In my San Ramon Valley teen counseling practice, the topic of self harm often comes up. Not to say that self-harm is just limited to teens, it is not, but if you interact closely with teens, are a teen yourself, or spend any time on social media/watching TV with teens casted in it, the topic with come up.
For instance, I have been watching Netflix's drama 13 Reasons Why, and there was a scene where the main character Clay Jensen spotted scars from cutting on another character's, Skye's, forearm. Skye had just told Clay that Hannah's (a classmate of theirs) decision to commit suicide was stupid. Clay gestures to Skye's scars and exclaims, "Then what are those?" Skye retorts in defense "It's what you do instead of killing yourself."
This exchange highlights one of the common misconceptions about self-harm; that people that self-harm are trying to commit suicide. Yes, both self-harm and suicide are responses to unimaginable emotional pain, and yes both self-harm and attempts to commit suicide take the from of inflicting physical pain on oneself, and yes both self-harm and attempting suicide necessitate the assistance of mental health professionals to provide treatment, but they are not the same. In this blog post, I want to address some of the misconceptions about non-suicidal self-harm, provide helpful ways to address self-harm and as well as provide some helpful resources for anyone who is struggling with self-harm or has a loved one who is struggling with it.
So, if self-harm is not to commit suicide, then why would someone hurt themself? Self-harm is a way to cope with emotional pain, not to end it once and for all like suicide, but to manage it. Common reasons that people self-harm (and this can be done through cutting, burning, sticking yourself with objects, hitting/punching yourself, swallowing harmful objects, throwing yourself into walls) are to distract themselves from emotional pain, to feel something if they constantly feel numb, to express physically the emotional pain going on inside, and to demonstrate control of their own body when everything else feels out of their control. These individuals aren't crazy masochists, but people who are just trying to cope with emotional pain so they can keep making it through.
It is important to acknowledge that self-harm is helpful in coping with emotional pain/numbness, but it definitely comes with some drawbacks and risks. The first being the obvious risk to physical wellbeing. While people who self-harm are not trying to kill themselves, there is still the risk that they will accidentally do serious, permanent physical harm to themselves. This fact in combination that self-harm has a addictive quality to it, can put someone who self-harms at great risk. What if they cut deeper this time to achieve the effects, and this time the cut is too deep? Our bodies have a remarkable ability to adapt, which can mean that more stimuli is needed over time to achieve the intended effect. Or what if the object being used to self-harm is dirty and breaks skin and starts infection? In addition to physical risk and risk of becoming addicted, self-harm is only a temporary relief. If it is not dealt with, the emotional pain/numbness will return and the act of self-harm will have to be done again to achieve it's effects.
So, what is helpful in reducing self-harming behaviors? When I work with individuals struggling with self-harm, I take a two-prong approach:
1. Finding an alternate safe behavior to help them cope with the emotional pain. It doesn't work well for us humans to be told to stop doing something; actually we are way more successful if we start doing something. So in the context of self-harm, what is something safer that can be done to replace the self-harming behavior? Activities such as writing/journaling, drawing/painting, verbally expressing your pain to a trusted individual, squeezing a stress ball, exercising, taking a cold shower, listening to relaxing music (to see more alternate activities go to https://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm -this is a great article that is all about self-harm; I highly recommend it-I'll also list it in the resources at the end of this post). It may take time and practice for these activities to take the place of self-harm, but again, our brains are adaptable and many people find that some of these activities can also help them manage their emotional pain taking the place of self-harming behaviors.
2. Addressing the underlying reasons/triggers for self-harm. Again, self-harm is merely a coping strategy for emotional pain, so it is important to address the cause or root of emotional pain, and decrease the experience of this pain. This can be done through multiple means depending on the struggles the individual is going through. In order to become more aware of these root causes, it can be helpful to keep a log of self-harming acts, identifying what was going on immediately before you self harmed, what emotions you were experiencing, and what thoughts were going through your head. Here is a link to an example Self Harm Log. That way you can begin to pick up on patterns and similar situations that lead to the emotional pain that causes you to self-harm. Once there is an awareness to what's causing the emotional pain, then it can be easier to address these causes.
If you or someone you know struggles with self-harm, there is hope, and the next steps are very similar to the next steps I talked about in my previous post "Mental Health Awareness Month Part II: Next Steps":
1. Reach out to a trusted individual and talk about it.
2. Seek professional help/resources whether it is through a primary care doctor, school counselor/teacher, religious leader, or other trusted adult.
I know conversations about self-harm can be very uncomfortable and scary, and there is a lot of guilt and shame associated with self-harm (which it is why it is so hard for someone who is self-harming to disclose this fact-there is a lot of hiding and secrets if someone believes that people would judge them if they were to say that they self-harm), but the more information we have and the more open we are in talking about uncomfortable topics like this, the less shame and guilt around it.
To learn more about this topic check out these resources:
S.A.F.E. Alternatives https://selfinjury.com/ or (800) 366-8288