About self harm
Self harm is a deliberate act by someone who intends to harm themselves in some way. This can include taking drugs or drinking alcohol excessively to cause harm, but is different from taking drugs for pleasure.
Some people think of self-harm as a spectrum, with suicide at one end and ‘normal behaviour’ at the other. In between are varying degrees of serious and minor self harm. The following information relates to acts of self harm which are considered separate from acts of attempted suicide, which require a different motivation. Someone who attempts suicide is motivated by the desire to end pain, and their life completely, whereas someone who self harms is trying to make them self feel better.
Who self harms?
According to the Mental Health Foundation
142,000 patients present themselves at hospital due to self harm in one
year, however there may be a greater number of people who harm without
seeking medical attention. The rate of self harm amongst adults over 25
is relatively low. It is most common amongst people between the ages
of 11 and 25. Between 1 in 12 and 1 in 15 young people deliberately
harm themselves.
People who self harm might:
- Have a difficult family life that includes abuse, neglect or rejection.
- Be
suffering from a psychological condition such as an eating disorder,
depression, bipolar, or a borderline personality disorder.
- Be people who take illegal drugs or drink an excessive amount of alcohol.
NICE
guidelines advice states that self harm is a symptom of an underlying
problem. It can be very helpful to discover what that problem is so
that the harmful behaviour can be treated.
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 (both of which are types of anxiety 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 and the NHS guidelines state that 1 in 6 people who present
with self inflicted injuries will do so again before the year is up.
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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