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Is Self-Harming the Same as a Suicide Attempt?

Kimberly Jones

A 3-Part Blog on the Truths behind the Thing No One Wants to Talk About

Part II

In Part I of this series on suicide, I talked about Cheryl, an acquaintance from high school who ended her life thirty years ago. Since then, suicide has increased substantially. What’s more, self-harming has made its way into our culture, becoming a coping method for daily stressors for people of all walks of life. If you ask anybody, most will say they know someone who is cutting or burning themselves. There is a shared assumption that self-injury is in fact a suicide attempt. Many people cut or burn, bang their head or punch things, but their mentality is actually quite different than someone who is considering suicide. The intentions are not alike.

With suicide, the objective is to die, in hopes that the pain associated with this life will disappear. On the contrary, self-harming is usually done during highly emotional situations to provide temporary relief from emotional distress.

What is Self-Harming?

Self-harming in a nutshell is an injurious behaviour, a planned-out action that is done (often in private) to oneself, possibly in a ritualistic pattern (using a specific object – on the same body part – in a precise environment – at a certain time) but with no suicidal intention. Deliberate self-harming has several names:

• Non-suicidal self-injury
• Self-injurious behaviour
• Self-mutilation
• Self-harming

Deliberate self-injury isn’t just ‘cutting’, it also includes putting oneself in harms’ way through reckless sex, careless driving, alcohol or drug use, or restricting food intake. Self-injury is an intentional, maladaptive coping mechanism that prevents individuals from ending their lives, through managing extreme emotions such as sorrow, numbness, anger or shame.

Ways that people self-harm:

Self-harm is often thought of as ‘cutting’ but it is any action a person uses to purposefully harm oneself. Self-injury is usually done to one’s arms, hands and wrists, thighs, stomach, head or genitals (1). Common ways to self-injure include:

• Punching things
• Hitting one’s head
• Picking at a wound
• Biting oneself
• Not eating
• Swallowing poisons or objects
• Cutting, piercing, or scratching one’s skin
• Burning or scalding oneself with lighters, cigarettes or hot objects
• Pulling out one’s hair
• Inserting objects into orifices

Who Self-Harms?

Self-harming stems from a combination of genetic, biological, social and psychological dispositions. Self-harming does not discriminate; it can touch anyone at any age, sexual orientation, background or race. Risk factors may include:

• Gender (girls and young women mostly cut but boys are progressively engaging in self-injury too)
• Dissociation (feeling detached from oneself or one’s surroundings)
• Learning disabilities or mental illness (Borderline Personality Disorder, Schizophrenia or Depression)
• Age (typically starts in pre-pubescent years)
• Emotion contagion (having friends who engage in self-harming)
• Survivors of physical or sexual trauma
• Unstable self-identity
• Gay, bisexual, transgender men and women
• Addiction (street drugs, prescriptions, over-the-counter medications or alcohol)
• People in jail

How widespread is Self-Injury? Statistics:

People tend to self-harm in private, leading to skewed statistics but here are some common stats obtained from the web:

• Studies suggest that roughly 4% of adults, 15% of adolescents and 17%-35% of college students in the United States are self-harming (2)
• 20% of females and 14% of males participate in self-injury (3)
• 90% of people who self-harm start in their teens (4)
• About 50% of those who engage in deliberate self-mutilation have a history of sexual assault
• Many report learning how to self-harm from their friends or the internet
• Approximately two million cases are reported annually in the U.S
• In Canada (2013–2014) there were almost 2,500 hospitalizations for self-harming among youth
(Age 10- 17), equating to 25% of hospitalizations for youth (5)

What to Look For:

Societal stigma regarding self-harming often leads individuals to cut or hurt themselves in private. The shame attached to these actions prevents them from revealing their self-injury to healthcare professionals or loved ones. The indicators that someone is self-harming will depend on what methods they are using. Signs and symptoms of self-injury can include:

• A history of depression or anxiety
• Scars, burns, scratches, cuts, bruises or broken bones
• Patches of hair loss
• Describing frequent injuries as accidents
• Difficulty regulating emotions
• Feeling detached from others
• Challenging emotions such as shame, guilt or hopelessness
• Conflict in relationships
• Social isolation from friends, family, and community
• Poor sense of self
• Possessing sharp objects, blood-stained clothing, towels, or blankets
• Wearing unsuitable attire for the weather (long-sleeved shirts in the summer)
• Stopping hobbies that were once enjoyed
• Engaging in risky behaviors

Complications of Self-Injury

As mentioned, deliberate self-harming behaviours are not deemed as acts of suicide; but even so, there are risks involved. Those who self-harm can develop:

• Permanent scarring
• Hepatitis, HIV or AIDS (if sharing sharp instruments)
• Bone fractures, damaged muscles, nerves, tendons or blood vessels
• Multi-organ damage or failure
• Infections in wounds or blood (if not sterilizing cutting devices)
• Loss of limbs, fingers and toes
• Permanent weakness in arms or legs
• Death (by mistake)
• Suicidal thoughts or behaviors
• Social isolation or compromised relationships
• Shame, guilt and low self-esteem

Why Do People Self-Harm?

The physical pain from self-harm has a calming effect during those times when life feels unbearable. People report that self-harming gives them the same euphoric sensation as spicy food, cocaine or exercise. In addition, it allows them to:

• Convert emotional pain into physical pain
• Express to others that they are in crisis
• Feel alive when they are numb, detached or dissociating
• Communicate feelings, views or experiences
• Increase sense of control
• Distract from trauma flashbacks
• Provide physical care for oneself
• Self-punish
• Convey suicidal thoughts safely without ending one’s life

Seeking Help for Self-harming

Self-harming has become a way for people to cope with life stressors. Most people report that they feel better after injuring themselves, but the improvement is short-lived and painful emotions regularly come back. Self-harming is addictive, and over time it is not as effective as it once was. Self-harming can lead to permanent scars that might be difficult to hide, and shame, guilt and loneliness frequently ensue.

Although most people who self-harm do not want to die, regrettably there is an increased risk of suicide over time. When they cut or burn themselves, they are actually problem-solving around their emotional pain in order to stay alive. But, the correlation between suicide and self-injury is complex. It is therefore imperative to seek help because people who self-harm sometimes accidentally cause more harm than planned (i.e. cutting too deep) thus leading to medical problems or death. Things that can help:

• Tell someone who is trustworthy (a friend, counselor, doctor, family member)
• See your family physician for an assessment
• Seek out psychotherapy such as Cognitive Behavioural Therapy and ensure that the therapist has expertise in working with self-harming
• Medication can be helpful to manage symptoms of depression, anxiety, and OCD
• Use distraction techniques such as walking, meditating, exercising, creating (mandalas or painting), journaling or blogging

Understanding Self-Harming in a Loved One

If you don’t have the compulsion to self-harm, it probably seems incomprehensible to you that someone would cut or burn themselves. It is important to remember that people who are self-mutilating are trying to problem-solve through some pretty distressing emotions. The physical pain that occurs from self-harming tells the brain to emit endorphins. This neutralizes the pain and creates a natural high, which becomes addictive (just like drug use or over-eating). People crave this sensation and therefore continue to self-harm to manage their problems temporarily.

Unfortunately, like many mental illnesses, there are myths and stereotypes connected to self-harming, which remains poorly understood. It is everyone’s responsibility to challenge these notions because they deter people from seeking therapy. Some of these myths include:

• Only females self-harm
• People who self-harm are suicidal
• Those who injure themselves are ‘attention-seeking’
• They must like it to keep doing it
• They are crazy
• Only teenagers self-mutilate
• People cut to manipulate their loved ones

Some tips for helping a significant other who is self-harming:

• Talk to them with full attention and freedom from distractions
• Validate how hard it must be for them
• Don’t force them to tell you details around their self-harming
• Steer clear of giving ultimatums such as “you must stop”
• Assist them in seeking professional support
• Remind them that you are there for them
• Don’t act shocked or repulsed when they talk about their self-harming
• Do not promise to keep secrets
• Seek medical attention if the person is in acute danger
• Keep the faith, things can get better with appropriate help
• Don’t try to be their therapist
• Remember, it’s unlikely they can stop immediately
• Try not to react with anger, distress, or sadness
• Don’t feel responsible for their self-harm
• Get therapy for yourself

Potential Consequences of Not Seeking Help:

If you’re like most people who self-injure, you probably try to keep what you’re doing secret or perhaps it has become addictive and hard to stop. Things to consider about continuing with self-harm are:

• Roughly 35% of people who try self-harming the first time will do it again
• Nearly 3% who self-harm over 15 years will die by suicide (6)
• People become socially isolated leading to loneliness
• Self-harming becomes a heavy burden
• Self-harming can lead to medical compromise

REMEMBER THERE IS HELP AND HOPE

References

1. http://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/dxc-20165427
2. http://www.mentalhealthamerica.net/self-injury
3. http://www.therefuge-ahealingplace.com/co-occurring/self-injury/effects-symptoms-signs/
4. http://www.healthyplace.com/abuse/self-injury/self-injury-self-harm-statistics-and-facts/
5. https://www.cihi.ca/web/resource/en/info_child_harm_en.pdf
6. http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/self-harm.aspx

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