Published in The Doctor Weighs In, January 18th, 2017. View the Article Here
For the vast majority of the population, deliberately hurting oneself just doesn’t make a whole lot of sense. We may even be horrified when we think of someone purposefully cutting on their own body. It can be especially upsetting when someone we love engages in self-harm. Questions begin to arise: Why would someone do this? What purpose does self-harm serve? And, most importantly, can someone stop self-harming once they have begun? Before I answer these questions, it’s important to know a little about self-harm:
Self-injury or deliberate self-harm is the intentional act of hurting oneself. Common forms of self-injury include cutting (with a sharp object such as a razor or knife), scratching, burning, carving in skin, hitting or punching, skin piercing, hair pulling, and scab or wound picking.
Self-harm typically begins in adolescence. Research data suggests that a significant portion of adolescents will engage in self-injury during their lifetime. A look at over 50 international studies shows prevalence rates ranging from 16-18% self-injury across adolescent populations across the world.
In another study of over 600 young people, researchers concluded that 14-15-year-old girls were the most vulnerable and more likely to engage in self-harming behaviors. Young women were 3 times more likely to engage in self-harming behaviors than their male counterparts. Methods of self-injury also differ by gender. For example, girls report using cutting and carving their skin most often while boys report hitting themselves as their preferred method. It isn’t just limited to teenagers, children as young as elementary school age may self-harm.¹
I draw heavily on a qualitative study (2013) conducted by Dr. Tiffany Brown, LMFT, and myself, where we interviewed a group of 11 individuals who identified as self-harmers in recovery.² Let’s revisit the questions from above:
Many people mistakenly confuse deliberate self-harm with a suicidal act. Although self-harmers are at a greater risk for suicidal ideation and attempts, self-harming, in and of itself, is not a suicidal attempt and is engaged in for different reasons. In fact, research suggests that only 1% of people who engage in self-harm want to die.
So, why do people self-harm? There are several reasons expressed by those in our study²:
As one of the participants eloquently stated:
[Self-harm and suicide are] different because suicide is a permanent solution to a temporary problem and self-harm is my way to deal with those temporary problems.²
All participants of our study expressed that one of the primary purposes of self-harm was to cope with their strong emotions, including dealing with multiple traumas they experienced (e.g., sexual, physical, emotional). They lacked the ability to recognize or deal with emotions, and self-harm became their primary coping mechanism. One participant expressed:
[Self-harm] started as a way of dealing with events that were occurring. One being my mom [who] was very emotionally abusive. I would say that it affected me, in the sense of not being able to handle things, not being able to cope. I didn’t learn that. I didn’t learn to cry safely. I didn’t learn how to share my emotions safely. I didn’t learn how to ask for help, in fact, I learned how to not ask for help.²
Self-harm may be an individual’s powerful symbol of wanting to live but not knowing how to cope with overwhelming or heightened emotions.
This is easily the most important question to ask about self-harm:
Can someone stop self-harming once they have begun?
YES! Many people who self-harm can learn new ways to cope and find recovery. Self-harm can be a one-time event or occur over a short period of time. For these individuals, quitting may be easier than for those individuals who become dependent on self-harming behaviors to manage life.
Six out of the 11 participants in our study identified self-harming as an addiction needing significant professional help, even treatment to stop, and extended long-term support in order to maintain wellness and recovery. All of our participants are examples of individuals who found recovery from an extensive history of self-harming behavior. Overcoming deep and difficult trauma and learning new ways to cope, give all self-harmers and those who love them significant hope.
Self-harm is not necessarily a suicidal attempt; in fact, most often it is not. Self-harm is more commonly seen in early teens with girls having a higher engagement in self-harming behavior than boys. Self-harm may be an individual’s powerful symbol of wanting to live but not knowing how to cope with the stress, trauma, and strong emotions of life. The hope for those who suffer—and those who love them—is that many people who self-harm can and will find recovery with appropriate understanding, help, and long-term support.