Understanding and Supporting Individuals Who Self-Harm : A Guide for Compassionate Intervention

1. What is Self-Harm?

   Self-harm is self-injury or self-mutilation. It refers to deliberately inflicting physical harm on oneself. This type of behavior is often a way for individuals to cope or express intense emotional pain, distress, or overwhelming feelings that they might find difficult to manage through other means.

   Self-harm can be in various forms, such as cutting, burning, hitting, biting, or other methods that cause intentional physical harm to one’s own body. Research states hitting and banging to be the most common type of self-harm performed by adolescents followed by pinching and hair pulling⁽¹⁾ It signals emotional or psychological distress and is not a suicide attempt. It can be an indication that an individual is suffering from a mental health issue that might need attention or support.

2. Prevalence of Self-Harm and Its Impact

   Self-harm can affect people of all ages and gender. It is more commonly seen affecting adolescents and young adults and affecting as many as 22% globally.⁽²⁾

   There may be gender disparities, such as females are more known to be involved in cutting and males in burning or hitting.

   It is important to know that self-harm is underreported due to stigma, shame, and fear of judgment. People may struggle in silence without seeking help.

   Self-harm may have an impact on the life of an individual in the following ways: 

   • Physical Consequences: Self-harming behavior may lead to immediate physical injuries that may range from minor cuts or bruises to more severe wounds that might need medical attention. Repeated self-harm may lead to long-term health complications including infections, scarring, and in extreme cases permanent damage to the body.
   • Psychological and Emotional Impact: Self-harm may provide temporary relief from emotional pain or overwhelming emotions in some individuals. However, this relief may be short-lived and can lead to a cycle of repeated self-harming behaviors.

   Also, over time engaging in self-harm can exacerbate the emotional distress, leading to the worsening of mental health conditions such as depression, anxiety, and other mood disorders.

   • Social and Interpersonal Consequences: Self-harm may strain relationships with family, friends, and colleagues. Loved ones may struggle to understand and provide support. It is also seen that some individuals may withdraw from social activities and isolate themselves due to shame or fear or judgment.
   • Suicidal Risk: Self-harm can be a risk factor for suicide and it is important to take self-harm seriously and seek professional help.
   • Financial Help: Treatment and medical care for self-harm may lead to financial strain for individuals and their families.

   It is important to approach self-harm with compassion and seek professional help for those affected.
   

Self-harm can be a way to neutralize negative thoughts and emotions. Some of the common underlying reasons and emotions that may drive self-harming behavior are as follows:⁽³⁾

• Overwhelming Emotions: Intense feelings of sadness, anger, anxiety, or despair can be difficult to manage. This may make the individuals resort to self-harm as a way to cope.
• Inability to Communicate Emotions: Some individuals find it difficult to express inner pain verbally or through other means. They resort to self-harm as a way to externalize their emotions.’
• Need for Control: Individuals with self-harming behavior sometimes feel having a sense of control over their bodies and emotions when other aspects of life are chaotic or uncontrollable.
• Release of Tension: There can be temporary physical release after self-harm, which may help alleviate emotional tension or numbness.
• Self-Blame or Guilt: Some individuals have a feeling of guilt, shame, or self-loathing, making them believe that they deserve to be punished.
• History of Trauma: Individuals who have experienced past trauma such as physical, emotional, or sexual abuse, may turn to self-harm as a way to cope with unresolved pain.
• Disconnect from Emotions: Some individuals may experience a sense of detachment or numbness from their own emotions, self-harm in such cases can be a way to feel something.
• Self-Identity and Expression: Self-harm can be a way individuals communicate their inner struggles when they are unable to do so verbally.
• Co-Occurring Conditions: Self-harm also occurs along with other mental health disorders such as depression, anxiety, borderline personality disorder, and eating disorders.

It is important to approach individuals struggling with self-harm with empathy, understanding, and without judgment. Encouraging professional help is crucial in addressing the underlying issues and providing the necessary support and treatment.

The physical signs of self-harm are not always obvious to others. Mostly people engaging in self-harm often hide marks and injuries or only harm themselves in the parts of the body that are rarely exposed.

Signs of self-harm may include: 

• Wearing inappropriate clothing such as long sleeves on a summer day
• High rate of accidental injuries
• Carrying sharp objects or having them readily accessible
• Scars
• Negative self-talk
• Going through a significant number of bandages or first-aid products
• Discovering items like razors, knives, lighters, or other tools that can be potentially used for self-harm
• Emotional and behavioral signs including a sense of deep sadness, lack of purpose, extreme and rapid shift of emotions, and avoiding social interactions
• Significant shifts in appetite, weight, or sleep duration
• Evading questions or changing subjects when asked about any visible wound
• Sense of being protective about personal space and belongings, and having a fear that others might discover self-harming tools

Sensitivity, empathy, and a non-judgmental attitude are needed for approaching a person with self-harm. A few steps to consider include⁽³⁾

• Appropriate Time and Place: Find a quiet and safe space where a conversation can be started without interruption or distractions. A time when the person is relatively calm should be chosen.
• Express Concern and Care: Avoid blaming and criticism, instead, communicate the worry and care you have for the person’s well-being. Concerns should be stated in a compassionate and understanding manner.
• Listen Actively: Allow them to share their feelings and experiences and acknowledge their emotions and validate any struggles. Make them realize your presence for them.
• Avoid Making Any Judgements or Giving Ultimatums: Avoid making any statements that may make them feel blamed or guilty. Avoid giving ultimatums such as if you don’t stop, I would not help you, as they may increase feelings of isolation.
• Ask Open-ended Questions: Pose questions and invite them to express feelings and thoughts.
• Offer Support and Encourage Professional Help: Let them know that there is someone who cares and is there to support their struggles. Suggest to seek help from a mental health professional and offer assistance in finding resources.
• Respect Their Boundaries: It is important to understand that they may not be ready to talk or seek help immediately and to respect readiness.

It is important to provide support and encouragement to people who have a tendency to self-harm. They should be encouraged to seek professional help and continue to be there for them.

Treatment for self-harm involves a combination of therapy, medical care, and support from a medical health professional.

• Cognitive Behavior Therapy: It involves identifying and changing negative thought patterns and behaviors.⁽⁴⁾
• Dialectical Behavior Therapy: It is a specialized form of therapy that focuses on developing coping skills, emotional regulation, and mindfulness techniques.⁽⁵⁾
• Psychodynamic Therapy: This explores the unconscious thoughts and feelings that may contribute to self-harm.⁽⁶⁾
• Trauma-Focused Therapies: If there is a history of trauma, therapies like Eye Movement Desensitization and Reprocessing (EMDR) or Trauma-Focused Cognitive Behavior Therapy can be beneficial.⁽⁷⁾

• Antidepressants: These medications are prescribed to individuals experiencing depression or other mood disorders that might be contributing to self-harm.
• Mood Stabilizers: These are recommended to regulate emotions.

Attending support groups is important for individuals who struggle with self-harm. This can be helpful in providing a sense of community and understanding.

In severe cases, especially if there is a high risk of suicide, hospitalization or participation in an intensive outpatient program may be necessary.

Art therapy, music therapy, yoga, and mindfulness practices can be helpful in expressing and managing emotions.

Educating individuals about mental health, coping mechanisms, and healthy ways to deal with emotions, can be helpful. Also, teaching skills for managing daily life stressors such as time management, communication, and problem-solving are important.

An effective treatment plan needs to be tailored to individual specific needs and circumstances.

It is not easy to know, how to help someone suffering from self-harm. It is important to approach them with compassion and without judgment.

Self-harm is a symptom of underlying emotional pain and distress and seeking professional treatment is paramount. Respecting their boundaries, encouraging healthy coping mechanisms, and participating in their journey towards recovery can have a positive impact on their healing process.

Open communication and support can help the loved ones talk about their experiences and seek professional help as soon as possible.