Self-harm is the act of self-mutilation, where an individual purposefully harms themselves in hopes to alleviate stress, emotional pain, trauma, depressive feelings or find control. A large number of self-harmers are approaching or are in adolescence; using these methods to cope with new emotions, mental illnesses and overwhelming situations, though many are adults or progress into adulthood with these maladaptive coping skills. Some self-harm for short periods of time or in crisis, whilst others may become fully addicted or may not know that they are self-harming because the method isn’t widely known.
Self-mutilation is not a suicide attempt; it is a maladaptive coping strategy to find control in out-of-control situations and can be replaced by healthy ones. The individual self-harming is struggling and needs professional help. They may use a combination of self-harming methods.
Cutting. Cutting is the most well-known self-harming coping mechanism and has been widespread on the internet over the last few years. It is the most heard of the bunch.
Most adolescents turn to cutting to cope with dysfunctional families, bullying, trauma, schooling and overwhelming feelings, though adults do also partake in this method. The act of cutting releases endorphins to the brain to deal with the emotional and physical pain, giving the cutter a high. It’s an exciting rush, followed by a sense of relief from what’s bothering them.
Cutting is often assumed as suicidal behaviour when, in actuality, it’s a very common way people cope with issues. The blood and mutilation factor frightens caregivers who feel they may have to bring their child to the hospital for an attempt, which is not a necessity.
It is important that, if the cutter chooses to continue, they use clean materials and clean their wounds to avoid infection and STD transmittal (as it can be deadly). They must monitor themselves; if they cut too deep, they need to request medical attention, as an excessive loss of blood can kill them.
Burning. Burning is frequently used in combination with cutting. The individual takes a hot object and holds it to their skin until it cools down and a wound is formed. Some may use hot baths or tap water instead, which may not leave a mark, but is as serious. These burn wounds may bubble up and “pop”, oozing a liquid; it is important for the person self-harming to monitor this wound and ensure bacteria doesn’t contaminate.
Scratching/Pinching. Someone may choose to scratch at their skin until blood surfaces for a quick sense of relief. This could be an occasional thing, develop into dermatillomania or be dermatillomania.
Dermatillomania (Excoriation Disorder or Skin Picking Disorder) is when the individual has an incessant need to scratch and pick at “imperfections” resulting in worsened bumps, wounds, acne or infection. This disorder can be combated through therapy and extreme efforts, but is not always noticed by the one doing it.
There is a difference between choosing to do it, and having a disorder. Someone with dermatillomania will scratch or pick during anxious or tense situations, but may not notice, while someone who is picking occasionally is constantly doing it on purpose. It must be monitored as the occasional behaviour can evolve into a disorder as they grow unaware of their actions, and lean on picking to cope. It becomes second nature.
Wound Interference. This ties in with dermatillomania and skin picking. The individual repeatedly picks at scabs which result in either blood or scars.
Hair Pulling. Hair pulling is because of a disorder called trichotillomania; a compulsive desire to pull out ones hair. The puller may notice bald patches from continuous pulling, self-esteem issues, and hair follicle changes (hairs growing in curly, thin or odd colours). Constantly pulling out one’s hair can increase anxiety, and affect their confidence, usually accompanied by depression. They may find flaws in specific hairs and feel that they do not belong, resulting in pulling it out.
Trich falls under the same umbrella as dermatillomania, (Body-Focused Repetitive Behaviour/BFRB) and is not always intentional. With over exposure to pulling, they become dependent on it and may not notice themselves acting out, and can be so severe that they pull in their sleep.
Drugs/Alcohol. Substance abuse starts off as using drugs and alcohol to cope. Someone may reach for a bottle when they are upset to “lose themselves”. With repetitive use, they will become heavily addicted and full-fledged alcoholics or drug addicts.
Their body will be tolerant of the substance and require higher doses for the same effect, develop a psychological and physical dependency where they may not be able to function without it as their body and mind experience withdrawal, and addiction. Addiction is the compulsive need for the substance and effort required to avoid or reduce usage.
Depending on the substance, risks include:
- STDs from needles and injectors
- Irregular heart rate or heart failure
- Lung damage
- Memory loss
- Periods of psychosis and disconnection from self
- Organ failure
- Irritability, anxiety, jumpiness, sweating and shaking
Hitting. Hitting involves violence towards oneself, where the individual hits and punches themselves for relief. This can result in bruises and painful areas.
Disordered Eating Behaviours. Disordered eating is a common gateway to eating disorders. They feel they have lost control when it comes to food or their body, finding flaws in their figure or eating patterns. There are heavy influences in media and they could turn to Pro Anorexia Websites for tips on weight loss. Disordered eating can be controlled and restrictive (anorexia), strictly healthy foods only (othorexia), use of laxatives and vomiting after binging (bulimia), over eating (binge eating) and other, personalized methods.
This behaviour must be heavily monitored as a traumatic change in diet can remove years off their life, become extreme with no way back or fatal. They must seek out medical attention and learn not to use food to cope. The recovery process is not short and may take years; it’s best to catch and treat it early.
“Suicide Attempts” (Testing the Grounds). These types of suicidal behaviours are parasuicidal, meaning it is suicidal in its nature, but suicide wasn’t the intent. This is very common with individuals diagnosed with Borderline Personality Disorder as they experience chronic suicidal feelings and use this to cope. They do not wish to die, but to control an out-of-control situation. Facing death but not dying can be satisfying to some.
Remember: Self-harm is used to gain control in out-of-control situations. It isn’t use to get back at or punish anybody.
Self-mutilation should be avoided, discouraged and discussed in therapy. Overcoming self-harm will take time, but can be done when trauma, pain and other factors are discussed, and healthier coping mechanisms are implemented. When an urge arises, they should consider journaling, going for a walk, drawing, calling a friend, etc. Constant denial to these urges will improve their quality of life, as they ween off of their need.
Relapse is inevitable, but self-mutilation can be conquered.
If you are a worried guardian or friend, do not demean them. It may not seem logical to you, but it is necessary you open the conversation, lend an ear once in a while, and tell them that it is acceptable to talk about self-harm. If you use it against them, they will lean on the behaviour more, and could hurt themselves further. Don’t overreact, don’t under react. Finding a balance can be complicated, but worth it. They are dealing with a serious problem and need your support.