SELF-HARM
What is self-harm?
Non-suicidal self-injury (a.k.a. self-injury or self-harm) is the intentional infliction of physical harm to your own body (e.g., cutting, burning, bruising, scratching). Tattoos and piercings (i.e., body modifications) are not considered self-harm. Self-harm is also not the same thing as suicide. Many people think that people who self-injure are suicidal (i.e., they assume that by cutting, the individual is trying to die), which is not true. Not all self-harm is an attempt to die.
What are the signs?
It can sometimes be hard to tell when someone is self-harming because many people try to hide the outward signs (e.g., by wearing clothing that covers the cuts/scratches/bruises/burns). Here are some signs to watch out for:
- Unexplained cuts, burns, bruises, or scratches, especially on the arms, legs, and stomach.
- Clothing that isn’t appropriate for weather/situation but covers significant portions of their body.
- Hoarding razors/knives and other objects that may be used for self-injury.
Is there something seriously wrong with me?
Self-injury is often misunderstood. Some people who hurt themselves may struggle with depression, anxiety, perfectionism, traumatic life experiences or an eating disorder. Others may have none of these difficulties. Self-injuring does not make you crazy. If you self-injure, it does not mean there is something seriously wrong with you but it usually does mean that you are struggling and could use some support.
Why am I self-injuring?
The most common reason for self-injury is to cope with difficult feelings (e.g., distress, anxiety, stress, sadness). These feelings or thoughts are felt to be so intense and overwhelming that they are intolerable. While it may not be a healthy way to cope, hurting yourself may make you feel better temporarily. This is why the behavior is so difficult to stop.
You may self-injure to punish yourself if you feel you have done something wrong (even though you may not have actually done anything wrong), or because you feel you have not measured up in some way to your own standards, even though these may be harsh and unrealistic.
You may self-injure to tell others how you feel (when it is hard to say it in words). You may self-injure to communicate to someone close to you or the world about your suffering or pain.
Self-injury can also happen when you feel disconnected from others or even yourself; it may be used to make you feel something, even if it is pain or to reach out to others.
If you have suicidal thoughts or urges, you may self-injure to avoid acting on these.
If none of these reasons sound like they fit for you, there may be other reasons why you self-injure. Everyone has their own reason for engaging in self-injury. Many people say that several of these reasons are true for them, and these reasons can change over time. It is complicated and while others often want to know “Why do you do this?”, it is sometimes difficult to really give one simple reason.
How do I know I need help?
Although many self-injurers say that the self-injury has ‘taken over’ and they know they need help, others who self-injure feel like they can control the behavior on their own, or stop injuring whenever they want. In either case, hurting yourself is a sign that things are difficult for you. It is a sign that you are not coping well, and that you need to find better ways to cope. Even if you are injuring only sometimes, this suggests that you are having some difficulties with strong emotions and/or communicating with others. Because of this, you might find that getting support is helpful.
Why is getting help important?
Many people who self-injure report that the more they do it the harder it is to stop. They tell us that it feels like the self-injury has taken over their life. Self-injury is not a life-sentence, and people can and do stop self-injuring. However, the longer a person self-injures, the more difficult it can be to stop. Some people who used to self-injure have found healthier ways to cope and stopped self-injuring. Some have done this on their own, while others have done it with the support of a professional. In either case it is important to remember that learning new, healthier ways to cope takes time and effort. Don’t be discouraged if it doesn’t happen right away or if you find it difficult; many people experience this.
How do I tell others who care about me that I’m injuring?
It is common to feel like nobody understands your self-injury. Thinking about telling someone else about your behavior may feel scary, intimidating and/or impossible. Different things may help with some of these worries.
Below are some suggestions that may help you feel safer sharing your self-injury with someone else.
- Identify someone you trust. This may be a parent, aunt, uncle, best friend, teacher, romantic partner or anybody in your life. There is no right answer about WHO can support you best.
- Write down your story. Sometimes writing how you started self-injuring and what your experience has been like can help you to share it with someone else. This is especially true if you have a hard time talking about your feelings.
- Although you want others to react with empathy, understanding, and kindness, this may not always happen right away. Sometimes when people really care about you they can react in ways that may be upsetting and which seem unhelpful. This may be because they don’t understand self-injury, find it scary, and do not know what to say or do. They may need some time to understand what you’re going through and how to support you best.
- Ask your friend or loved one to educate themselves on self-injury. Share our resources page.
What kind of treatments are there?
There are some treatments that may be helpful for self-injury. Ideally it is helpful to do this with a professional and support system, but if you don’t have that, or feel unable to seek help there are some things you can try on your own to begin coping better. Below, we talk about treatments that you can get from professionals and resources you can use on your own.
Who treats self-injury?
Licensed mental health professionals are often the people who treat self-injury. This may include: psychologists, psychiatrists, counselors, nurses, and social workers.
Is treatment on my own? Or, in a group?
Treatment can be individual or group-based. Individual treatment will mean that you will work one-on-one with a mental health professional. The professional will take time to get to know you and understand your self injury, and has likely seen many other people with this struggle before.
Treatment can also be group-based. The group sessions will be led by at least one professional, sometimes two.
Will I have to leave my home or be committed to a hospital?
Most often, self-injury can be treated in an outpatient setting. This means you will go to treatment once or twice per week, but will continue on with your regular daily life (e.g., still going to work or school, etc.). If the self-injury is severe or you are at risk of suicide, you may require more intensive treatment, which can happen in an inpatient setting, such as a hospital.
What kind of things happens in treatment?
Treatment for self-injury will often take a few different forms, depending on where you seek help. Two commonly used approaches are:
Cognitive Behavior Therapy (CBT):
CBT is a type of treatment that can help you identify and adjust negative thoughts you may have (e.g., I’m stupid, Nobody loves me) and the feelings that follow from thinking this way (e.g., sadness, pain). Self-injury may be the only way you have to cope now, but CBT focuses on teaching you new ways to cope, including ways to think less negatively. CBT can also help you to cope with urges to self-injury (e.g., what to do instead) and can help you get back involved with things you may have stopped doing because of your self-injury.
Dialectical Behavior Therapy (DBT):
DBT includes many of the components of CBT mentioned above. However, it also includes teaching you how to be okay with negative emotions, to talk to others more openly and to help reduce some of the tension you may feel when really upset.
Key Parts to Recovery
In general, research has shown that people who learn healthier ways of coping and who stop self-injuring have done so using one or more of the following key pieces -- in either formal treatment or on their own with some other form of support:
- Learning about self-injury, getting information from reliable sources to better understand your self-injury (see our resources page and below for more information).
- Being really motivated to recover, seeing clearly how the self-injury is negatively affecting your life, seeing the clear. benefits to stopping (for yourself) and believing that it is possible.
- Having at least a few people who know about your efforts to recover, and who are supportive (and know how to support you).
- Working through resources or with a professional to get the skills to manage urges, developing healthy alternative coping skills to replace self-injury, and tolerating/coping with intense emotions.
- Learning how to express emotions and problem solve.
- Developing a new identity as someone who has overcome self-injury.
How can I help?
If you notice the signs listed above, ask your friend about self-injury. Self-injury doesn’t improve on its own. People need to learn more adaptive and effective coping strategies before they will be able to stop self-harming. Trying to force people to stop self-injuring without teaching them better coping strategies will leave them with no tools for handling their difficult emotions. Learning better coping takes time and patience. Be supportive of your friend’s struggle. Respect his or her right to privacy but don’t promise to keep it a secret. Be honest with him or her about your concerns; encourage him or her to seek help from a counsellor or psychologist; don’t judge; and don’t freak out. Your friend needs your support; let them know they’re not alone.