It is not uncommon for people who are struggling with their mental health to intentionally inflict physical harm on themselves. March is Self-Harm Awareness Month, so now is a good time to learn more about why people do this and how you can help them. At Cottonwood, in Tucson, Arizona, we treat behavioral health disorders that are at high risk for self-injury.
Reasons Why People Self-Harm
When a person engages in self-injurious behaviors, they are often struggling to cope with intense emotions. They may be trying to reduce the intensity of those feelings. Alternately, some people use self-harm to make themselves feel anything at all if they typically experience a numbing of their emotions. People who engage in self-injurious behavior are more likely to:
- Have underlying trauma
- Be a teenager or young adult
- Have friends who self-harm
- Have a mental health diagnosis, especially borderline personality disorder, depression, anxiety, post-traumatic stress disorder (PTSD), or an eating disorder
- Struggle with substance misuse
- Be dealing with tough personal issues
- Feel like they are out of control of their bodies, lives or feelings
What Self-Harm Involves
To qualify as self-harm, the act has to be done intentionally, to cause pain or injury. Medical treatment, some spiritual observances, or getting a piercing or tattoo, might be painful, but if they are done for reasons besides causing themselves harm, they do not fall into self-injury. There are several methods that people use to hurt themselves, such as:
- Cutting the skin with a razor blade, knife, or other sharp object
- Punching themselves or an object
- Pulling out their hair
- Burning the skin with a lighter, match, cigarette, candle, or by rubbing excessively
- Inserting objects into body openings
- Breaking bones
Signs of Self-Harm
If someone you know is engaging in self-injurious behaviors, you might notice some of the following indications:
- Scars, often grouped in one area, such as the thighs, upper arms, or abdomen
- Fresh injuries (bite marks, burns, cuts, scratches, bruises) that appear more often than what seems normal
- Always having sharp objects nearby
- Wearing long sleeves or pants to hide injuries, even when it’s too hot to comfortably do so
- Generally being impulsive, unstable, or unpredictable
Risks Associated With Self-Harm
People who engage in self-injury can place themselves in danger of some potentially serious consequences:
- Feelings of guilt, shame, and worsening self-esteem
- Infections as a result of the injuries or the tools used to inflict them
- Permanent scarring/disfigurement
- Accidental death, as a result of self-harm that goes further than planned
- Worsening of the issues that are driving self-harm, but potentially not addressed in a more effective, healthy manner
Self-Harm and Suicide
Many people who engage in self-injury are not suicidal at the time that they are harming themselves, however, there are common factors between self-injury and suicidal ideation, which include:
- Intense emotions, including helplessness, hopelessness, and worthlessness
- Not feeling like they have better ways to manage their problems
- Impulsive tendencies
For this reason, even though self-harm is often not a suicide attempt, people who engage in self-injury should be screened for suicidal ideation and given appropriate treatment to keep them safe. When talking to someone about self-harm, it is important to:
- Pick a time when emotions aren’t already running high.
- Make observations about what you’re seeing, such as, “I saw that you have some cuts on your arm. I care about you, and I am concerned that you might have been hurting yourself.”
- Acknowledge the pain they are likely feeling, that could have contributed to their self-harm.
- Ask them what triggers them to engage in self-harm.
- Offer support and help them seek professional attention.
- Allow them to come back to the conversation later if they aren’t ready to talk yet.
- Avoid asking to see the injuries, unless you are doing so to administer first aid, making light of their pain by telling them that their problems aren’t a big deal or that they are overreacting, or threatening to remove your relationship with them.
Alternatives to Self-Harm
It can be very difficult for people who intentionally hurt themselves to stop doing so. Lack of more effective coping skills and the rush of endorphins people feel when they engage in self-harm, can make the urge to hurt themselves difficult to resist. Rather than focusing on just quitting self-harm, it may be more helpful to replace the behavior with one or more of the following:
- Putting a name to the emotion, to make it less scary
- Using grounding exercises
- Talking to someone they trust
- Taking a shower
- Getting outside
- Wrapping up tightly in a blanket or using a weighted blanket
At Cottonwood, we treat people who are struggling with mental illness, substance use disorders, and secondary eating disorders. We have treated many people who struggled with self-harm. Our experienced clinical team provides trauma-informed, evidence-based care for our patients and their support systems, to navigate this and other difficulties they may encounter.
