The Psychology of Self-Harm

Adolescence, that complex time of sorting out what it means to be an adult when you’re still a kid, can feel like a long string of missteps with, perhaps, a few intermittent successes. This is often when we first learn to be hard on ourselves. We are tasked with determining who we want to be when we grow up at the time in our lives when it is most difficult to stand out in any way. Most of us manage to get through it, despite the challenges. However, for kids (and even some adults) who lack healthy coping skills, self-harm can be a way to deal with challenging emotional situations.

What is self-harm?

An estimated two million people in the U.S., of all races and backgrounds, intentionally injure themselves – the majority being teenage girls. (mentalhealthamerica.net, n.d.) This behavior, known as self-harm or self-injury, is confusing and distressing for the family and friends of those who do it.

Most people are aware of cutting – making small cuts on the arms or legs with a knife – but there are other self-harm behaviors, such as:

• severely scratching the skin
• burning or scalding
• hitting or punching
• throwing oneself against walls or other objects
• sticking objects into the skin
• swallowing objects or poisonous substances
• intentionally preventing wounds from healing

(Smith, Segal, & Shubin, 2016) 

This behavior is easily misunderstood. Much of the confusion comes from the paradox that people engage in self-harm in order to feel better. Self-harm is a way to relieve deep emotional pain and anxiety, and to cope with intense feelings such as sadness, self-loathing, emptiness, guilt and rage. (Smith, Segal, & Shubin, 2016) For those who learned as young children to hide their emotions, self-harm can be a form of release, or a way to escape the numbness of those buried feelings. (NAMI, n.d.) The relief that comes from self-harm, however, is only temporary, and can quickly be replaced with shame and guilt over the behavior itself, compounding the problem.

What self-harm is not

Self-harming behavior should be taken seriously, but some misconceptions can get in the way of seeking help for yourself or helping someone else.

Self-harm is not a suicide attempt. Most people who self-harm do not want to die. On the contrary, they want to live, and are looking for a way to deal with their emotional pain so they can function in everyday life.

Self-harm is not an attempt to get attention. People who self-harm tend to do it in secret. They feel shame around this behavior and their inability to stop it, and that keeps them from asking for help. (Smith, Segal, & Shubin, 2016)

Self-harm itself is not a mental illness, and most who engage in self-harm do not suffer from depression. (Hartwell-Walker, 2015) It may, however, be associated with borderline personality disorder, anxiety disorder or PTSD. (Mayo Clinic Staff, 2015)

What are motivations and causes for self-harm?

Self-harm originates in anxiety or trauma in most cases. It is primarily a way to cope with psychological pain, in the absence of healthy coping skills. People who self-injure typically have a hard time expressing or processing emotions.

People self-harm in order to:

• manage and gain relief from severe anxiety
• provide a distraction from painful emotions by causing physical pain
• feel a sense of control
• feel something, rather than feeling nothing at all
• express feelings
• punish themselves for their perceived faults 

(Mayo Clinic Staff, 2015)

How to help someone who is self-harming

If you know someone who is self-harming, you can help by first acknowledging your own feelings. It’s not uncommon to feel shocked, confused or even disgusted by this behavior, but don’t let those feelings prevent you from helping. One way to get past your own perceptions is to learn more about this behavior to understand it from your loved one’s perspective. Express your concern and offer support without ultimatums or judgment. Encourage communication. (Smith, Segal, & Shubin, 2016)

Two therapies that have been used successfully to treat people who self-harm are Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy.

DBT focuses on behavioral skills including mindfulness (being fully present in the moment), distress tolerance, interpersonal effectiveness (how to respectfully ask for what you want and say no when appropriate), and emotion regulation (how to change emotions that you want to change). These skills can be taught concurrently in a group setting and individually. (The Linehan Institute, n.d.)

EMDR is useful for people who self-harm as a result of trauma. EMDR is a way to process a past negative experience by allowing the person to take what is useful from it and store that appropriately in the brain along with the appropriate emotions. The person then gains the emotions, understanding and perspective that lead to healthy behaviors and interactions. (EMDRIA, n.d.)

Both of these techniques are employed by therapists at Maria Droste. If you are seeking support for yourself or someone you care about who self-harms, or would like more information, contact us at 303-756-9052 or Intake@Mariadroste.org.

Sources:
Mental Health America (n.d.) Self-Injury. mentalhealthamerica.net. Retrieved on March 29, 2016, from https://www.mentalhealthamerica.net/self-injury

Smith, M.; Segal, J., Shubin, J. (2016) Cutting and Self-Harm – Self-Injury, Help, Support, and Treatment. Helpguide.org. Retrieved on March 29, 2016, from https://www.helpguide.org/articles/anxiety/cutting-and-self-harm.htm

NAMI (n.d.) Self-Harm. National Alliance on Mental Illness. Retrieved on March 29, 2016, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Self-harm

Hartwell-Walker, M. (2015). Teens Who Self-Harm. Psych Central. Retrieved on March 29, 2016, from https://psychcentral.com/lib/teens-who-self-harm/

Mayo Clinic Staff (2015) Self Injury/Cutting. Mayo Clinic. Retrieved on March 29, 2016, from https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/dxc-20165427

The Linehan Institute/Behavioral Tech (n.d.) What is DBT? Retrieved on March 29, 2016, from: https://behavioraltech.org/resources/whatisdbt.cfm

EMDRIA (n.d.) What is the actual EMDR session like? EMDR International Association. Retrieved on March 29, 2016, from https://behavioraltech.org/resources/whatisdbt.cfm