Today I’m going to talk about Self-Harm and Self-Injury. What do these terms mean to you? and have these affected your life directly or indirectly ?
Many of us may answer No to the last question immediately. The image of skin cutting may jump straight to mind or maybe someone you have seen with obvious scars. It was a question I was asked when I started my training at ‘Bristol Crisis Service for Women’ (Now called ‘Self-Injury Support’) . We explored the idea that self-harm and self-injury may be direct and non-direct and we may use them to cope with psychological distress.
Before this question was posed to me I never considered that I harmed myself until I realised that some of my behaviours were a consequence of the psychological and emotional pain I was feeling inside that I was not always aware of but they indirectly harmed me in some way and served a purpose to numb pain. Immediately I could relate to this connection that seemed at first, far beyond me as a helper.
Sutton Et al 2000 defines Self-injury as
‘A compulsion or impulse to inflict physical wounds on ones own body, motivated by the need to cope with unbearable psychological distress or regain a sense of emotional balance. The act is usually carried out without suicidal, sexual or decorative intent’
Here is a suggested list of Direct Self- Injury and Non-direct Self-Harm from Sutton (2007)
Skin cutting, Slashing and carving (words, symbols, designs, dates)
Skin burning, scalding and erasing (rubbing of layers of skin)
Compulsive skin picking (CSP) and excessive scratching (sufficient to cause bleeding)
Inserting objects into the anus, penis, urethra , uterus or vagina with the purpose of causing harm (non-sexual intent)
Self-punching, hitting, slapping, biting or bruising
Self-stabbing with sharp objects (pins, needles, compasses, scalpels, nails (finger nails and carpentry type nails)
Hair pulling, eg scalp, eyelashes, eyebrows
Interfering with wound healing
Inserting needles under the skin or into veins
Pulling off skin and nails
swallowing foreign objects
Disordered eating :Anorexia, bulimia, compulsive overeating
Substance misuse: Misusing alcohol, using illegal drugs or misuse of prescribed medication
Self-poisoning without suicidal intent (overdosing)
Extreme risk taking (reckless driving, high risk sports)
over exercising/ under exercising
overworking/ under working
Self-neglect/ always putting others needs first
Staying in violent/ abusive relationships
The National Institute for Health and Care Excellence defines Self-Harm as:
‘The term self‑harm is used in this quality standard to refer to any act of self‑poisoning or self‑injury carried out by a person, irrespective of their motivation. This commonly involves self‑poisoning with medication or self‑injury by cutting. Self‑harm is not used to refer to harm arising from overeating, body piercing, body tattooing, excessive consumption of alcohol or recreational drugs, starvation arising from anorexia nervosa or accidental harm to oneself.’ NICE 2014
Nice suggests that there is a grey area around some behaviours that are not seen as non direct self harm such as substance misuse and overeating, what do you think?
Self- harm and self-Injury are complex behaviours because as people we are complex. No textbook or definition can write our unique life story or explain why we do what we do. Some of us may recognise the suggested link between our psychological or emotional pain and the behaviours we might do to soothe them . For others, we may need to understand our pain in order to move forward and find other alternatives to self soothe and get what we need in our times of distress rather than inflicting pain on ourselves. The pain may come from the past , the present or both. Some pain may come from anxiety about the future. Why you Self-harm or injure will be unique to you and how you feel is unique.
One final point to make is that self-injury and self-harm is not usually carried out with suicidal intent but can be seen by some people as a life saver and a way of coping and surviving distressing feelings. Some individuals who self-injure do experience suicidal thoughts and some do take their own lives with intent. Self-injury does carry risk and accidental death may occur. Self-injury needs to be taken seriously but more so do the feelings that lie beneath.
If you would like help and support for Self-Harm or Self-Injury or would like to help someone you know I would suggest and encourage the following:
What is helpful:
Attitudes : Acceptance, listening caring and understanding- Try to talk about your feelings, what’s really going on for you with someone who will listen without judgement. If you want to help someone who is harming themselves in some way try to address the feelings and encourage them to talk.
Counselling and therapies: to explore and address the experiences and feelings which underlie self-injury and self harm confidentially. Art and body therapies are helpful, as well as talking. Exploring alternatives in the short term to help you exercise more choice about self injury and self-harm whilst the causes are being addressed.
Groups: Support from others who share experiences
Crisis support: someone to call and somewhere to go in bad times
MindLine telephone helpline – out of hours confidential listening service
Freephone: 0808 808 0330
Wednesday to Sunday, 8:00 PM to Midnight
Samaritans– 24 hours local and national helplines
UK: 08457 909090
Text: 07725 909090
National Mind InfoLine
08457 660 163
Mon to Fri, 9.15am – 4.15pm
Offers information on topics ranging from types of distress, where to get help, drug treatments, alternative therapies, who’s who in mental health and where to find advocacy and other services.
Self Injury Support- Helpline, Text help and support groups
What is not helpful
Being condemned, dismissed ‘told off’ or punished
Shock, fear, ignorance and misunderstanding
Self-injury taboo – some people believe that if you talk to someone about self injury it will ‘reinforce’ it. So people are not able to explore the issue
Being treated as ‘disturbed ‘and not responsible
Useful Resources and References
Jan Sutton, 2008. Healing the Hurt Within: Understand Self-injury and Self-harm, and Heal the Emotional Wounds. 3 Edition. How to Books Ltd.