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Talking about self-harm

Introduction

This booklet is for people who self-harm. It may also help family, friends and professionals to understand some of the reasons why people harm themselves. It provides basic information about self-harm and suggests some sources of further help. It also contains references to other reading material and to organisations which can provide further information for those who want to find out more. A selection of useful sites on the Internet has also been included.

What is self-harm?

People may cope with difficulties and distress in their lives in a number of ways which can be harmful to themselves. They may drink too much, overwork, smoke, eat unhealthy diets or abuse food or drugs. The term deliberate self-harm is used more often when people take overdoses or use other methods to try to kill themselves. However, most people who self-harm can make a clear distinction between suicidal acts and other motives for self-harming behaviour. Some of the ways people may harm themselves include cutting or scratching the skin, particularly the arms, burning themselves, biting or punching themselves or hitting their body against something. Some people may swallow or insert objects into themselves, whilst others may pull out their hair or eyelashes.

"I didn’t want to die, I just wanted to hurt."

Self-injury is another term which is becoming more commonly used. In this booklet the issues around repeated cutting of the skin, scratching, scalding and burning are explored using the term self-harm.

How common is self-harm?

The true extent of the problem is unknown. Self-harm is much more common amongst women than men. This is thought to be because women experience and express their emotions in different ways to men. Some men may be more likely to be angry or violent towards other people or things. Women may harm themselves when they are feeling angry or upset. Approximately 1 woman in 1,000 aged between 15 and 35 years is known to self-harm.

"All of us live in isolation and secrecy like the alcoholic who self-abuses on drink or the person suffering an eating disorder hiding in silence."

"We don’t always cut, there are many forms of abuse that can be passed off as accidental. "

Understanding self-harm

Quite often people harm themselves in ways that can be noticed by other people as a way of asking for help at that time. Some other people hide what they do. This can be due to shame, humiliation and fear. The reasons why people self-harm can be difficult for others to understand. They are complex and differ from one person to another.

"For me, cutting is a coping mechanism. It’s not something I’m proud of, but it’s something that gets me by when things get too heavy to deal with. It’s a very stressful experience at the time but it does help me get back in control of myself, albeit with having the embarrassment factor the next day."

Why do people harm themselves?

Many different reasons can lead someone to harm them-selves. Sometimes these stem from childhood experiences, but this doesn’t always have to be the case. Self-harm can often be a sign of low self-esteem, powerlessness, loss of control or a fear of loss of control. Feelings of self-hate which may have developed from a number of experiences may also be present for some people.

Some other commonly expressed reasons include:

• to manage moods or feelings. Some people describe intense feelings of anger and distress before harming them-selves. They may see the self-harm as a release of pent-up emotion, or as a way of reducing tension. Others see self-harming as a way of coping with a state of emotional numbness: “at least this way I feel something.” Sometimes people carry things around with them in case they feel the need to self-harm. This can make them feel in control.

"Personally, I think cutting is a way of releasing emotions for people like me who have a lot of trouble with crying and expressing emotional things. I personally find that I’ll cut if I’m feeling empty inside … cutting is a simple way of feeling real and checking if you can still feel."

• Wrong beliefs about themselves. Some may believe they should punish themselves for “being a bad person”. These thoughts and beliefs may be related to painful early experiences, quite often a history of some kind of abuse in childhood. Sometimes people who harm themselves experienced hurt, rejection and abandonment during their childhood.

Self-harm doesn’t “just happen”. It is part of a recurring cycle of responses to “triggers” which happen in someone’s life.

"Days and sometimes weeks can go by when we do not harm ourselves, we are proud of the fact but like a long lost friend it returns, starting again the cycle of torment, creating more torment and guilt."

Some of these triggers could be:

• being rejected by someone who is important to you
• being blamed for something over which you had no real control
• feeling inadequate
• being “wrong” in some way.

Self-harm can also be seen as part of a desperate struggle to cope with something and a way of communicating this when words are difficult to find.

Some common questions about self-harm

• Is self-harm a sign of madness?. No, self-harm is a sign of distress, not madness. It is a way of trying to cope with a painful situation.

"I’d rather feel that pain (from cutting) than the pain I don’t understand."

• Is self-harm a failed suicide attempt?. Rarely. Usually when someone harms themselves they don’t want to die, and sometimes it can be seen more as a way of “staying alive”.

"It hurts a lot, but that makes me feel something and that is better than feeling numb."

• Is someone who self-harms a danger to others?. No, the hurt is directed at the person themselves and not towards others.

"After, I’m most always mad at myself, and rarely self-conscious."

• Is self-harm “attention seeking”?. Rarely, because many people actually hide their injuries. When someone harms themself it is usually because they feel overwhelmed by events from the past or something which may have happened more recently. Sometimes people find it very difficult to find the words to express how they feel.

"Afterwards, I feel tired, physically and emotionally, as though there is nothing left in me."

• Is self-harm used to manipulate others?. This is not usually the case, it is more likely to be used to communicate rather than manipulate people.

How can I get help?

It is important to seek help and support to deal with your difficulties. Sometimes it can be hard to speak to someone about your situation. It is worth making the first step. Once you have got to know that person, you will begin to feel that you can trust them and share some of your difficulties with them. You may find it useful to contact one of the organisations listed later to find out what help is available in your area.

Counselling and therapy

It can be useful to address the issues underlying the reasons for the self-harm, rather than the behaviour itself. Counselling and therapy can give people the chance to talk through their difficulties. It is important for people who self-harm to be listened to and taken seriously. It is also vital to be accepted and not judged or condemned and it is very important that someone who self-harms is respected for their own experiences and feelings. Talking through feelings and emotions in counselling can help you understand why you sometimes feel the way you do. It can also help you look at practical ways of dealing with difficulties as well as helping you find better alternatives to deal with them.

One therapy known as cognitive therapy can be useful in helping people overcome negative ways of thinking which may have led to that person harming themselves.

Self-help

It can also be useful to meet with other people who have similar experiences of self-harm. It can overcome the feeling of isolation and provide a chance to help others, too. Groups can provide a valuable opportunity to talk about feelings without having to explain or justify. Groups can offer acceptance, friendship and belonging.

Creativity, such as art, drama etc, can be useful not only as a distraction but can also be a good way of expressing feelings in a non-verbal way.

Other things can help to distract you if you are feeling vulnerable. It depends on your own circumstances and preferences. To be useful at distracting you from feeling the impulse to self-harm, the activity should be something you really enjoy. It should not upset you further, eg avoid watching a violent film or listening to music that does not help you relax. You may also find it useful to participate in an activity that involves other people.

Some things that people have found to be useful include:

• listening to music
• watching a video
• doing some housework
• going shopping
• doing exercise or going for a walk
• baking or cooking a meal.

Using relaxation techniques can also help, as can aromatherapy or listening to relaxing music. It may seem trivial to some, but having a long soak in a bubble bath can be helpful. It is advisable to avoid using alcohol and/or drugs as these can increase the likelihood of acting more impulsively and therefore increase the risks of self-harming.

Of course you cannot expect these things to completely change how you feel all of the time or totally solve your problems, but they can help you in the short term by helping you cope at the time and making you feel better about yourself.

It is also important to realise that self-harm is rarely entirely impulsive. There are quite often thoughts and feelings which can lead up to you harming yourself. It is important to try to recognise them and interrupt them as this will help to break the cycle.

What can family and friends do to help?

Your needs

Self-harm can be extremely stressful, frustrating and anxiety provoking for everyone involved. Get support for yourself if you need it. This can be from your family doctor, other family members or a close friend.

Caring for someone who harms themselves is an exercise in knowing your limitations. No matter how much you care about someone, you cannot force them to behave as you’d prefer them to. Setting ultimatums does not work. Some-times the self-harm is suppressed for a while, but it will inevitably surface again.

Accept your limitations. If you feel rejected by the person you are trying to help, try not to take it personally. Some people need time to decide to trust someone else, particularly if they’ve received a lot of negative responses from people in the past.

Your role

When someone harms themselves, the people around them, whether professionals or families, can express a number of emotional reactions. These emotions range from panic, anger and hopelessness to hate. As a result, people who harm themselves often receive a poor service and little comfort when they look for help and support. Family, friends and workers can experience a number of feelings such as inadequacy, failure or anxiety about how to respond.

People who self-harm are incredibly sensitive to the feelings of those around them. They are able to “pick up on” the frustration, anger and rejection of others. They expect this and are looking for it.

• Maintain an accepting, open attitude about the self-harm. Most people who self-harm have problems with low self-esteem and are disgusted by their own self-harm. Try to make the person feel safe discussing it, and accepted regardless of it. This is not always easy to do: you may find it useful to try not to pay more attention to the self-harm than the healthier things the person does.
• Try not to get angry at the person for the self-harm. Again, this is easier said than done, but getting angry with the person only reinforces the upset and discouragement that the person already feels. Try not to minimise how much distress a person is in, regardless of how small the stressor might seem to you. Try not to use statements like “it’s not that bad” or “you can’t be that upset about it”. Acknowledge that the person is under a lot of stress, and that you are there if there’s anything that you can do to help.
• If you think the person is in immediate risk of self-harm, stay with them until the impulse passes or encourage them not to be alone. Physical contact can sometimes be helpful if the relationship is appropriate and trust is sufficient.

Professional workers

Being judgmental and putting blame on the person who has self-harmed does not achieve anything. In fact, it can make the situation much worse, and leaves the person who has self-harmed feeling even more worthless. Quite often workers who have contact with people who self-harm can have a number of feelings around the issue of the act of self-harm which can be directed back at the person. Unfortunately, because of other work pressures it may not be possible to spend as much time as you would like with the individual person. If this is the case, it is important to emphasise to the person that this is not a personal reflection.

Self-harming behaviour is more about the person who does it than about the people around them. The person you’re concerned about is not harming themselves just to make you feel bad or guilty. Even if it feels like manipulation, it probably isn’t intended as such. People generally don’t self-harm to be dramatic or to annoy others. Professional support can be useful in helping the person look at alternative ways of coping with distress.

Acceptance, caring and listening are vital.

It is very important to explore the issues underlying why someone harms themselves. People who are able to help are those who are able to understand that self-harm does not constitute a character flaw but is a problem-solving device that “manages” the painful feelings while making life more difficult at the same time.

What will the future bring?

Self-harming behaviour can be reduced with counselling and support. Hope for improvement and control over your life can be very important in reducing and eventually discontinuing the way you self-harm. Many people do stop harming themselves - when they are ready. You could find that you will be able to sort out your problems and find other ways of dealing with your feelings. It might take a long time, but things will get better.

"I can’t scream
I can’t shout
I hurt myself
to get pain out."

Suggestions for reading

Self-Harm Help Book
Copies from The Basement Project, 82 Colston Street,
Bristol BS1 5BB.
Tel: 0117 922 5801 (£5.00 incl. P&P)

Choosing to Live
by Ellis & Newman (1996).
Published by New Harbinger Publications.
A very useful book which gives advice on how to cope when you are feeling vulnerable.

Women and Self Harm
by G Smith et al (1998).
Published by The Women's Press, London.

Cry of Pain
Understanding Suicide and Self-Harm
by M. Williams (1997).
Published by Penguin.

Useful addresses

National Self-Harm Network
PO Box 16190
LONDON NW1 3WW

Campaigns for the rights and understanding for people who self-harm andprovides information and leaflets.

Bristol Crisis Service for Women
PO Box 654
BRISTOL BS99 1XH

Information, publications and training about self-harm.
Helpline: 0117 925 1119. Friday and Saturday nights,
9 pm - 12.30 am.

SHOUT
c/o PO Box 654
BRISTOL BS99 1XH

A newsletter for women who self-harm.

Samaritans
24 hour helpline: 0345 909090

The Mental Health Foundation
37 Mortimer Street
LONDON W1 8JU
Tel: 0171 580 0145

Provides a number of articles on self-harm.

Mental Health Foundation Scotland
24 George Square
GLASGOW G2 1EG
Tel: 0141 572 0125

For information about what's available in your area you can contact:

Health Promotion Library Scotland
Health Education Board for Scotland
The Priory
Canaan Lane
Edinburgh EH10 4SG
Tel: 0645 125 442
Text: 0131 536 5593
Email: library@hebs.scot.nhs.uk

The Internet

If you have access to this facility either at home, work or using a publicaccess point then you may wish to check the following sites. As you find othersyou can make a note of addresses (URLs) below or, if you have a computer,'bookmark' them.

http://www.geocities.com/wellesley/1520/help.html
Self-Injury Information and Resources. Provides a lot of information ondifferent aspects of self-harm.

http://crystal.palace.net/~llama/psych/fself.html
Self-injury: You are NOT the only one. Provides lots of advice on self-harm.