What are self-harm?
Self-harm is any act done to harm oneself without suicidal intent and through the immediate destruction of the body surface (skin). Self-harm is not considered if it has occurred involuntarily or accidentally or if it falls within socially acceptable practices (tattoos, religious rituals…).
Most self-injury (> 80%) consists of cuts with a sharp object to the legs, arms, or abdomen. Although they usually consist of minor injuries, their continued practice can lead to more severe injuries, infections or even death.
In recent years, an increase in these behaviors has been observed among adolescents and young adults, which is why self-harm is beginning to receive more attention from mental health experts.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed self-harm disorder as a problem on which more research is still needed. Some studies indicate that self-harm is not a disorder in itself but a symptom present in different disorders or health problems. If self-harm is just a symptom or it is a new entity, it must be proven by the numerous studies on the subject that are being developed both internationally and in Spain.
Diagnosis of Self-Injury Disorder.
The DSM-5 has incorporated new criteria to define non-suicidal self-harm (ANS) . These criteria are as follows:
- In at least five days in the past year, the person has inflicted injuries that have caused bleeding, bruising or pain, with the intention of causing pain, but not death.
- These behaviors are performed in the hope of: alleviating a negative feeling, solving personal problems, or eliciting positive feelings.
- The subject’s behavior is not socially accepted (as is the case with tattoos or piercings) and goes beyond picking a scab or biting nails.
- This form of action interferes in important areas of the subject’s life: academic, work, social …
- This behavior is not attributable to other existing mental pathologies.
Epidemiology of self-harm (ANS).
Are self-harm frequent?
Traditionally, self-harm (ANS) was considered a very strange behavior, which appeared associated with significant psychological disorders. To this day that conception has taken a 180 degree turn. A significant increase in this behavior has been observed among young people and adults without disorders.
The latest studies carried out indicate that slightly more than 4% of the population report having inflicted self-harm at some point in their life.
Who does it happen to?
Although there are no data in the population under 12 years of age, the initiation of this type of behavior occurs at a very young age. One in four people who self-harm claim to have initiated such behavior when they were 10 years old or younger.
Globally, between 13 and 45% of adolescents have engaged in self-injurious behaviors. In Europe, more than 27% of adolescents claim to have injured themselves on at least one occasion.
These percentages increase among the clinical population. About half of the adolescents admitted to psychiatric units have suffered continuous self-harm. In general, self-harm behaviors are significantly reduced under the age of 30 (reaching less than 5%).
Self-harm, gender and culture.
There is no scientific consensus on whether this behavior is more prevalent among men and women.
Yes, verifiable differences have been observed in the method used. Guys tend to use bumps and burns. Girls tend to cause themselves to bleed with cuts or scratches. These data apply equally to adults and adolescents.
Significant statistical differences have been found in the percentage of self-harm, for example, between countries such as France and Hungary.
Are self-harm a passing behavior?
The most propitious age for the onset of self-harm is in a range above 11 and below 18 years. Adolescence is probably a stage of greatest vulnerability for the development of ANS. This would be due to the impulsiveness and emotional responses characteristic of the brain changes during this stage.
Some risk factors for incurring self-harm are: having carried out self-injurious behaviors before, having done it using different methods, feeling hopeless and showing histrionic, narcissistic, antisocial or borderline personality traits.
We cannot consider that self-harm occurs in a temporary phase, since almost two out of three people who self-harm maintain their harmful behavior a year later.
Self-harm: associated factors, psychopathology and suicide.
Adolescents who do self-harm on a recurring basis show greater problems with emotional regulation, more personal difficulties and worse school performance than those who only do it in a timely manner. Emotional regulation is probably a key role in understanding why self-harm occurs.
The early onset of self-harm has been associated with an increased risk of developing Borderline Personality Disorder (BPD). More than 50% of adolescents who self-harm show criteria to be diagnosed with BPD.
Self-harm also appears in other conditions such as anxiety disorders, substance abuse and eating disorders such as anorexia nervosa and bulimia.
Some studies have found a significant correlation between childhood sexual abuse experiences and self-harm. Having suffered bullying increases the risk of self-harm.
The relationship between ANS and suicide has been extensively studied. The practice of self-harm appears as an important risk factor for suicide. This is especially the case in people who show very frequent episodes of self-harm, who report no pain, and claim immediate relief afterward.
Why do teens self-harm?
Normally, self-harm is not impulsive but planned behavior. It usually occurs alone, in the face of unpleasant memories, emotions or events.
Among young people, self-harm can be used to express emotions that cannot be transmitted through appropriate language. When performed in the body, they symbolically give a structure, place and tonality to what they feel. Likewise, self-harm can serve the purpose of making emotional or internal suffering visible, in a way that is perceived and recognized by others.
Many people say they don’t feel pain when they do self-harm. This may be because they have become used to the habit or because the brain secretes a large amount of opioid neurotransmitters during the process.
There are different scientific models to explain self-harm. Some of them are: the experiential avoidance model, the emotional waterfall model, and Nock’s integrated model. In this last model, it is proposed that there are two types of basic motivations to explain self-injury: intrapersonal and interpersonal.
- Intrapersonal motivations, also called automatic, seek to change the internal experience of the person: generate a positive feeling (for example, feeling “alive”) or avoid a negative emotion or thought (for example, suicidal ideas or anxiety).
- Interpersonal motivations usually pursue a social and external change: receive attention or admiration, avoid an argument, etc …
Learning and imitation processes play an important role in the development of self-harm. A wide dissemination of this phenomenon has been observed among adolescents through social networks. However, many also use the internet to seek help on how to handle them.
How to deal with self-harm?
If you find that someone close to you is self-harming, you are likely experiencing a lot of frustration, confusion, sadness, and even anger. They are normal emotions in these cases and you must take care, first of all, of the discomfort that this sad discovery has produced in you. A good option is to ask for professional advice and / or lean on a loved one by telling them what happened.
Try not to act impulsively, even if it’s about your child or a good friend. It is common for self-harm to cause us great rejection. Even so, we must show an attitude of understanding and concern for the person who harms himself.
We must think that the person who is engaging in this behavior may be because he suffers great discomfort or because he feels powerless in the face of certain events in his environment. It is important that we make him feel heard and cared for, that we look beyond the injury itself and show interest in his life, his problems, etc …
We should not blame, judge, or attack the person who harms himself. Nor ask him to promise that he will not do it again, at least not from the first moment, since it is likely that he will not be able to control this behavior 100% and if he fails in his promise he will feel guilty. Self-harm, despite being shocking and can be associated with psychological disorders, is not always an indicator of serious pathologies. On many occasions they may be signaling a deficit of social and emotional resources in the person.
Seek specialized help.
If we decide to use the Internet as a source of information, we must avoid low-quality pages that promote myths and misconceptions. It is always preferable to consult with a mental health professional. If it is not within your reach, you can resort to guides promoted by the public health system such as:
“Behavioral disorders in children and adolescents: guides for parents.” (link at the end of the article).
If you find a loved one self-harming, give them your full support. Encourage him to go to psychological therapy to learn how to manage emotions in a less harmful and more creative way. Some alternative behaviors to self-harm, when a negative thought or emotion appears, can be: talking with someone you trust, listening and singing a song you like, hitting a cushion to vent, going for a run, playing sports, drawing or write about how you feel.
A real testimony about self-harm.
I started to injure myself around the age of 14. My best friend and I were very obsessed with weight control. We told each other what we had eaten every day. We were talking about how to improve each other.
We started to think of ways to “punish” ourselves when we missed something. On the hardest days, what we would do if we were very hungry was to burn a cigarette in our hand, in the center, so that they looked like the normal lines of the hand.
Later I began to go into deep depression and started going to the psychologist. I had agoraphobia and when I had anxiety attacks I thought about cutting myself. The first time was with a knife, very little and with a lot of fear on the wrist. From then on, when I had very large panic attacks, I scratched my arms as if in compulsion and burns appeared on my forearms from friction.
One of the last, most serious times, I cut myself with a knife on my leg and I have a rather large scar. By then she had already been admitted. I had been diagnosed with Borderline Personality Disorder (BPD) and went to the day hospital.
I started therapy and they taught me how to cope with panic attacks. I counted multiples of three upside down, waiting for the necessary time to pass for the anxiety to subside from exhaustion. It took me about three hours to go down and little by little, due to exposure to what scared me, I was getting used to it and having less anxiety. He also tried to find solutions less bad than self-harm. At times, I would allow myself consensual self-harm like getting a piercing.
And so little by little I was redirecting him towards healthier methods to control my anxiety, until I was able to control it by myself without using self-harm. I am now perfectly capable of controlling my panic attacks and have never harmed myself again.
I have managed to have adequate control of the management of my emotions. This does not mean that I do not live it every day and that I can stop being on guard … but, as I know myself, I know what I have to do and how to react to things so as not to go back to my past times.
So, this is my advice: “Although it seems that it does not work, which is very hard and a burden, do what the experts tell us and you will see that it does work. Really, don’t give up because it’s a long-distance race… don’t forget what you’re making the effort for, because in the end, it happens ”.
And I hardly ever think about it or need to talk about it with anyone. It is something that people do not know or associate with me. Going through this does not mean that you have a scarlet letter for life, time passes and you meet new people who do not even imagine that you have been through this. (Anastasia, 28 years old).
Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.