If you self-harm, you know that it can be soothing at the time and could be an instinctive reaction to pain without necessarily understanding why it offers relief or why you practise it. And if your child, partner or friend self-harms, you might struggle to get your head around it. Nursing Manager at Netcare Akeso Milnerton, Denise van Niekerk, says it’s possible to find less harmful ways to overcome it.
TRIGGER WARNING.
Glamour: What is self-harm?
Denise van Niekerk: It’s when someone directly and intentionally inflicts harm or injury on their body to cope with distress and emotional pain. While it’s not attempted suicide, such activities could be deadly.
Glamour: What are some of the common causes?
DVN: Teenagers and young adults are most likely to self-injure, though it’s not restricted to these age groups. This often starts in pre-teen or early teenage years, when emotional changes happen fast, often and unexpectedly. During this time, teens also face increasing peer pressure, loneliness and conflicts with parents or other authority figures. Self-harm is a way of dealing with distress and emotional pain. The person may feel they have no other option and may not want to talk about issues that are causing them distress. These feelings build up, and self-harm is a way of releasing the burden. The pressures of life and feelings of being unable to cope may become unbearable, leading the individual to harm their body to express thoughts and feelings they can’t say out loud.
Complex contributing factors include:
• Difficulties at home, relationship problems or perceived lack of support from family.
• Low self-esteem, where a person may feel they deserve nothing better or want to punish themselves by hurting themselves.
• Bullying.
• Social isolation.
• Growing up and remaining in an unstable family environment.
• Questioning personal or sexual identity.
• Having friends who intentionally harm themselves increases your likelihood of self-injury.
• Being highly self-critical and struggling with problem-solving also increases risk.
Glamour: What psychological issues are associated with self-harm?
DVN: It’s commonly linked with certain mental health conditions, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder and eating disorders. Past experiences of neglect, sexual, physical or emotional abuse or other traumatic events may increase the risk of self-injury. Becoming upset can trigger a person’s urge to self-injure, and being under the influence of alcohol or recreational drugs may increase the risk.
Glamour: What are the misconceptions around self-harm?
DVN:
It’s attention seeking. That’s not the case. A person who self-harms often feels they can’t talk to anyone about what they’re going through. It’s very hard for them to find the courage to ask for help.
Only girls self-harm. Girls are more likely to self-harm, but boys also engage in these behaviours and dangerous activities (e.g. speeding while driving).
They enjoy doing it. There’s no evidence that people who self-harm feel pain differently than others – it often causes tremendous emotional and physical pain.
People who engage in it are suicidal. This is a common misconception, but it’s vital to understand self-harm isn’t a suicide attempt. The person doesn’t want to die; by self-harming, they’re trying to release the distress they’re experiencing, using it to cope with difficult feelings and circumstances.
Glamour: Is it treatable?
DVN: Yes, and with professional help, you can learn healthier, less harmful ways to cope.
Glamour: Are there better ways to cope with underlying issues?
DVN: Critical thinking skills can help you to become more aware of the influences around you, which may help to reduce their negative impact. Someone at risk of self-harm can learn to manage stress and cope with life’s problems better and adopt healthy coping skills during distressing times, build supportive social networks, as feeling lonely and disconnected may contribute to self-injury, and form healthy connections with people who don’t self-injure to improve relationships and communication skills. Risk management should be part of their care plan, including their current and long-term risk, factors that increase their risk of self-harming, and a crisis plan. Therapy can help identify their underlying reasons for self-harming. There are many different types of therapy, including cognitive behavioural, psychodynamic and problem-solving.
Glamour: Is there a connection between self-harm and suicide?
DVN: Not everyone who self-harms wants to end their life, and self-injury isn’t usually a suicide attempt, but it can increase the risk of suicide because of the emotional problems that trigger it. The pattern of damaging the body in times of distress can make suicide more likely. There’s evidence of a clear link between suicide or suicidal thoughts and people who’ve previously self-harmed, so it’s crucial to find the best support or treatment to help deal with the underlying causes less harmfully.
Glamour: How do you know if it’s a cry for help?
DVN: Self-harm’s often a cry for help, although this is commonly misunderstood as attention seeking. Most sufferers try to hide their behaviours from their families. Some describe this way of responding to or coping with severe emotional distress as their way of staying alive. A person may see it as a way to communicate internal feelings they can’t express in words, which is why people have described it as the voice of the skin, cutting out the silence and even as a sign of hope. People may see self-harming as an outlet to regulate their feelings or show others how they feel or to cope with trauma and memories of it. Many people self-injure only a few times and then stop, but for others it can become a long-term, repeated behaviour. While self-injury may bring a brief sense of calm and a release of physical and emotional tension, it’s usually followed by feelings of guilt and shame, and the return of painful emotions.
Glamour: What are warning signs to look out for, since some people hide it?
DVN:
• Changes in sleeping or eating patterns.
• Loss of interest in activities they usually enjoy.
• Avoiding activities where their legs, arms or torso are exposed.
• Wearing clothes that cover up their arms and legs, even in summer.
• Hiding objects such as razor blades, knives, lighters and matches, or keeping sharp objects or other items to injure their hands.
• Risk-taking behaviours, such as recklessness with an intention to self-harm.
• Frequently missing school and allowing their grades to drop.
• Isolating themselves from others.
• Using drugs and alcohol.
• Aggressive behaviour.
• Extreme non-compliance.
• No longer caring about their appearance.
• Significant mood changes: they may be easily agitated or explode for seemingly no reason.
• Behaviours and emotions that change quickly and are impulsive, intense and unexpected.
• Showing signs of feeling sad, empty, hopeless, guilty or worthless.
• Expressing helplessness, hopelessness or worthlessness.
• Talking about death.
• Unexplained injuries or frequent reports of accidental injury.
• Scars that often appear in patterns.
• Fresh cuts, scratches, bruises, bite marks or other wounds.
• Excessive rubbing or scratching of an area to create a lesion.
• Difficulties in relationships with others.
• They may seem slow, tired or have very little energy.
Glamour: How can you support a loved one who engages in self-harm?
DVN: If a friend or family member is self-injuring, you may be shocked and scared, but that doesn’t mean you should ignore the situation. Take all talk or signs of self-injury seriously. It’s too big a problem to ignore or to cope with alone. Start by talking to your healthcare provider, who can perform an initial evaluation or refer your loved one to a mental health professional. Express your concern, but don’t yell at them, and avoid making threats or accusations. Encourage a child or teenager who’s self-harming to talk to their parents, a teacher, a school counsellor or another trusted adult. Adults should gently express their concerns and encourage them to seek treatment.
Glamour: Please list self-injurious behaviours that count as self-harm.
DVN:
• Cutting, scratching or stabbing with a sharp object on any body part is one of the most common methods.
• Burning with lit matches, cigarettes or heated, sharp objects such as knives.
• Carving words or symbols on the skin.
• Hitting, punching or biting yourself, walls or other hard surfaces.
• Breaking bones or bruising yourself with objects or dangerous activities.
• Pulling out hair.
• Inserting objects under the skin.
The arms, legs, chest and belly are a self-harmer’s likeliest targets, but they may harm any body part, sometimes using more than one method.
Glamour: What’s the best way to create awareness around self-harm?
DVN: Teach people about the warning signs, types of self-harm and contributing factors, encourage friends or peers to seek help and avoid secrecy around the topic, and be aware of the dangers of social media or media, including music that promotes self-harming behaviours, as these visible examples of self-injury may nudge children and young adults with mental or emotional issues to experiment.
Glamour: How can we address the stigma?
DVN: Public stigma typically arises from believing an individual is responsible for causing their condition. We can help to address this and create awareness by teaching people to understand the warning signs, types of self-harm and contributing factors.
Glamour: Is there a support network available?
DVN:
• Family aided by a doctor or mental health professional.
• Counselling via the South African Depression
and Anxiety Group (SADAG, 0800 567 567).
•The Netcare Akeso Crisis Line (0861 435 787).
• Tell someone. Talking to someone is the first step out of the cycle and shows strength and courage. Talk to family, friends, a teacher or a youth worker. And discuss your problems with a healthcare professional.
Glamour: Anything else we should be aware of?
DVN:
Self-injury can cause complications, such as:
• Worsening feelings of shame, guilt and low self-esteem.
• Infection, either from wounds or from sharing tools.
• Permanent scars or other permanent harm to the body.
• Worsening of underlying issues and conditions if not properly treated.
• Severe injury that could lead to death.
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