- Trigger Warning: This post may contain triggers surrounding multiple forms of self-harm and suicide.
- Disclaimer ← please read ;).
- This post was revised on 3/6/17.
↓ The reason I revised this blog post is:
“I feel I change my mind all the time. And I sort of feel that’s your responsibility as a person, as a human being – to constantly be updating your positions on as many things as possible. And if you don’t contradict yourself on a regular basis, then you’re not thinking.” ― Malcolm Gladwell
What Is Self-Harm & Why Do People Do It?
Self-harm is a coping tool, albeit a self-destructive one. It is not a suicide attempt. However, in some instances it may be a cry for help (not attention). And it should always be taken seriously. As people who self-harm at are a higher risk for suicide.
Self-harm is a way of coping with unbearable emotions. Some people use it to release emotions (the kind that make you feel like you’re going to explode from the inside-out). Some people use self-harm to ground themselves, to help them feel something when the only thing they feel is numb, or unreal from anxiety. And some people use self-harm as a way to gain a sense of control. I, and I’m sure many others, have used it in each case.
People usually self-harm in private. It can be isolating and shame-inducing.
As my own battle with self-injury progressed, I became more purposeful about the placement of each cut. I made sure they’d be covered by my clothing. And although I didn’t plan it, this prolonged the comfort I received from self-harm. Each time my clothes rubbed against my broken skin, or water ran over it, I was again rewarded with that tranquilizing sensation.
Is Self-Harm a Mental Illness? An Addiction?
A Mental Illness? – NO: According to NAMI (National Alliance on Mental Illness), “Self-harm is not a mental illness, but a behavior that indicates a lack of coping skills. Several illnesses are associated with it, including borderline personality disorder, depression, eating disorders, anxiety or post-traumatic stress disorder.”
An Addiction? – YES & NO: Self-harm itself isn’t classified as an addiction. However, it can become addictive. Particularly alcohol and drug misuse, which is one way people self-harm. In a Psychology Today article, Elana Premack, L.C.S.W., M.P.H. shares a quote from a young woman she heard speak on self-injury, “…self-injury can be a sort of addiction – an addiction to the release of emotions. Unlike talking to another person about anger or fear, the tools used in self-injury give a reliable response. These tools cannot fail us in the ways that people can.”
Examples of Self-Harm:
- Cutting (more common among females)
- Scratching or pinching (e.g. using fingernails)
- Skin picking (e.g. at scabs or pimples)
- Hair pulling
- Carving into skin (e.g. letters or symbols)
- Intentionally restricting food and/or purging, binge-eating (e.g. anorexia or bulimia)
- Excessive use of laxatives
- Excessive exercise
- Misuse of alcohol and/or drugs
Risk Factors for Self-Harm:
- Social Difficulties (e.g. being bullied, problems at work, school or in relationships, struggling with sexuality or cultural issues).
- Trauma (e.g. physical or sexual abuse, death of someone close, miscarriage).
- Psychological Factors (e.g. disassociation, borderline personality, anxiety, eating disorders, bipolar disorder).
Identify Triggers & Make a Plan
Triggers are stressors that elicit the intense emotions that lead to self-harm urges, or cravings. It can be frustrating because, even when we’re following our treatment plans and diligently working to overcome these urges, there will inevitably be times when we become triggered. But seeking help and practicing self-awareness enables us to identify our triggers, minimize and sometimes even eliminate them.
Everyone’s triggers are different, but some general examples of triggers include: arguments with loved ones or co-workers, death of a loved one, financial stress and situations that remind you of past traumatic events. Once you’ve identified your triggers, you and your therapist can develop a plan for how to combat them if they arise.
Grab Your Journal: 5 Prompts to Get You Started
- Ask yourself what emotions are present when you have urges to self-harm.
- Next, what circumstances and/or events lead to those emotions?
- What are some of your favorite alternative coping tools? Check out The Sunny Shadow ‘Coping Tools’ category for inspiration! Also snag 50 Simple Ways to Cope from the Free Download Library. Not a Subscriber yet? Subscribe HERE for access.
- Which coping tools will be most effective when you become triggered and aware of the emotions that lead to self-harm urges? Which ones will be easiest to implement?
- Whoops! You missed the trigger and have a strong urge to self-harm. Which coping tools will be most effective now? Which ones will be easiest to implement?
» You may enjoy this blog post: Identifying Bipolar Disorder Triggers
When it comes to self-injury, I realize that I’m human. That means that, yes, I slip-up from time-to-time. But I TRY not to beat myself up when I do. Instead, I do my best to learn from it. I ask myself, ‘what was so different about this particular time that I couldn’t resist the urge?’
Relapses are common when it comes to self-harm. If you relapse, show yourself some love. Be compassionate and empathetic towards yourself, just as you would a friend or loved one. Try to look at it as a self-growth opportunity rather than a moment of weakness. I believe relapses are a sign that we need to learn some type of lesson. If we learn from relapses, we grow stronger because of them. And this leaves us better equipped to handle future urges and triggers.
TREATMENTS FOR SELF-HARM
There is no ‘one-size-fits-all’ treatment for self-harm. Treatment plans vary and are specific to each individual’s needs. It depends on the type of self-harm a person uses and their unique set of challenges. But in all cases, new coping strategies must be learned.
Do not expect self-harm to suddenly cease because treatment begins. A person uses self-harm for a reason — it works for them. After using it for a lengthy period of time, it becomes habit-forming and sometimes even addictive.
The first steps toward recovery is seeking support and visiting a psychiatrist and a therapist. A psychiatrist will be familiar with your condition and can further determine what underlying conditions may be contributing. Those conditions and/or illnesses will be treated alongside the self-harm. Treating the underlying illness may even reduce one’s urge to self-harm. A therapist can work with you on developing new coping skills, and much more. Be patient, recovery is a journey — not a destination.
Treatment for All Types of Self-Harm May include a Combination of:
- Psychotherapy: There are different types of psychotherapy. But generally speaking, psychotherapy will help you identify circumstances and emotions that trigger your urge to self-harm. A psychotherapist will also teach you self-serving coping strategies to replace self-harm. It’s also helpful in developing problem-solving skills.
- Medications: If you’ve been diagnosed with a mental illness, you may be prescribed medication.
- Inpatient or Outpatient Psychiatric Hospitalization: Unfortunately, psychiatric hospitalization still has stigma attached to it. But it shouldn’t. Getting help for an illness is nothing to be ashamed of. Do your best to ignore societal and self-imposed stigma. Focus on getting the help you need, that’s all.
» You may enjoy reading this blog post: The Reason I LOVE Psychotherapy
Treatment for Eating Disorders May include a Combination of:
Eating disorders are difficult to treat. People who battle anorexia are 18 times more likely to die prematurely. There is not a clearcut cure, but eating disorders can be managed and treatment is available. In addition to psychotherapy, treatments may include the following:
- Nutritional Counseling: This is an essential component of eating disorder treatment. A dietician works closely with patients to teach them how to develop meal plans and healthy eating habits. The goal is obviously to change patients’ perceptions toward food and return them to a healthy weight. Medically supervised diets are sometimes necessary.
- Medical Treatment: Symptoms of eating disorders, particularly anorexia, can become life-threatening. If anorexia progresses to a chronic level, it can affect the organs and cause other symptoms that require immediate medical attention and monitoring.
- Cognitive Behavior Therapy (CBT): CBT is a short-term goal-oriented therapy that focuses on changing a person’s negative thought patterns and behaviors. “Behavioral therapy pays close attention to the relationship between our problems, our behavior and our thoughts. Most psychotherapists who practice CBT personalize and customize the therapy to the specific needs and personality of each patient,” according to a PsychCentral article by Ben Martin, Psy.D.
» You may enjoy this blog post: 5 Things to Consider When Selecting a New Therapist
Treatment for Alcohol & Drug Misuse:
“The most effective treatment for co-occurring illnesses is intensive inpatient integrated care where both illnesses are treated at the same time and receive the same level of care. Followed by long-term aftercare and support. Inpatient care may include a medical detox, group and individual therapy, and medication management.” ~The Best Treatment for Co-Occurring Illnesses, The Sunny Shadow
There are different treatment approaches to alcohol and drug dependency. As well as philosophies surrounding the dependency itself (e.g. is it a disease or a compulsive behavior?). Perhaps the most well-known recovery programs are the 12-steps of Alcohol Anonymous (A.A.) and Narcotics Anonymous (N.A.).
While the number of dual diagnosis treatment centers continues to grow, each has their own treatment philosophy. There’s not one empirically-based treatment for addiction of which all treatment is based on, yet.
“It’s common for a person to relapse, but relapse doesn’t mean that treatment doesn’t work… Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.” ~National Institute on Drug Abuse
Here’s some helpful information from the National Institute on Drug Abuse (drugabuse.gov) about Evidence-Based Treatment to Drug Addiction Treatment. Be sure to visit my Mental Health Resources page for lots of resources!
When someone self-harms, there’s often an underlying contributor that needs to be addressed, such as an undiagnosed mental illness.
Treatment is imperative.
Although self-harm is not a suicide attempt, people who self-harm run a higher risk for suicide. Sometimes self-harm, and even suicide attempts, are the only way people know how to express the level of pain they’re experiencing. It could be someone’s way of asking for help.
My first suicide attempt was meant to make my loved ones understand how much pain I was in. I felt that either they weren’t listening or I was unable to get it across otherwise. I was desperate for someone to understand the living hell that had become my mind. Eventually I started to believe that no one ever would, it was a hopeless feeling of loneliness. But I just wasn’t looking in the right place. Once I finally started seeing a good psychiatrist and psychotherapist, things began to fall into place. Still, healing took time.
» You may be interested in this blog post: Suicide Warning Signs
You Are Not Alone
No matter ‘how’ you self-harm, there is no reason for you to suffer alone or in silence. I know it’s hard, because as open as I am about my bipolar, I’m just not it there yet with what my psychiatrist calls an eating disorder. Not to mention the laxatives I’m now dependent on. Acceptance takes time. Everyone is on their own path to healing, but remember we’re on the journey together. Be gentle with yourself. And try to let go of stigma. Don’t allow it to keep you from seeking the help you need and deserve.