Self-Harm: Breaking the Silence

By Ruth Davis, BSN, RNC

Approximately one percent of the population has, at one time or another, used self-inflicted personal injury as a means of coping with an overwhelming situation or feeling.

Self harm scares people. The behavior can be disturbing to those who discover it and difficult to understand. It is typically treated in a simplistic or sensational manner by the media. As a result, friends, family, and loved ones of people who self injure often feel frightened, isolated, and helpless. The first step to coping with self-harm behaviors is education.

What is self harm?
Self harm is also known as self injury, self-inflictive violence, self- injurious behaviors, or self mutilation. It is defined as a “deliberate harm or alteration of one’s body tissue without conscious intent to commit suicide.” The harm can result in tissue damage, such as scarring. The most common methods of self harm are cutting, burning, scratching, skin picking, hair pulling, and interference with wound healing. Both in clinical studies reviewed and in my professional experience, the most popular method seems to be cutting, and the most popular sites for self harm are wrists, upper arms, and inner thighs.

Why would someone engage in self- harm behaviors?
This is the most puzzling to those who do not engage in this behavior. For many, self harm is dismissed as “senselessness” or “irrational” behavior. It is important to remember that all behavior has meaning for the person engaged in it. The reasons may not be apparent or may not fit into our frame of reference, but they exist. The recognition of this existence is critical to understanding self harm. Self harm is all about coping. People who are involved in self-harm behaviors often never developed healthy ways to feel and express emotion or to tolerate distress. Research studies have shown self harm can put a person that is at a high level of physiological arousal back to a baseline state. This would suggest a possible biological or psycho-neurological reason some people find relief in self harm while others don’t.

Some reasons given for self-harm behaviors.

Affect Regulation: Calming overwhelming, intense feelings. A distraction from emotional pain, to end feelings of numbness, lessening a desire to suicide.

Communication: Some people use self harm as a way to express what they cannot speak. It becomes a communication of anger and the depth of their emotional pain in order to seek support and help.

Self Punishment: They believe they deserve punishment for either having good feelings or being an “evil” person, or they hope self punishment will avoid worse punishment from outside sources.

Self Nurturing: Self harm has a nurturing component for some individuals through the self care they are able to give themselves afterwards. By making an internal wound external, there is an attempt to heal oneself.

Who gets involved in self-harm behaviors?
Researchers have found most individuals who engage in self-harming behaviors exhibit mood-dependent behavior. They tend to act in accordance with the demands of what they are currently feeling, rather than considering their long term desires or goals. Anger and anxiety are two major, emotional states commonly present at the time of the self-harm incident.

Some common characteristics for individuals who engage in self-harming behaviors:

Strong dislike for self;
Hypersensitivity to rejection;
Angry, usually at self;
May direct aggressive feelings inward;
May be impulsive;
Tend to be irritable;
Tend to be avoidant;
See self as having little control over how or whether they cope with life situations.

Those who engage in self- harm behaviors can be members of both genders who may range from 13 years of age all the way to adulthood. These behaviors cut across the boundaries of race, education, and socioeconomic brackets. It typically begins in adolescence and involves a person who has no other way to cope. This is not only a teenager, female, or an “American way” to cope. Some who hurt themselves have had sexual, physical abuse, and neglect in their background. However, many of those who hurt themselves have suffered no childhood abuse. In Marsha Linehan’s studies, a national authority on self-harm behaviors, she talks about people who self harm as having grown up in “invalidating environments.”(Lineham, 1993) While an abusive home qualifies as invalidating, so do other “normal” situations.

An invalidating environment is one where the expression of a person’s experience is often punished or trivialized and the experience of painful emotions is disregarded. As a result, the person believes he or she is wrong in both the description and the analysis of the experience.

Examples of invalidating comments:

"You’re angry, but you just won’t admit it."
"You say no—but I know you mean yes."
"You really did do (something you know you didn’t). Stop lying."
"You’re just being hypersensitive."
"You’re just lazy."
"Cheer up. You can get over this."
"I’ll give you something to cry about."

Everyone experiences invalidations like these at some time. However, if these messages are constantly received by children, it can lead to a subconscious self invalidation and self distrust, and result in “I never mattered” feelings. Parents may mean well but be uncomfortable with negative emotion, and therefore, discourage children from expressing these emotions. This can result in unintentional invalidation.

How can family and loved ones help?
The first step is to understand the role of this powerful coping mechanism. If you determine a child or adult engages in this behavior, it is important to remain nonjudgmental and compassionate in your interactions.

The reactions of family, peers, and others to self-harm behaviors have an impact on the self harmer. The behaviors tend to solicit shock, frustration, sadness, guilt, revulsion, anger, and fear, to name a few. When facing the physical evidence of the extent of a self- harmer’s pain, people often realize their own helplessness in being able to stop the behavior. It is not uncommon for this helplessness to be expressed as frustration and anger. Shame is a very powerful emotion that will keep self harmers feeling negative about their behaviors. Self harm is not the typical behavior, yet there is nothing shameful about self harm. It is through self-harm injuries the person is able to cope and survive. The scars are testimonies to this survival. “The courage it took to survive the difficult time in their lives is something that can be a source of pride.” (Alderman, 1997)

Self harm exists whether it is talked about or not. Keeping the silence reinforces the sense of shame many feel about the behavior, and maintains the isolation and alienation that can lead to the behavior. Whether you know what to say or not, letting the self harmer know you are willing to talk is a way you are able to provide support. An important factor in being able to provide support is to be able to regulate your own reactions. This means you need to keep any negative and judgmental responses to yourself, while providing support. It is necessary to find a time and place where you can express your responses openly, as well.

Stopping the behavior is only possible when the person is ready and when they have developed new skills for coping. While most attempts to force, persuade, or suggest the person to stop are based in caring and in a genuine desire to help, if self harmers are not doing it for themselves then failure will most likely be the outcome. The self harmer may also interpret your attempts to help them stop as being judgmental and demanding. This may serve to make them more secretive and to further break down communication. Self harm is a way to cope, and if there was another way to cope at that time they most likely would have used it.

Self-harm behavior speaks loudly of the pain an individual feels long before they have the words to express it. There is hope for those who engage in self-harm behaviors. The behaviors may or may not occur along with other mental health diagnoses; therefore, seeking professional treatment is recommended.

There is no magic pill for stopping self harm. Psychotherapy approaches have been, and are, being developed to help self harmers learn new coping mechanisms, and are being used to teach them how to apply these techniques instead of self harm. The motivation to change this behavior needs to come from within the person. A combination of treatment and education, in addition to an understanding, supporting, and empowering environment, can encourage self harmers to take risks in trying new skills to deal with their overwhelming, intense feelings.

References:
• Alderman, T. 1997. Scarred Soul. Oakland: New Harbinger Publications.
• Favazza, A.R. 2nd Ed. 1996. Bodies Under Siege.
• Linehan, M.M. 1993. Cognitive-Behavioural Treatment of Borderline Personality Disorder. New York: The Guilford Press.
• Martinson, D. 1999. Self-Injury: Beyond the Myths. selfinjury.webjump.com
• Pattison, E.M. & Kahan, J. ‘The Deliberate Self-Harm Syndrome.’ American Journal of Psychiatry. 140:7, July 1983.