Self-harm - Causes

Why do people self harm?

There are many reasons why people self harm. Each person who self-harms has his or her own reason. Often the reasons people give for their self harm behaviour is different from what the professionals say. In a survey of young people conducted by the Samaritans (2001), the most common reason given was 'to find relief from a terrible situation’. The least common reason was 'to get my own back.'

The reasons that people who self harm give for their behaviour can be broadly grouped into three categories:

Controlling Mood

Affect (mood) regulation is how a person is able to cope with emotions and feelings, especially feelings which are particularly unsettling, unpleasant or intense. Often people who self harm feel unable to deal with strong and powerful emotions such as these and feel overwhelmed or incapable of controlling themselves. Self harm can offer relief as it can lead to dissociation (becoming disconnected from feelings) and can also trigger the release of positive brain chemicals which can bring about improved mood.

Communication

Some people use self harm as a way of expressing themselves. If these expressions are directed at others this can be seen by some as attention-seeking and manipulation. However, people who self harm for this reason have often tried many other more acceptable ways of communicating and have been ignored, or received an inappropriate response. Self harm gets the attention of people but often in an unhelpful way. Understanding what an act of self harm is trying to communicate can be crucial to dealing with it in an effective and constructive way.

Control/punishment

People who self harm have often experienced traumatic experiences in their lives including emotional, physical or sexual abuse. Self harm can be a form of trauma re-enactment (bringing about the feelings the person felt when they were first traumatised) or a way of bargaining or engaging in magical thinking - ‘if I hurt myself I will prevent the thing I fear or protect the person I care about’.

Why do more women than men self harm?

In a survey carried out in 1986 respondents who self harmed were 97% female although a more realistic figure might be 64 - 85% according to studies carried out more recently. It is therefore relatively certain that women are more prone to this sort of behaviour than men. One theory why this might be is that society sees it as less acceptable for women to express violence externally and so when confronted with feelings of rage or anger they take it out on themselves.

Is self harming a mental health problem?

When assessed, the majority of individuals engaging in self harm will be diagnosed with depression, although two thirds will no longer fit the criteria after a year. People who self harm are also often given the diagnosis of borderline personality disorder, as it is in the diagnostic criteria for this condition. This can be unhelpful as it may detract from the assistance the individual receives in overcoming the problems that have caused their behaviour.

Bipolar disorder and schizophrenia are linked with self harm but they only make up 10% of the total number of people who present to hospital with self imposed injuries. However, someone who suffers from a mental health condition such as an eating disorder, obsessive compulsive disorder or post traumatic stress disorder is twenty times more likely to injure themselves. There are many people who self harm who have no formal diagnosis and are not in touch with psychiatric services.

What is the difference between self harming and Munchausen's syndrome?

Self harm is quite different from Munchausen's syndrome. This is a condition where people cause harm to themselves in order to achieve a specific physical symptom and often to get hospital admission to a medical ward.

Do people repeatedly self harm?

The Samaritans estimate that 10-15% of people who self harm will do so again within the year . Therefore it is important that someone who has self-harmed in the past seeks support and advice as they are at risk of self-harming again.

Self harm and suicide

Self harm is not always an attempt at suicide despite it often being termed ‘parasuicide’. In fact often people who deliberately harm themselves are not aware of the dangers of what they are doing and do not intend to kill themselves. Their actions can be attempts at communication, psychological or physical relief or punishment, but should be considered distinct from attempts to end life entirely. Despite this someone who self harms is 50-100 times more likely to attempt suicide than someone who does not.

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