Self-harm, or self-injury, is a term that describes a variety of behaviors that individuals engage in with the intention of hurting themselves. Common examples of self-harm may include: cutting oneself, scratching, punching or hitting, or burning. According to the National Alliance on Mental Illness (NAMI, n.d.) Individuals that engage in self-harm are often secretive about their behaviors for a multitude of reasons, so people may be unaware that these behaviors are not uncommon in adolescents and young adults.
Why do people engage in these behaviors?
Engaging in self-harm behaviors is often used as a coping mechanism to manage thoughts and feelings that someone is struggling with, but these behaviors can ultimately lead to greater emotional distress, feelings of shame, and difficulty in social situations or relationships (e.g. avoiding situations because of the behavior, negative feelings about scars or marks, limited communication with supports when struggling, leaving social situations to attend to wounds). Additionally, self-harm can lead to greater injury than intended. It is a common myth that self-harm behaviors are intended to result in death. This is often untrue.
When an individual engages in self-harm, it may be to shift focus away from difficult emotions, or to help people feel something, if they are feeling emotionally detached. Self-harming is not a diagnosable mental health condition in itself, but it is associated with anxiety, eating disorders, posttraumatic stress disorder, borderline personality disorder, and depression, as well as abuse and neglect.
What does treatment look like?
Studies that look at self-harm behaviors and treatment often tend to look at these behaviors in the context of other difficulties (e.g. borderline personality disorder), but emerging research has begun to address self-harm by itself. The ultimate goal of treatment will depend on the individual. Initially treatment may focus on reducing the behavior or identifying safer alternatives.
Dialectical behavior therapy (DBT) has been shown to be helpful with adolescents and young adults who engage in self-injury. This treatment focuses on four sets of skills: interpersonal effectiveness, emotion regulation, mindfulness, and distress tolerance. These skills help individuals learn how to communicate more effectively, identify, manage, and regulate emotions more effectively, increase awareness and one’s ability to live in the moment, and strategies to handle difficult thoughts, feelings, and behaviors. Cognitive behavioral therapy (CBT) has resulted in positive outcomes in some studies as well. This form of treatment focuses on the underlying thoughts, beliefs, and feelings associated with the self-injury, and changing these problematic patterns. Treatment of Self-Injurious Behaviors (T-SIB) is a treatment approach that combines aspects of both DBT and CBT and shows some positive results as well. It is important to note that addressing other mental health issues that may be present can also have an impact on the frequency and intensity of self-injury.
According to an article written by Beth Morrisey, the following are warning signs that a loved one may be struggling with self-harm.
· Unexplained cuts and bruises on the body.
· Wearing long sleeves and pants, even in warm weather.
· Secrecy, such as keeping a specific drawer locked or hiding specific items.
· A breakdown in typical communication.
· Mood changes or mood swings.
· Changes in eating patterns.
· Changes in sleeping patterns.
· Changes in socialising patterns.
· Evidence of drug or medical paraphernalia.
· Evidence of carrying unnecessary sharp objects, matches or lighters.
· Poor performance or results at school or work.
· Loss of interest in favourite hobbies or sports.
If you or someone you know is struggling with self-harm, there are many resources available to assist you in the process of support and problem-solving, including professional counseling. Call (215) 487-1330 or email us at Greenridge@intercommunityaction.org for more information about our counseling services, which include one-on-one therapy with a trained clinician.
Author: Erin Hopkins Stern, M.A.
Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., & Miller, I. W. (2017). An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. Journal Of Consulting And Clinical Psychology, 85(6), 620-631. doi:10.1037/ccp0000206
Morrisey, B. (2018). Warning signs of self-harm. Retrieved from http://www.teenissues.co.uk/warning-signs-of-self-harming.html
National Alliance on Mental Illness (n.d.). Self-harm. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Self-harm