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Self-harm is the deliberate injuring of oneself in an attempt to cope with strong feelings such as anger, despair or self-hatred. Someone who self-harms may inflict physical injuries in a variety of ways such as cutting, piercing, burning or biting themselves. This is known as direct self-harm.
Generally speaking, someone who self-harms isn’t trying to commit suicide. A person who is suicidal is desperate to never feel anything again, whereas the person who self-harms is only trying to make themselves feel better. In some cases, a person may self-harm in an attempt to drive away suicidal feelings. Research is scarce, but it seems that between 1986 and 1991, about five per cent of public hospital injury-related admissions in Victoria were self-inflicted. (However, this estimate includes cases of failed suicide attempts.) Other terms for self-harm include self-injury and self-mutilation.
Reasons for self-harming behaviour
Some of the many reasons why a person might self-harm could include:
- Low self-esteem
- Poor body image
- Self-hatred
- Post traumatic stress disorder
- The belief that punishment is deserved
- Strong feelings of anxiety or depression
- Emotional numbness (feeling physical pain is ‘better’ than feeling nothing)
- A response to physical, sexual or emotional abuse.
Other forms of self-harm
Indirect self-harm involves inflicting physical injury in a more roundabout way, such as neglecting to manage an illness or failing to seek help for a disorder or alcoholism.
Direct and indirect self-harm is generally different from socially acceptable forms of ‘self-harm’, such as tattooing and body piercing, because the reason for doing it is different. Tattoos and body piercing may be done for spiritual, aesthetic or cultural reasons, whereas self-harm is a destructive coping mechanism for dealing with psychological problems, such as severe anxiety.
Severity of self-harm
Direct self-harm can be categorised by the severity of the injuries, for example:
- Moderate self-harm - such as cutting, burning, piercing, biting and hair pulling.
- Stereotypic self-harm - such as head banging. Stereotypic self-harm may be associated with other disabilities..
- Major self-harm - such as amputation and castration. Major self-harm is often associated with some form of psychosis.
Regularity of the self-harming behaviour
Direct and moderate self-harm can also be categorised by the amount of times the behaviour is repeated, for example:
- Compulsive - this type of self-harm is thought to be linked to obsessive-compulsive disorder. The person may be overwhelmed by anxiety, and so self-harms to relieve the tension.
- Impulsive - the person may occasionally self-harm, but injuring themselves isn’t used on a regular basis as a means of coping. The person may not even consider themselves to be a self-harmer.
The response from the medical profession
Anecdotal evidence from people who self-harm suggests that many workers in the medical and health professions don’t understand and often react in negative ways. This may include:
- Showing horror or revulsion.
- ‘Talking down’ to the person, ridiculing them or trying to shame them.
- Resentment that the person is ‘wasting’ hospital time and resources that could be given to people who are in ‘genuine’ need.
- The mistaken belief that the person has a form of Munchausen syndrome (the desire to inflict injuries or induce symptoms to get medical attention).
- Deliberately delaying treatment or giving them inadequate treatment, such as little or no pain medication.
- Instructing the person on where to cut their wrist (for example) so that their next ‘suicide attempt’ will be successful.
Treatment options
Treatment could include:
- Psychological intervention and/or counselling.
- Psychiatric treatment.
- Learning other forms of effective coping techniques.
- Understanding and support from family members, friends and doctors.
- Medical treatment for the physical injuries.
- Until the self-harming behaviour is under control, advice on harm minimisation techniques; for example, how to keep piercing and cutting implements sterile.
- Until the self-harming behaviour is under control, first aid training and adequate supplies of first aid equipment in the home (such as bandages and antiseptic solution).
Other forms of coping
Self-harming behaviour may be destructive, but it seems to help the person to manage their strong feelings. This is why it is so important to introduce other, more positive coping strategies before attempting to stop. Otherwise, the self-harming will continue, despite the person’s best intentions or their promises to loved ones. Different coping strategies that could be helpful include:
- Regular exercise
- Stress management
- Counselling
- Forms of personal expression, such as writing or painting
- Relaxation therapy
- Yoga and meditation.
How to help during an incident
If you witness a loved one self-harming, try hard to control your emotional response. Yelling, crying or becoming hysterical will only make your loved one more stressed, which can reinforce their self-harming behaviour. Suggestions include:
- Try to act in a neutral way.
- If necessary, take them to a more private place.
- Help them to administer first aid to their injuries.
- If their injuries are severe, take them to the nearest hospital emergency department for treatment.
- If this is the first time you discovered their self-harming behaviour, ask your doctor for referral to appropriate mental health services.
Where to get help
- Your doctor
- Psychologist
- Lifeline Tel. 131 114
- Suicide Help line Tel. 1300 651 251
- Kids Help Line Tel. 1800 551 800
- Mental Health Foundation of Australia (Victoria) Tel. (03) 9427 0406
Things to remember
- Self-harm is the deliberate injuring of oneself in an attempt to cope with strong feelings such as anger, despair or self-hatred.
- Many workers in the medical and health professions don’t understand self-harm and often react in negative ways.
- Self-harm is not a type of suicidal behaviour - in some cases, a person may self-harm in an attempt to drive away suicidal feelings.
You might also be interested in:
Borderline personality disorder.
Youth suicide - the warning signs.
Want to know more?
Go to More information for support groups, related links and references.
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