Self-harm, also called self-injury, is where someone deliberately injures themselves in a way that is not intended to end their life. Strong emotional reactions to self-harm are common, and some people may find it distressing to read the following information. It is important to seek help if you are feeling distressed.
There are many different ways a person might hurt themselves, such as:
- Punching or hitting
- Taking too many tablets
- Swallowing things
In many cases, people self-harm as a way of coping with or expressing overwhelming emotions; however, while self-harm may provide short-term relief, it poses risk and danger to the individual’s safety, and people usually end up feeling worse. With the right treatment, it is possible to learn safer and healthier coping mechanisms, soothing techniques, and communication skills.
Prevalence of self harming behavior
Research suggests that 1 to 4% of adults and 15% of adolescents in the United States have self-harmed (1). The actual figure is probably higher than this, as many people do not report self-harm due to feelings of fear or shame. In one study, a third of students who had self-harmed reported that their injuries were of the severity that should have received medical attention, yet only 5% actually did seek treatment (2).
Research suggests that people of a sexual minority (2) or young people who are bullied (3) are more likely to self-injure.
Why do people self harm?
The reasons people give for hurting themselves vary, but it generally occurs when people are experiencing distress beyond that which they can cope with, and for which they do not have other healthier coping mechanisms.
People self-injure for reasons such as:
- To feel something
- To gain a sense of control
- To distract from difficult situations or emotions
- To reduce tension
- To punish themselves
Types of problems contributing to this kind of distress include:
- Feeling depressed
- Feeling out of control
- Self-esteem issues or feeling like you are to blame
- Relationship problems
- Being unemployed
- Difficulties at school or work
- Feeling lonely or that nobody is listening to you
- Feeling hopeless
- Feelings of shame or guilt
Unfortunately, it is often misunderstood that people who self-harm are “attention seeking”, but this is not the case. Health professionals know this and are trained to help.
What mental health symptoms are linked with self harm?
Self-harm is not a diagnosable mental health condition itself. It is a behavior associated with a number of diagnoses, including:
- Trauma, including Post-Traumatic Stress Disorder (PTSD)
- Borderline personality disorder (BPD)
- Substance abuse, including alcohol use
- Eating disorders
- Psychotic disorders such as Schizophrenia
- Bipolar disorder
Research suggests that having a mental health condition increases the risk of self-harm, and that self-harm is associated with more severe symptoms.
Ways to heal from self harm
There are many resources available to help people to recover from self-harm. If you are relying on maladaptive coping strategies, know that professionals can help. You might consider one or more of these options:
- Therapy. Find a therapist who specializes in self-harm. Therapy can help you understand why you self-harm, identify triggers, find alternative coping strategies, and help you with problem solving.
- Check-ups: If you have any concerns, it is important to have a medical doctor examine your injuries. Some people may worry about being judged or feel ashamed - keep in mind that doctors are trained to help in these situations. The more honest you can be, the more your doctor can help you stay physically safe.
- Hotlines: If you’re having thoughts of suicide or need immediate support, you can always call the National Suicide Prevention Hotline at 1-800-273-8255. If you have experienced any kind of sexual trauma, the RAINN National Sexual Assault Hotline can also provide support and resources at 1-800-656-4673. The Crisis Text Line is available for help without having to speak by texting HOME 741741.
- Get information: It can help to read others’ stories about recovery, such as those available on the Self-Injury Outreach and Support website.
- Social support: It’s important not to isolate yourself. If you feel like self-harming, try calling a friend or a helpline. You might also consider joining a support group in your local area.
- Support groups: During the recovery journey, many people find it beneficial to speak with others who are experiencing similar difficulties. Emotions Anonymous support groups are based on the 12-step Alcoholics Anonymous model and are widely available across the United States.
- Coping strategies: If you feel like self-harming, you might try one of the following strategies until the urge goes away:
- Talk to someone, or phone a helpline
- Distract yourself by listening to music, watching TV, or reading a book
- Try a relaxation exercise
- Go for a walk
- Write about what is happening in a diary
Types of therapeutic approaches to consider
Common therapeutic approaches to treating self-harm include:
- Dialectical Behaviour Therapy (DBT): DBT helps people learn how to recognize and regulate intense emotions with more adaptive coping strategies and skills. Usually, DBT involves both group and individual therapy. It is a highly recommended and evidence-based treatment for individuals with self-harm behavior.
- Cognitive Behavioral Therapy (CBT): CBT helps change unhelpful thinking patterns linked to self-harm and develop new and more helpful behaviors. As a skills-based therapy, it can be helpful for individuals with self-injurious behaviors as it can provide immediately actionable tools to cope more effectively with stressors and difficult emotions.
- Mindfulness Practices: Mindfulness encourages deliberate, non-judgemental, moment-to-moment awareness. Through mindfulness, people develop increased awareness of the urge to hurt themselves, tolerate the distress, and not act on the urge to self-injure.
- Family or Couples Therapy: It can be helpful to involve family members or partners as supports in the recovery process. These important support people are better placed to support you in your recovery once they understand how you feel, what your triggers are, and what they can do to help.
- Psychodynamic Therapy: Psychodynamic therapy involves the exploration of past experiences and how they influence current patterns of thought, emotion, and behavior. This can help people who want to gain insight into how their past has shaped how they feel currently, to reduce the feelings of anxiety or depression that are linked to self-harm.
It’s important to consider different therapy types and how they resonate with you before choosing. If you’re unsure, your prospective therapist is a great person to seek advice from.
What should I look for in a therapist for self harm?
There are several factors to keep in mind when selecting a mental health professional, including:
Education and credentials: Look for a licensed mental health professional who has specialized training in self-harm and therapies that help people who self-harm, such as DBT and CBT. For example, some therapists will have certification from the DBT-Linehan Board of Certification. It can be helpful to take a look at therapists’ biographies, as this is where they often include their experience and specializations.
Personal fit: It’s important to find a therapist with whom you feel comfortable working with and trust. The trusting working relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy.
Talk in advance: The best way to judge how you might feel about your prospective therapist is to ask for a preliminary phone call (using Zencare, you can book a free initial phone consultation directly on the website with vetted therapists). Most therapists are happy to speak with clients before a first appointment, and many in fact require an initial call to ensure a good fit. This initial call allows you to ask about:
- Their qualifications
- Their experience working with people who self-harm
- Any ongoing training they are participating in that relates to the treatment of self-harm
- What type of therapy they suggest for self-harm, and what that will be like
- Their participation in insurance plans and cost of therapy
Sources and references:
- (1) Kerr, P.L., et. al., 2010, "Nonsuicidal Self-Injury: A Review of Current Research for Family Medicine and Primary Care Physicians”, The Journal of the American Board of Family Medicine. Accessed online December 2019 at https://www.jabfm.org/content/23/2/240.full
- (2) Whitlock, J., et.al., 2011, "Nonsuicidal Self-injury in a College Population: General Trends and Sex Differences”, Journal of American College Health. Accessed online December 2019 at https://www.tandfonline.com/doi/abs/10.1080/07448481.2010.529626
- (3) Laurence Claes, et al., 2015, “Bullying and Victimization, Depressive Mood, and Non-Suicidal Self-Injury in Adolescents: The Moderating Role of Parental Support”, Journal of Child and Family Studies. Abstract accessed online December 2019 at https://link.springer.com/article/10.1007/s10826-015-0138-2
- American Psychological Association, 2015, “Who self-injures?”. Accessed online December 2019 at https://www.apa.org/monitor/2015/07-08/who-self-injures
- Royal College of Psychiatrists, “Self Harm”. Accessed online December 2019 at https://www.rcpsych.ac.uk/mental-health/problems-disorders/self-harm