Trigger warning: This article discusses self-harm and related mental health challenges. If you or someone you know needs help, please contact SADAG at 0800 21 22 23 or Lifeline on 0861 322 322.
Self-harm is not a mental illness; it is often about seeking relief from emotional distress. Therefore, coping through pain rather than escaping it.
Self-harm is also referred to as non-suicidal self-injury (NSSI). In clinical contexts, it may be diagnosed as non-suicidal self-injury disorder (NSSID). Often, it’s simply called self-injury.
This means that hurting oneself is usually a symptom of deeper underlying issues. Consequently, self-harm often occurs alongside mental health illnesses. Self-harm is a serious condition and therefore should not be ignored. Instead, we need to offer understanding and support to someone who is using self-harm as a coping mechanism.
What is Self-harm?
Self-harm is also known as non-suicidal self-injury disorder. Often, it’s just called self-injury. Self-harm is the act of purposely injuring one’s body. It could be rooted in an attempt to cope with emotional pain, for example sadness, anger and stress. Self-harm is not a mental illness; it is a symptom which means it often occurs as a result of an underlying issue. It could mean that injuring oneself has a link to emotional turmoil and is therefore a way of coping with an intense or overwhelming emotion. Or it might be a symptom of a mental illness.
“Self-harm is the deliberate injury to oneself.”
Self-harm often involves:
- Deliberately injuring one’s body (e.g. cutting, burning or hitting)
- Attempting to manage emotional pain such as sadness, anger or stress
- Using one or multiple methods of injury
Notable is that self-harm is often mistaken for suicidal behaviour, but they are distinct. Suicide aims to end life, while self-harm seeks relief from emotional distress. Self-harm is used to cope with pain rather than escape from it. However, despite suicide not being the intention, self-harm does increase suicide risk, and it can lead to unintentional death.
5 Common Types of Self-harm
- Cutting in patterns or carving symbols into skin.
- Fresh bruises, scratches and bite marks.
- Head banging and/or self-hitting.
- Burns using, for example, cigarettes, lighters, matches or other heated objects.
- Deep piercing or inserting objects under the skin.
6 Symptoms of Self-harm
- Unexplained injuries, especially cuts on the forearm, upper arm or legs.
- Keeping objects on hand that can be used for self-harm.
- Excessive rubbing of areas (to create burns).
- Wearing long-sleeves or pants to cover body when the weather is hot.
- Frequent bloodstains on bedding, towels and/or clothing
How Common is Self-injury?
Self-injury is complicated because there are many unknown factors associated with it. Research indicates that this behaviour is rising. It’s been noted that it has become a major global public health concern. A recent study found that South Africa faces a significant burden of self-harm. Those at particular risk are adolescents and young adults aged 15-24 years.
While research shows that self-harm is more prevalent amongst females than males, it does affect people across all ages, genders and demographics. It’s estimated that about 17% of people will self-harm over the course of their life and that self-harm is more common in younger age groups than in adults.
A systematic review and meta-analysis published in the Lancet Physiatry Journal found that world-wide there is a concerningly high number of children, aged 6-12 years, who engage in self-harming behaviour. Studies also report that, over the last ten years, the prevalence of self-injurious behaviour in adolescences has increased. Further findings report that over one-third of college students with major depression had a history of non-suicidal self-injury. It’s also been noted that minority populations, for example those within the LGBTQ+ communities, have a higher rate of self-harm than cisgender and heterogender peers. Vulnerable populations, such as those who experience intermate personal violence, gender-based violence (GBV), live in refugee settings and prison populations, have also been reported to have a higher risk of self-harm.
It’s unknown if self-harm is a sudden epidemic or has been gradually increasing. Adolescents who practice self-harm are reported to be at a higher risk of mental, health and social issues later in life. Self-harm is also regarded as one of the strongest clinical predictors of death by suicide.
Why Do People Self-harm?
Research indicates that mental health problems are one of the core-drivers of self-harm. Examples of other factors associated with self-injury include physical and mental health issues, interpersonal conflict, and intergenerational trauma. Self-harm can also have a link to social challenges such as high prevalence of crime, changes in traditional life, rapid modernisation and loss of cultural identity. A common reason for adolescent self-harm, particularly among adolescent females, is feeling misunderstood and a lack of access to help.
5 Underlying Causes of Self-harm
1. Self-harm as a Coping Mechanism
Self-harm is commonly used to regulate or manage emotions. Self-injuring often starts in adolescence, especially in repressive homes where negative emotions are ignored. Many who self-harm learned early on that their feelings were “bad” or “wrong.” They may lack role models for healthy emotional expression. Physical pain from self-harm temporarily numbs emotional pain. Alternatively, someone who uses self-injury to help cope might physically harm themselves to feel something as they’re experiencing emotional numbness. They might also be using it as a way to punish themselves out of self-hatred, perceived failure and/or guilt.
2. Self-harm and Mental Health Challenges
Hurting oneself is a symptom, not a mental illness. It can, for example, accompany bipolar disorder, borderline personality disorder, schizophrenia, eating disorders, OCD, or PTSD. Therefore, psychologist’s play an important part in intervention and treatment. Therapy can help and individual recognise triggers and develop healthier coping strategies. Relaxation techniques, coping mechanisms, and medication can reduce anxiety and impulsive responses.
3. Using Self-harm to Communicate
Self-harm is usually a coping mechanism, a result of feeling overwhelmed and/or expressing pain. It can therefore be a way in which someone is indicating they need help. Essentially a physical manifestation of a cry for help.
4. Sensation-Seeking Self-harm
For some people injury gives them an energy rush. This creates feelings of “being alive” and exhilaration. Self-harm can also releases endorphins which are natural painkillers that create relaxed feelings. The short-term relief experienced through self-harm by some people can reinforce repetitive self-harm behaviours.
5. Creating Connections via Self-harm
It’s not a common reason but for some self-harm is a way of identifying and being part of a group. This type of self-harm is particularly challenging because it may become normalised and even encouraged.
The Link between Substance Use and Self-harm
There are numerous reasons why people use substances. For example, substance use can be a way of escaping stress, numbing emotional pain, self-medicating a mental illness or coping with physical pain. Alternately they might be trying to fit in or to induce feelings of pleasure. Some people use substances recreationally, while others develop dependence over time. The result of someone under the influence of, for example, alcohol or an illegal drug, might be an escalation in personal risk taking and/or heightened emotional instability. And therefore, self-injury risk can be compounded by substance use; however, abusing alcohol or drugs is generally not regarded as an act of self-harm.
How to Help Someone who Self-harms
As the underlying reasons of self-harm are often complicated and can be linked to mental illness, seeking professional help is advisable. Treatment is often long term and recovering from using self-harm as a coping mechanism can be a long and demanding process.
Recovery often involves:
- Identifying emotional triggers and learning better coping mechanisms
- Building problem-solving and emotional-regulation strategies
- Strengthening self-esteem and relationships
- Continuous support from loved ones and professionals
Do you have an interest in finding out more about human behaviour and the way the mind works? Do you have a desire to enter the caring profession? If so, why not consider studying counselling at SACAP (The South African College of Applied Psychology)? SACAP offers a range of vocational, academic and professional counselling courses aimed at everyone from qualifying graduates to mature students. For more information, enquire now.
Deepen your understanding of non-suicidal self-harm and learn how to respond with confidence and care. Register for the Understanding Non-Suicidal Self-Harm online workshop at SACAP Global and equip yourself with practical, evidence-based tools for assessment and intervention.
FAQ:
1. What is Self-harm?
Self-harm is non-suicidal, deliberate injury to oneself.
2. What are the symptoms of self-harm?
Examples of symptoms of self-harm include unexplained injuries, covering up injuries with long clothing, blood-stains on clothes, towels or bedding and keeping sharp objects that could be used to self-harm on hand.
3. What are examples of types of self-harm?
Self-harming behaviour includes purposeful cutting, bruising and scratching, biting and burning,
4. Why do people self-harm?
There are numerous underlying reasons for self-harm. The most common reason that they purposefully injure themselves is to relieve emotional stress. Therefore, self-harm is often a way of coping through pain.
