Self-harm – sometimes referred to as deliberate self-injury – is a term used to describe self-inflicted physical injuries to the body, such as cutting the surface of the skin or burning and hitting the body. It can also be referred to as deliberate self-injury, cutting and parasuicide.
The term self-mutilation is primarily used to refer to serious and sometimes lethal body mutilations where the aim is often to cut out or off an offending body part such as the genitals, eyes and tongue. With these severe injuries there is usually a link with psychosis, drug addiction or brain disorders.
As self-harm can take a variety of forms it may also include the risk of suicide. It is also the case that someone who self-harms is 100 times more likely to commit suicide whether accidental or not.
If self-harm takes place over a period of time – weeks, months or years – the actions are not necessarily suicidal. The harming may become repetitive, and addictive, partly because of the relief from tension experienced as a result of the action.
Types of self-harm
● Cutting, ripping or tearing the skin or pinching the skin to cause bleeding or a mark. Cutting is the commonest form of self-harm used by more than two-thirds of those who harm themselves. The cutting can make superficial, delicate and designed incisions that can heal to leave no visible scar, or can cause deeper cuts which leave permanent scars and lumpy flesh.
● Banging or punching parts of the body (usually the head or knuckles).
● Carving signs or words onto the skin (usually arms, thighs, or stomach).
● Burning the body through use of an iron, matches, cigarettes, cigarette lighters, hot water or cooker hot plates.
● Pulling out large clumps of hair.
● Deliberate overdosing on over-the-counter drugs when this is not consciously intended as suicide.
Who harms themselves and why?
Epidemiological findings show that self-harming behaviour usually begins in children over the age of 11 and increases in frequency in adolescence.
An Oxford study in 2000 found that approximately 300 out of 100,000 males aged between 15 and 24 years, and 700 out of 100,000 females of the same age, were admitted to hospital following an episode of self-harm during that year.
Those who harm themselves usually see it as a way of dealing with an immediate anxiety and a solution to a problem. Some see it as a way of feeling in control, while others paradoxically as a way of feeling better for a while and more able to cope.
Studies show that using such behaviour as a way of coping is associated with earlier distress, even a history of early abuse, neglect or trauma such as physical illness, major surgery or loss of a loved one.
Young people who harm themselves say they do so to escape from deep distress, hopelessness and misery as a way of dealing with anger and frustration a relief from inner tension and conflict to punish others or themselves as a way of feeling back in control and as a way of feeling alive.
How to respond?
Counselling and therapy will help if the person who is harming wants to understand the reasons for their self-harming behaviour. Social work skills in establishing relationships of trust will be important for the young person who is harming.
If you notice that someone you are working with is hurting themselves then you need to discuss it with them. If you are able to see the wounds or scars then there is a definite possibility that the person would like you to say something.
Let the person know that you have seen the injuries but without expressing a strong negative reaction. The best way is to ask calmly about what you have noticed, remaining aware of your own feelings.
Any discussion should focus on finding other ways of relieving distress and in due course on the underlying reasons. Therefore stopping the self-harm is not the priority. Survivors of self-harm stress the need for professionals not to minimise the reasons given for, or the events that have triggered, the behaviour. The person needs support and not punishment or threats of abandonment unless they stop the behaviour.
Self-help groups and survivors advocate alternatives to harming. It might be possible to work with the young person who is harming to devise a plan to be used when the urge to harm arises, such as plucking hairs on arms or legs, writing about how they are feeling or phoning the Samaritans.