Self-harm: Modern Trend or Complex Mental Health Issue?

I write this post in an attempt to discuss a topic that, even in 2018, is shrouded in shame, judgement and aversion. We need to talk about it because those living it, typically adolescents and young adults, deserve all the understanding, empathy and support they can get. As do their care-givers.

Self-harm or self-mutilation refers to damaging, cutting or altering a part of oneself; that part usually being the skin. In most cases, a knife, razor, or other sharp metal object is used. Sometimes people use cigarettes, lighters or hot objects to burn the skin.  Rarely are veins, arteries, ligaments or tendons damaged. As such, self-harming is not an attempt to end one’s life. The technical term is non-suicidal self-injury. Although people who self-harm are almost 50% more likely to attempt suicide, self-harm is not suicidal ideation.

Nonetheless, self-harm is a disturbing behaviour accompanied by cosmetically gruesome results. Although statistics suggest the incidence of self-harm is rising in the past 20 years, self-harm should not be attributed to imitation. To call people copy-cats or attention-seekers is to over-simplify and belittle them. Yes, self-harming has been “normalised” in some online forums. And yes, social media has increased anxiety, competitiveness, and shame for many teens. However, do not think of it as an adolescent ‘trend’. Instead it should be seen as a sign of something much deeper in a person’s life. Young adults frequently imitate each other with trends like piercings, tattoos and clothes. Yet rarely does a teen or young adult who is developing normally engage in repeated self-harming, even if their friends do. I have never met a young person with a warm and secure attachment to trusted adults who self-harms. Not to say they don’t exist, but I haven’t met one. Usually, self-harmers have insecure attachments, lots of shame and anxiety, and need help to feel loved and to love themselves again.

Self-harm is difficult for most friends, parents, and educators to understand. But these behaviours should be considered genuine manifestations of psychological illness, and parents and families must remain open and compassionate to the underlying causes.

The number one issue behind self-harm behaviours is usually another mental illness, often long-standing depression or unbearable anxiety. For each person who cuts, their story of cutting is really quite complex. Often these people feel there is no one they can trust; they feel emotionally isolated and lack supportive bonds with others.

The paradox of self-harm is this: Cutting is an attempt to self-soothe. In other words, the person often feels strangely better, at least for a few moments, not worse. Some individuals describe it as an attempt to deal with the vagueness of overwhelming mental pain, to pull it out of their body into a more concrete reality.

In her book Skin Game Caroline Kettlewell says: “I cut to quiet the cacophony. I cut to end this abstracted agony, to reel my selves back to one present and physical whole, whose blood was the proof of her tangibility”.  Seen in this way, cutting can be an attempt to make sense of the chaos of one’s psychological anguish.

Cutting may also be a way to stop feeling numb. People with a history of trauma may cut to have a sense of control over their pain and feel something other than numbness. Kids raised in households where sadness, hurt, anger or disappointment are invalidated or mocked come to believe it’s not okay to feel bad. They turn to cutting as an “acceptable” way to feel bad; if they’re not allowed to let it out any other way, they’ll let it out physically. For others, it can also be a way of punishing oneself for not measuring up.

As a psychologist I have come to see that the more disordered the behaviour, the greater the (temporary) escape from the emotional pain.  Whether that disordered behaviour is cutting, using drugs, raging, purging food, even sleeping all day, it is always an attempt to re-establish a sense of control in one’s life and get some kind of relief. And it kind of works, at least for a time. We consider it “disordered” because it comes at such a cost to the individual’s life and well-being, and never works in the long-run.

What helps people quit?

One of the key components for people to stop self-harming is what I call “getting better at feeling bad”.  When people come to realise they can handle feeling crappy for a while (and will probably feel better soon), they increase their capacity to tolerate difficult feelings. Psychologists call this distress tolerance. This is like “being really patient” with yourself. With better distress tolerance, you can ride out the urge to self-harm. One strategy is to promise yourself you will put 20 minutes between the urge to self-harm and actually doing it. This increases the chance that the intense emotions will subside before you do anything.

With the help of a good therapist, mentor or coach, you can increase your distress tolerance, as well as learn ways to assert your needs, build your self-esteem, and find healthy ways to self-soothe. Furthermore, a good therapist can also be someone in your life who cares about you.  In research studies, people who stopped cutting often did so once they developed healthier relationships in their lives. Caring relationships help us feel supported and worthy. When we can tell our stories, express our feelings, and be heard, we begin to dissolve the shame and loneliness that fuels self-harm.

Of course, the above changes often take time. So in the meantime, if you want to stop yourself, channel your intense feelings into other activities. Listen to sad or angry music filled with pain and let yourself feel the dark emotions. Bash a couch or a pillow, have a good cry, write your thoughts in a journal, or just write pages of profanity in big bold letters!  If cutting is a way to relieve overwhelming stress, move your body strenuously by taking up boxing or running. If you crave the physical aliveness of pain, give yourself pain by squeezing ice cubes in your hand. (Ice-bucket challenge anyone?!)

If you are the parent, friend or teacher of someone you are worried about, remember that early detection, as with all developing problems, offers the best prognosis and outcome with the help of skilful and supportive others. Feel free to ask questions, or comment below about what has helped you or others you know to stop self-harming.