Despite its prevalence self-harm is an area of mental ill health that continues to be widely misunderstood. Search Google for the key terms and you will find that the behaviour is characterised by some as “attention seeking” or as a precursor to suicide. While this may be true in some cases, research indicates that self-harm behaviours are largely private and unrelated to suicidal intent (Hawton & James, 2005). Furthermore, rather than being ‘attention seeking’, it is perhaps more accurate to consider the behaviour to be a visual communication of emotional distress.
What is it?
Self-harm or non-suicidal self-injury (NSSI) as defined in the DSM 5 (APA, 2013) is the intentional infliction of harm to oneself regardless of motive (National Collaborating Centre of Mental Health, 2012). The most commonly occurring methods include cutting, scratching, bruising, pulling and burning of one’s own body parts.
Who does it?
Individuals across all ages engage in self-harm, although research suggests that the rate is highest among young people between the ages of 11 and 25 years old (Mental Health Foundation, 2016).
Rates of self-harm behaviours appear to peak between the ages of 12 and 15 (Hawton, Saunders & O’Connor, 2012. However the available data is primarily collected from episodes where individuals sought medical intervention. This accounts for only 12.5% of adolescents who engage in self-harm (Madge et al, 2008), and so the prevalence is likely to be much higher than reports suggest.
Why?
The literature indicates that adolescents who engage in self-harm do so as a maladaptive coping mechanism in response to adverse life events and stressors (Mikolajczak, Petrides & Hurry, 2009; Andrews, Martin, Hasking & Page, 2013).
Reasons may include:
- a physical distraction from emotional pain;
- a method of combatting numbness;
- releasing built up tension;
- exerting physical control over the body, when emotions are experienced as being out of control;
- a desire to punish oneself due to feelings of low self-esteem and self-worth;
- a way of signalling emotional distress to others;
- learned behaviour from peers/ family;
- From a biological perspective, self-harm can become an addictive behaviour. The body responds to pain by releasing endorphins which result in feelings of euphoria comparable to the ingestion of opiate drugs such as morphine (Van Ree et al, 2000).
What can you do?
Whether you are a teacher, parent or friend of a young person who is self-harming, there are many things that you can do to support them. Here are some that we hope will be helpful:
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Do not judge – disclosing self-harm can leave a young person feeling extremely vulnerable. Despite what your own feelings about self-harm may be, the best way you can help a young person is by providing them with non-judgmental support.
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Listen – If they trust you enough to open up to you about their self-harm that is great news! Instead of giving advice, let the young person guide your conversations. That way you can gain insight into why they have resorted to self-harm, which will inform any alternative coping strategies you may suggest.
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Remain Calm – Witnessing the result of self-harm can be alarming. While the instinct to panic is entirely understandable, it is important to remain calm. This will let you provide constructive support to the young person and limit further distress.
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Assess the risk – While self-harm is not typically linked to suicidal intent, we suggest that you assess the risk for suicide by identifying if the young person has a plan in place to kill themselves which they intend to act upon. If they seem to be an active suicide risk, do not leave them unattended. If you suspect that they have taken an overdose please call 999.
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Refer to a mental health professional – You cannot do everything! If the needs of the young person are more complex than you can manage, contact a mental health professional. We are here to help! At Innovating Minds we work within schools supporting the emotional wellbeing of both students and teachers.
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Take care of yourself – In the process of supporting a young person who has self-harmed please ensure that you look after your own emotional wellbeing. This may mean seeking supervision to reflect on the experience, or perhaps handing the young person over to another member of staff/family member who is emotionally better equipped to handle the situation.
For accessible evidence-based information and advice regarding self-harm designed especially for young people, please check out the exciting new distrACT app which has contributions from Innovating Minds CEO Dr Asha Patel. Currently available on IOS and Android devices.
By Princess Rose, Assistant Psychologist, Innovating Minds
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Andrews, T., Martin, G., Hasking, P., & Page, A. (2013). Predictors of continuation and cessation of nonsuicidal self-injury. Journal of Adolescent Health, 53(1), 40-46.
Hawton K, Saunders K and O’Connor R (2012) Self-harm and suicide in adolescents. The Lancet, 379, 2373-82
Hawton, K., & James, A. (2005). ABC of adolescence: suicide and deliberate self harm in young people. BMJ: British Medical Journal, 330(7496), 891.
Madge, N., Hewitt, A., Hawton, K., Wilde, E. J. D., Corcoran, P., Fekete, S., … & Ystgaard, M. (2008). Deliberate self‐harm within an international community sample of young people: comparative findings from the Child & Adolescent Self‐harm in Europe (CASE) Study. Journal of child Psychology and Psychiatry, 49(6), 667-677.
Mental Health Foundation. (2016). The truth about self-harm for young people and their friends and families. Mental Health Foundation
Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self‐harm as an emotion regulation strategy: The protective role of trait emotional intelligence. British Journal of Clinical Psychology, 48(2), 181-193.
National Collaborating Centre for Mental Health (UK. (2012). Self-harm: longer-term management. British Psychological Society.
Van Ree JM, Niesink RJ, Van Wolfswinkel L, Ramsey NF, Kornet MM, et al. 2000. Endogenous opioids and reward. Eur. J. Pharmacol. 405, 89–101