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Self Harm; Pain from the Inside out

Canadian Health Network. Public Health Agency of Canada

Youth and self injury; Information about self-abuse
Caution: This article contains sensitive information about self-harm behaviours which may be emotionally uncomfortable for some readers.

Self-harm is a broad term that refers to deliberate, self-damaging behaviour. It is sometimes called self-injury, self-mutilation, or self-abuse. It is deliberate, often repetitive actions to cause damage to skin, bones or other body parts.

Self-harm can take a number of forms that include:

  • cutting or burning the skin
  • scratching until the skin breaks
  • interfering with wound healing
  • breaking bones through repeated hitting
  • hitting oneself resulting in bruising
  • consuming poisons.

"I used to only self-harm when I was mad or upset. It gave me somewhere to release my anger, but now I find myself doing it everyday with anything I can find... the feeling is indescribable. I feel so in control... it's something that no one else has a say in. I try and hide it, because I'm ashamed of it... Long sleeve shirts have become my best friends."

Note: The quotes throughout this article are postings on the Kids Help Phone web site, and each includes a response from a counsellor.

Difficult to measure

Self-harm is a very private behaviour and people who deliberately injure themselves are often very good at keeping it a secret, even from those closest to them. They often harm parts of their body that are not seen by others or that can be easily covered.

Because most injuries are not seen by a doctor or nurse, it is very difficult to get a sense of how common self-harm is in Canada. The current estimation is less than 1% of the population.

There is no typical or common profile of a person who self-harms. People from all races, education levels, and socio-economic status self-harm. However, self-harm does seem to be more common among women. It's also more of a concern for youth because it usually begins in early to middle adolescence (around age 14) and seems to peak between ages 16 and 25. Self-harm behaviour can last for years, even well into adulthood.

Why people harm themselves

For those who don't self-harm, it can be difficult to understand why people would want to intentionally injure themselves. Self-harm is a coping mechanism (albeit an unhealthy one); a way of dealing with overwhelming emotions, intense disassociation, invalidation and feelings of isolation.

For those who do it, self-harm is a way of releasing the pain they feel emotionally, often creating a physical sensation of the pain felt inside. Sometimes people harm themselves to create the feeling of something, in contrast to the numbness they feel inside.

People who engage in self-harm behaviour may have experienced problems during childhood, which could include sexual or physical abuse. They may have grown up in a family where it was difficult to express emotions freely, especially sadness and anger. Those who self-harm may also have an eating disorder or depression and may abuse drugs or alcohol.

"About 2-3 months ago, I tried self-harming because I suffer from depression, and well after I self-harmed for the first time, I felt better like I wasn't afraid... and it felt good to... feel. So I self-harm more and now whenever I get really scared of something (usually school or parents) I self-harm... "

It's not a suicide attempt

The intention of self-harm is not a suicide attempt. Rather, people self-harm to carry on, to get relief or to feel something in the face of overwhelming emotions or intense disassociation. Where a suicide attempt is to end life, self-harm is an attempt to feel relief. That's not to say people who self-harm are not at risk of suicide.

Individuals who self-harm often report experiencing a feeling of calm and relief after a session. But this relief is only temporary and once the person experiences another trigger (a stressful situation, event, or even memory that leads to self-harm), they are at risk of repeating the cycle.

Because self-harm is effective at offering temporary relief, some people report being addicted to it. There is also the risk that damage from self-harm may escalate, as people get used to the sensations, they may need to do more damage to feel relief.

"Basically I hate myself so much that I [self harm]... it's like a drug that I need to relax me and that I need to live... it's hardwired into my brain... I [self harm] because it's the only way I know how to release the pain that I have inside... I hate that I can let people get to me so easily... I don't let my feelings show so basically I keep them inside until I can't handle them anymore... "

Self-harm is hard for others to understand

The reaction of others can sometimes make things worse. Some people who harm themselves report that others may react with disgust, confusion and avoidance. Fearing this kind of reaction, those who self-harm may refrain from seeking medical attention for their injuries to avoid judgmental reactions from medical staff.

"...I began (self-harming) when I was 12 years old, now I'm 16. I can't stop. I told my mom last year that I needed help, but she just ignored it and never talked about it again. It's not an easy subject to bring up, but I need help. It gets worse as the years go by. I made a doctor's appointment to tell her what I've been feeling lately but when I went I was too scared and embarrassed to say anything. I don't know how to start, where to start, what to say. "

Underlying causes are key to healing

Often the first step, and the hardest, for individuals who self-harm is to ask for help.

Because self-harm is a coping mechanism, the underlying causes should be identified before the self-harm behaviour can be successfully addressed. Focusing on the self-harm behaviour alone will not help the individual learn to cope with the underlying issues.

Successful treatment helps people learn new ways to express and articulate their emotions and needs, increase their tolerance for intense emotions, and recognize their triggers so that they can minimize, avoid or diffuse them.

A good therapist can help address underlying issues as well as offer alternatives to self-harm behaviour like developing distractions, squeezing ice-cubes or painting and drawing.

What to do if you suspect someone is involved in self-harm

If you suspect a friend, girlfriend or boyfriend, son or daughter, or co-worker is involved in self-harm, first educate yourself so you can understand the reasons why that person does it. The key is to approach this person with compassion, rather than criticism and judgement.

With understanding, the behaviour may seem less shocking and you will be better prepared to hear what the person has to say. There are great support websites where you can read about first-hand experiences around self-harm behaviour.

Positive steps to help:

  • Try to learn about self-harm before talking to the person.
  • Be non-judgmental.
  • Offer support and validation of his/her feelings.
  • Allow the person to express what he/she is comfortable talking about.
  • Avoid probing questions if the person doesn't offer details.
  • Recognize the control the person has over his/her body, mind and life.
  • Offer to help the person find professional mental health support.
Although self-harm is an extreme method of coping, it is just that, a means of getting through stressful times. For many individuals, it seems to run a course of five to ten years. With help, many youth will outgrow their self-harming behaviour as they mature and learn better coping skills.

Learn more about self-harm

The following sites are good places to visit for more information about self-harm behaviour:

Youth and Self Injury
A new web section on self-harm among youth, recently launched by the Canadian Mental Health Association.

Centre for Suicide Prevention: A Closer Look at Self-Harm
An excellent fact sheet explaining the reasons, circumstances, and treatment for self-harm behaviour within a Canadian context.

SAFE in Canada
SAFE (self-abuse finally ends) is a support organization that works directly with individuals who engage in self-harm and indirectly by educating the friends, families, and professionals who care for them.

Kids Help Phone (1-800-668-6868)A support web site that offers free, anonymous counseling services by trained counselors to Canadian children and youth. It also offers information about self-harm, other mental health issues and resources to find help in any part of Canada.

Date published: April 1, 2006

This feature was prepared by the McCreary Centre Society, a member of the CHN Youth Affiliate Consortium, with assistance of the CHN Mental Health Affiliate.
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