by Heather Hayes, M.Ed, LPC, CIP, of Heather Hayes & Associates
Self-harm is defined by the World Health Organization as “an act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage” . It is surprisingly common, yet many people know little about it. Statistics show varying degrees of prevalence; some researchers estimate that 5.9% of American adults have engaged in self harm at some point, while others claim that the figure is closer to 7.3%. It is shown that the population outside of psychiatric institutions with the highest incidence of this are teenagers, with an estimated 15-20% engaging in self-harm at some point. Even if the lowest statistic is used as a baseline, this issue still directly affects millions of Americans.
Researchers commonly use two acronyms to refer to self-harm: Non-Suicidal Self Injury (NSSI) and Deliberate Self Harm (DSH). For the purposes of this article, I will refer to all of these as “self-harm.” Self-harm is typically thought of as cutting oneself, which is indeed the most popular method, with 46% practicing this, but it can include using blunt force, like banging one’s head against an object, or burning oneself, among other actions.
Self-harm incidents can range from minor to life-threatening injuries, but all are especially dangerous because self-harmers are less likely to seek medical assistance. It is absolutely crucial for practitioners to be aware that not all self-harm is visible. I once had a client who overdosed on Advil to self-harm through stomach pain. This would have remained untreated had I not carried out a comprehensive diagnostic interview with the client. It is also important to note that many clients do not consider what they are doing to be self-harm. This means that in order to thoroughly screen a client, practitioners must use targeted and comprehensive questioning.
Like many self-destructive habits, there is not one sole cause for self-harm. It is attributed to a multitude of factors, several of which may simultaneously come into play. Two studies have shown that rates of self-harm were much higher in teenagers who reported being bullied. People have also reported self-harming to distract themselves or express feelings of loneliness, to release anger, to punish oneself, to feel in control of a situation, or to detach emotionally. Often, trauma survivors either use self-harm as a way to re-channel the emotional pain into physical pain, giving them temporary relief and a way of physical expression, or may use cutting or self-harm to feel alive when they are feeling numb and dissociated. Suicidal ideation is also a predictor for self-harm, and vice versa . Childhood trauma has also been linked to self-harm. Furthermore, increased risk of self-harm is associated with depression and anxiety, schizophrenia, and psychosis.
There is a variance among genders in how, how often, and why self-harm is committed; between men and women, it is shown that women are more likely to cut whereas men are more likely to burn or hit themselves. It has been postulated that this could be due to women feeling less like they have a “voice” in society and consequently expressing their feelings through harm and it being more socially acceptable for men to express themselves through outward violence. People who identify as transgender have an even higher rate of self-harm than those who identify as cisgender male or female; research has found that between 13-45% of transgender individuals between the ages of 16-20 engage in self-harm.
Due to its wide range of causes, there are many proposed treatments for self-harm. Usually, doctors and mental health specialists attempt to diagnose the underlying mental health condition which is precipitating the symptoms. Once the underlying source is identified, the condition can be treated with therapy and the drugs one would typically prescribe for such a disorder, e.g., SSRIs for depression or antipsychotics for schizophrenia.
Various therapeutic approaches have also been effective in treating self-harm, and it is suggested that these should be combined with pharmaceutical interventions. Group therapy has been shown to reduce instances of self-harm; however, it is important to note that this study did not find a reduction in depression. Dialectical Behavioral Therapy has also been proposed to reduce self-harm and suicidal ideation. Cognitive Behavioral Therapy is also commonly used and has been shown to be effective.
While it can be very hard to remove all potentially harmful items from a household or institution, steps can be taken to make it harder. Toxic household chemicals and sharp objects such as knives and razors should be stored in locked containers. If possible, internet access should also be restricted due to the worrying trend of pro-self-harm websites and Instagram tags that have been linked to an increase in self-harm . Restricting internet access should be approached as gently as possible, and there are many support groups available which some people have reported as helpful.
A study of teenagers who had histories of violent behavior towards themselves or others showed that mindfulness reduced both types of violence. This practice has also been linked to a reduction in depression, anxiety, and psychosis, which are all predictors for self-harm. Exercise and yoga have also been linked to a decrease in symptoms in some of these disorders. However, there is little research on its direct effect on self-harm. Some specialists have also suggested punching or screaming into a pillow as a safe way of relieving stress.
In some instances, it may be safest to deliver treatment for self-harm and its associated disorders in a residential treatment setting. This has many benefits. For example, the client can be treated by trained professionals, and a personalized treatment plan can be administered in a safe and supportive environment.
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