According to the Center for Suicide Prevention, self-harming behaviors continue to be a major issue. This is especially true for young people, whose self-harm rates far outnumber those for adults. Self-harm can sometimes be associated with increased suicidality. Self-harm has been defined as “a preoccupation with deliberately hurting oneself without conscious suicidal intent, often resulting in damage to body tissue” (Muehlenkamp, 2005, p.324). Self-harm does not include tattooing or piercing, or indirect injury such as substance abuse or eating disorders.
What is self-harm?
According to Mind Soother Therapy Center, self-harm or self-injury means hurting yourself on purpose. Despite popular belief, self-harm is most likely not a suicidal gesture. Self-harm is, simply, a coping strategy. Although it is negative and harmful, it helps people cope. There are many ways to self-harm; common methods include cutting or scratching, but any intentional hurting of yourself is considered self-harm. People often keep their habit a secret, but the urge to self-harm isn’t uncommon, especially in adolescents and young adults. Hurting yourself – or thinking about hurting yourself – is a sign of emotional distress. These uncomfortable emotions may grow more intense if you continue to use self-harm as a coping mechanism. Learning other ways to tolerate mental pain is essential to recovery. Self-harm also causes feelings of shame as the behavior is most likely a secret and the idea of sharing can seem scary. Scars caused by frequent self-harming can be permanent. Self-harm often becomes a ritual as taking care of wounds or focusing on ways to prevent being discovered take thought, time and energy.
Why people self-harm:
Self-harm is not considered a mental illness but, rather, a behavior that indicates immature or poor coping skills. Self-harm occurs most often during the teenage and young adult years, though it can also happen later in life. Those at the most risk are people who have experienced trauma, neglect, or abuse or who have not yet developed healthy coping strategies or tolerance for mental or physical pain. People who binge drink or do drugs are at higher risk because alcohol and drugs lower self-control. It may seem to make no sense, but those who self-harm describe that it feels like a release. Sometimes, self-harm stimulates the body’s endorphins or pain-killing hormones, thus raising mood. Or if a person doesn’t feel many emotions, he or she might cause pain in order to feel something “real” or to replace emotional numbness. Once a person self-harms, he or she may experience shame and guilt. If the shame leads to intense negative feelings, that person may self-harm again as a way to cope. The behavior can thus become a dangerous cycle and a long-time habit. Some people even create rituals around it. Self-harm isn’t the same as attempting suicide – it is a symptom of emotional pain that should be taken seriously. If someone is self-harming, he/she may be at an increased risk of feeling suicidal or of accidental suicide.
According to the Center for Suicide Prevention, people who self-harm may:
- appear withdrawn, or more quiet or reserved than usual;
- stop participating in usual activities;
- have rapid mood changes;
- get angry or upset easily;
- have had a significant event in their lives, e.g. a breakup with significant other;
- suffer poor academic/school performance when they usually do very well;
- exhibit unexplained cuts or scratches;
- wear clothes that are inappropriate for the weather, e.g. wearing long sleeves on a hot day.
Treatment and coping:
Therapy designed to help a person understand emotions and to learn safe and effective coping strategies for managing emotional and physical pain is essential in managing self-harm. Depending on any underlying illness, a doctor may prescribe medication to help with difficult emotions. For someone with depression, for instance, an antidepressant may lessen harmful urges. Several different kinds of therapy can help a person with self-harm understand and manage urges. These include:
- Psychodynamic Therapy focuses on exploring past experiences and emotions so that a person can understand triggers and urges.
- Cognitive-Behavioral Therapy (CBT) focuses on recognizing negative thought patterns, challenging them and learning new ways of thinking. For example, if you automatically feel hopeless every time you have an argument with a friend, you are at risk for self-harming. CBT helps you challenge your old thoughts (“I am such a bad person if I argued with my friend and I deserve to hurt myself”) and create new ways of thinking that focuses on facts instead of interpretations (“I had an argument with my friend which is expected in relationships at times. I feel yucky about this now and this feeling will pass over time.”)
- Dialectical Behavior Therapy (DBT) can help a person learn positive coping methods to manage self-harm urges. DBT teaches specific strategies such as Distress Tolerance – ways to get through difficult moments without giving in to urges. DBT also teaches Emotion Regulation – ways to understand the messages your emotions are sending and how to cope with feelings or urges instead of giving in to them to get immediate relief.
What to do when someone you love self-harms:
Perhaps you have noticed a friend or family member with frequent bruises or bandages. If someone is wearing long sleeves and pants even in hot weather, he or she may be trying to hide cuts or scars. Here’s what to do (and not do) if you suspect someone you know might be self-harming:
- Ask the person how he/she is doing.
- Be prepared to listen to the person’s answer, even if it makes you uncomfortable. This may be a hard subject to understand. One of the best things to tell them is that while you may not fully understand, you’ll be there to help.
- Validate feelings even if you don’t understand or agree. Say, “sounds like you are going through a rough time.” A person who self-harms is experiencing pain and, even if it doesn’t make sense to you, it is very real to him/her.
- Don’t joke around or try to lighten the subject matter. A person who self-harms is in pain and needs to know that he or she will be taken seriously.
- Gently encourage the person to get appropriate therapy by stating that self-harm isn’t uncommon, and doctors and therapists can help. If possible, offer to help find treatment.
- Avoid asking the person to make promises to stop. Self-harm becomes a habit that offers physical and mental relief – it is very difficult to stop “cold turkey.” A person who self-harms needs more than “willpower” to stop. Licensed professionals who are trained in self-harm will be able to help.
Suicide is a major health problem and a leading cause of death in the United States. Suicidal thoughts, although real and scary, are not suicide. Suicide is directed violence at self with the intent to end life. A suicide attempt – is an intent to direct violence to end life, without death as the result.
Who is at risk for suicide?
Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. According to the National Institute of Mental Health (NIMH), the main risk factors for suicide are:
- A prior suicide attempt
- Depression and other mental health disorders
- Substance abuse disorder
- Family history of a mental health or substance abuse disorder
- Family history of suicide
- Family violence, including physical or sexual abuse
- Having guns or other firearms in the home
- Being in prison or jail
- Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
- Medical illness
- Being between the ages of 15 and 24 years or over age 60
Even among people who have risk factors for suicide, most do not attempt suicide. It remains difficult to predict who will act on suicidal thoughts.
Why do some people become suicidal while others with similar risk factors do not?
According to the National Institute of Mental Health (NIMH), most people who have the risk factors for suicide will not kill themselves. However, the risk for suicidal behavior is complex. Research suggests that people who attempt suicide may react to events, think, and make decisions differently than those who do not attempt suicide. These differences happen more often if a person also has a disorder such as depression, substance abuse, anxiety, borderline personality disorder, and psychosis. Risk factors are important to keep in mind; however, someone who has warning signs of suicide may be in more danger and require immediate attention.
What are the warning signs of suicide?
According to the National Institute of Mental Health (NIMH), the behaviors listed below may be signs that someone is thinking about suicide.
- Talking about wanting to die or wanting to kill themselves
- Talking about feeling empty, hopeless, or having no reason to live
- Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
- Talking about great guilt or shame
- Talking about feeling trapped or feeling that there are no solutions
- Feeling unbearable pain, both physical or emotional
- Talking about being a burden to others
- Using alcohol or drugs more often
- Acting anxious or agitated
- Withdrawing from family and friends
- Changing eating and/or sleeping habits
- Showing rage or talking about seeking revenge
- Taking risks that could lead to death, such as reckless driving
- Talking or thinking about death often
- Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
- Giving away important possessions
- Saying goodbye to friends and family
- Putting affairs in order, making a will
What should you do if you are in crisis or someone you know is considering suicide?
If you or someone you know has warning signs or symptoms of suicide, particularly if there is a change in behavior or a new behavior, get help as soon as possible.
Text HOME to 741741 – the Crisis Text Line
Often, family and friends are the first to recognize the warning signs of suicide and can take the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions.
If someone is telling you that they are going to kill themselves, do not leave them alone. Take the person immediately to the nearest hospital emergency room or call 911. There is no harm in being safe.
Do not promise anyone that you will keep their suicidal thoughts a secret.
Make sure to tell a trusted friend or family member, or if you are a student, an adult with whom you feel comfortable.
After the person is deemed safe, enroll them in consistent psychotherapy with a therapist trained to assess and help manage suicidal thoughts and urges. The right therapist will assess for imminent danger, help create a safety plan, work with family members to understand and support and use evidence-based therapy techniques to challenge urges.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.