Understanding self-harm

Self-harm describes a range of different behaviours that cause personal harm, whether done to oneself deliberately or not. They can include self-abusive behaviours such as neglect, substance abuse or failing to take care of oneself (either emotionally or physically) and this would include eating disorders (although it can be helpful to consider eating disorder management separately). But probably the main image that comes to mind when hearing the term ‘self-harm’ is where an individual inflicts wounds on themselves, either through burning or cutting. This is a particularly prevalent form of self-harm in the school environment and amongst teenagers, although continues into adulthood for many individuals. 

Self-harm is becoming worryingly prevalent. Recent data from the Samaritans estimate that 24,000 teenagers in the UK are admitted to hospital because of self-harm, with other research estimating the prevalence as being up to one in ten teenagers. It is equally common amongst both boys and girls.

The idea of self-mutilation is difficult for many people to understand and is often thought of as attention seeking. However, most people who self-harm go to great lengths to keep it hidden and secret and thus it is usually not about attention. Instead, it may be more helpful to think of self-harm as an ‘inner scream’ expressing the emotional pain being experienced by an individual in a way that externalises it so it is visible rather than keeping it internal where it can’t be seen and is harder to acknowledge.  Individuals often feel better when they see a real wound, this makes more sense to them than the internal anguish that they feel. Those who inflict this type of harm on themselves often describe feeling a ‘release’ through being able to experience physical pain that, although often temporary, provides a respite from the continuum of internalised emotional pain. 

It can be very difficult to understand or know how to respond to self-harm. If we think of self-harm as a way of an individual dealing with and surviving their pain then it can take on a somewhat different dimension. The earlier we can address the psychological pain that an individual is trying to express, the less likely they are to get caught in an escalating cycle of internalising and then externalising their anguish. 

Self-harm indicates internalised psychological distress that is often associated with loss, trauma, abuse and neglect. Obviously there are different degrees of distress and a one-off incident of self-harm does not always signify a severe internalised trauma. But it is still, nonetheless, is an important warning sign that something is wrong for that individual. Whilst the ultimate form of self-harm is suicide, self-mutilation is very different from suicide as it is an attempt to stay alive and survive rather than to die. It is a way of trying to feel power and control when the individual otherwise feels powerless and hopeless. It is the powerless and hopelessness with their situation that the self-harming individual cannot bear.

The earlier individuals can access counselling support the less likely the problem is to escalate. We know that there is a stigma around self-harm and this secrecy can compound and exacerbate the problem, creating a shroud of shame around the individual and their harming behaviour. There is also a difficulty for many individuals in taking self-harm seriously - it can seem pointless and attention seeking. But if we think of self-harm as an individual’s solution to their problem then the more we can be helping individuals to address and work through the ‘problem’, the less likely the self-harm is to be a requirement. The goal of counselling would be to help that individual find a healthier way of acknowledging and expressing their pain and distress.