusing on young people suggests that 10 per cent of 15 to 16 year olds have self-harmed, usually by cutting themselves, and that girls are far more likely to self-harm than boys. The most common reason is 'to find relief from a terrible situation'. Young people are often under great pressure within their families, from school and among their peers. Many young people report having friends who they know to also self-harm.
The research suggests that young people who self-harm are much more likely to have low self-esteem, to be depressed and anxious. They seem to be facing more problems in life, but may be less good at coping with them. They may retreat into themselves, feeling angry, blaming themselves, tending to drink and smoke too much and to use more recreational drugs. They confide in fewer friends, and tend not to talk to their parents or other adults, or to ask for the help they need.
Women often find themselves in a caring role, putting their own needs last. This can grossly undermine their sense of worth, their opinions and strengths. In due course, a woman may come to feel she is an unimportant, silent witness to the abuses she has to endure. She may lose her sense of identity, power and rights. To survive, she may cut herself off from her real needs; for example, if the focus for this is the size and shape of her body, she may drastically restrict what she eats.
If men conform to the macho stereotype that expressing emotion is a weakness, it can leave them unable to fully experience their feelings, and detached from that side of themselves. They may have less difficulty showing anger than women, but if they are in prison, where pent-up feelings can't be released, men are more likely to turn to self-harm, especially if they have been abused.
Is self-harm a suicide attempt?
Self-harm can be about trying to stay alive – a coping mechanism for survival, and to escape from emotional pain. The majority of people who self-harm are not suicidal, but a small minority will intentionally attempt suicide. Some suicides resulting from self-harming behaviour may be accidental, occurring when someone has hurt themself more than they intended to.
Is self-harming behaviour attention-seeking?
Because it can be hard to understand, healthcare professionals, friends and relatives sometimes mistakenly regard people who self-harm with mistrust or fear and see their behaviour as attention-seeking and manipulative. If someone you know self-harms, you may feel helpless when faced with their wounds; your own feelings and fears about the situation may cause you to blame them instead of supporting them (See For friends and family). Bear in mind they may be using the only way they can to communicate their plight and to get the attention, care and comfort they need. However upsetting it may be for you, it doesn't necessarily mean this is their intention.
Whether people have deep wounds or slight injuries, the problem they represent should always be taken very seriously. The size of the wound isn't a measure of the size of the conflict inside.
What triggers it?
You may harm yourself once or twice at a particularly difficult time in your life, and never do so again. But self-harming can become an ongoing way of coping with current problems and may occur regularly, on a monthly, weekly, or daily basis, depending on circumstances. The trigger could be a reminder of the past (such as an anniversary) which sets off a hidden memory, or something unexpected could happen to cause a shake-up. But sometimes, ordinary life is just so difficult that self-harm is the only way to cope with it.