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  • Writer's pictureJohnson Behavioral Health Group

Truths Concerning Self-Harm: Self-Harm Awareness Month


What is Self-Harm?

People think sometimes it’s just cutting ourselves, but that’s not the case. Self-harm is deliberately harming your body to cope with emotional pain, and it brings a momentary sense of pain relief, whether it be on a release of tension and whether it be cutting yourself, which is the most common way of self-harming.


It is a part of mental health, as a part of depression, and not everybody experiences self-harm. It’s definitely a part of what happens in our adolescent population, but it occurs amongst all populations. However, the biggest thing is that it happens in our adolescent population, and most people don’t know how to handle it. But it’s definitely increasing, especially due to the exposure to the internet in today’s digital landscape.


Signs of Self-harm

Cutting on your arms, torso, legs, your inner thighs. Those are the most common areas to cut, but cutting is not the only way to self-harm or self-injury. Burning—people get cigarette lighters and touch them to their skin. Burning and scratching happen a lot with younger children. Clawing their skin and banging their heads happen a lot with children. I’m not saying this cannot happen with our teenage population or adults. This can happen to anyone.



In my experience and within psychiatry, here’s something that I had to kind of understand. We see excessive tattoos and piercings, and that can be a form of self-harm, too. I’m not saying those who have excessive tattoos and piercings are harming themselves, but sometimes people will get tattoos because they’re upset, and the physical pain will calm them down. That is a form of self-harm. Also, pulling hair out of your head can be a form of self-harm. So you get what I mean when I say there are multiple ways to self-harm other than just cutting oneself.


Fresh cuts

Are they hiding their arms? Are they hiding their legs? If you notice a pattern of fresh cuts, especially small, superficial ones, it may indicate self-harm. While a single fresh cut could be a sign, a consistent pattern of cuts that reopen wounds suggests a deeper issue. If you observe them excessively rubbing their skin in one area, it could be a sign of self-harm.


Accidental injuries

The other thing that’s kind of a taboo thing and people don’t even realize is accidental injuries. For instance, somebody who’s always accidentally falling or accidentally has bruises all over them. It can go to the extreme of jumping off of high, increased height levels and causing themselves to hurt their leg or dropping weights on their leg repetitively to the point where they break a bone. I typically see that more in adulthood versus adolescent teenage years, but just progress to that point.


Withdrawal

You’re seeing someone or your child withdraw. Their grades are failing. They’re more irritable. They don’t want to be around family. What is going on? Something is going on that’s causing this, right? These behaviors could indicate various underlying issues, including self-harm, depression, or hormonal changes. It’s crucial not to ignore these signs. If you notice symptoms, consider seeking an evaluation for your child OR recommending it for a friend, family member, or adult in need. Early intervention and support can make a significant difference in addressing these issues.



What if someone is hiding the cut?

So, if you are not able to see the physical signs of self-harm, would there be other signs to look for?


  • Increased time alone: Keep an eye out for increased time spent alone, particularly in the bathroom or bedroom, as individuals may try to conceal their self-harm activities.

  • Long clothing: You may also notice that they wear clothing that covers their skin, even in warm weather, such as long sleeves or pants, as they may be trying to hide any marks or scars.

  • Open communication: It’s important for parents to remain vigilant and to have open and honest conversations with their children about any concerns they may have.



What Causes Self-Harm?


Anxiety

As I mentioned, depression, particularly anxiety. One in three adolescents experiences anxiety. So, we’re essentially contending with a lot of pressure from high expectations in certain groups and, conversely, low expectations in others, which can lead to anxiety. We’re dealing with both anxiety and depression among adolescents.


Bullying

Research shows that 80% of children diagnosed with anxiety receive no treatment, be it counseling or medication. This lack of support can contribute to bullying, which has become even more prevalent with the rise of social media. The comparison game on these platforms exacerbates feelings of inadequacy and can lead to cyberbullying. Unlike in the past, where schoolyard conflicts stayed at school, today’s children face constant digital harassment that follows them home, perpetuating a harmful cycle.


What can you do in that cycle to help? Firstly, it’s crucial to limit screen time. Regardless of your child’s age, excessive screen exposure isn’t necessary. Social media platforms, in particular, should be introduced at an appropriate age, as younger children may struggle to manage their time effectively.



Abuse and Trauma

Abuse can stem from various sources and manifest in different forms. It’s a pervasive issue that often goes unnoticed or unaddressed. For many individuals, self-harm becomes a coping mechanism—a way to exert control over their internal struggles when they feel powerless over external circumstances or past traumas. By engaging in self-harming behaviors, they may attempt to manage overwhelming emotions, such as anxiety or depression, associated with their traumatic experiences.


Depression

Unfortunately, depression and suicide are significant concerns in young adults, with suicide being the second leading cause of death among individuals aged 15 to 24. This underscores the importance of addressing depression early on, as left untreated, it can exacerbate over time.


How to Manage Self-Harm Urges?

Remember, if you take something negative away, you have to replace it with something positive. You have to; if you don’t, you’re just going to fall back into that same behavior pattern. It’s scientifically proven.



You can fill that void with God. You can fill that void with positive ways to cope, which can definitely include writing in a journal, exercising, yoga, meditation, and talking to somebody. By identifying the triggers and emotions associated with self-harm, you can begin to address these underlying issues and replace harmful behaviors with healthier coping mechanisms.


So, how can we support someone struggling with self-harm? Therapy. If you notice signs of self-harm or see someone spiraling, it’s crucial to take action. For minors, involving their parents is essential. Ignoring the issue isn’t an option, as self-harm often escalates over time. The cuts may become more severe, leaving lasting scars. In some cases, self-harm can unintentionally lead to a suicide attempt. Early intervention and professional support are critical to prevent further harm and provide effective coping strategies.


Self-Harm is Not a Suicide Attempt

So, the biggest thing is that self-harming is not a suicide attempt. Self-harming can progress to the point where the severity of the cutting can progress to accidental suicide, cutting too deep, close to an artery, that kind of thing. But typical cutting does not mean that the patient or the person is trying to kill themselves.



I think that the biggest misconception about self-harm or self-injury is that a lot of times, when people think they’re self-harming, they need to get evaluated for suicide, which obviously needs to be rolled out. Was it a suicide attempt?


Most of the time, it’s self-harm and is not a suicide attempt. It’s pretty much a negative way to cope with emotions. You have to have an understanding of why you’re doing what you’re doing. So, you can get a sense of relief and replace that with positive coping.



Self-Harm May Bring a Sense of Guilt and Shame

Oftentimes, self-harm is accompanied by feelings of guilt and shame, leading individuals to hide their actions and avoid seeking help, and it just spirals. Understanding why someone engages in self-harming behaviors is crucial. The biggest thing is how you can identify why somebody is cutting, or if you have suspicions of somebody cutting, how can you figure it out? 


Obviously, you can talk to the person, but nine times out of ten, if somebody is hiding something, they’re not going to tell you. This is especially true if you notice concerning behavior in a child, such as spending excessive time in the bathroom or wearing long clothing despite warm weather—these could be significant warning signs.



What Happens in the Brain During Self-Harm?

When someone self-harms, their brain undergoes certain chemical changes. Typically, individuals who self-harm often have lower serotonin levels in the brain, which can be associated with conditions like depression, anxiety, or a history of abuse. 


During the act of self-harm, the body releases endorphins, which are natural pain-relieving chemicals. This can create a temporary sense of relief or even euphoria. However, this feeling is short-lived, and soon after, the individual may return to their previous emotional state. 


In essence, self-harm can be seen as a maladaptive coping mechanism, similar to substance abuse or alcohol misuse, where individuals use harmful behaviors to numb emotional pain or distress. It’s important to address the underlying issues causing the distress and provide healthier coping strategies to help individuals manage their emotions effectively. And again, that’s self coping. It’s all a negative way of coping.



What Do They Want to Express?

What might the patient be trying to convey through self-harm? It could be a way to fill an emotional void or numbness they feel inside. For some, inflicting pain serves as a means to externalize internal emotions. I’ve encountered individuals who carve words representing their pain, trauma, or deception as a form of expression. It’s a way for them to communicate their inner turmoil to the outside world.


Some individuals believe they deserve punishment or shouldn’t experience certain emotions, often stemming from challenging childhood experiences. This complex interplay between internal struggles and external expressions underscores the need for compassionate support and understanding.


Traumatic events and an unstable environment can often lead to feelings of unworthiness or guilt, which may manifest in self-harming behaviors like cutting. Understanding the underlying reasons behind these behaviors is crucial for effective intervention and support.



Self-Harm and Suicide

Self-harm is a serious concern, often linked to thoughts of suicide, so it’s crucial not to ignore any symptoms your child or someone you know may display. Self-harm can serve various purposes, such as managing anxiety, providing relief from painful emotions, or asserting control over one’s body and emotions. It’s not just about cutting; there’s deep reasoning and rationalization behind it.


Suicide is an act of intentionally ending one’s own life. While there can be overlap between self-harm and suicidal behavior, not everyone who self-harms intends to die by suicide. However, self-harm can increase the risk of suicide, especially if the underlying emotional issues are not addressed.



Self-Harm and Borderline Personality Disorder

It’s important to recognize that self-harm can also be associated with certain personality disorders, such as borderline personality disorder (BPD).


Individuals with BPD may engage in self-harm as a way to manipulate or control their environment or relationships. For example, they may use self-harm as a means to communicate distress or to prevent abandonment.


“Hey, look, I cut. You see these cuts on my arm, that’s because you hurt me... You’re trying to break up with me. If you leave me, I’m gonna cut myself... You see this, I cut myself because of what you did.”

That is borderline personality behavior. A lot of borderline personality disorders cut themselves as a form of manipulation, whether it be a spouse, a parent, or whatever, but that definitely is related.


Research has shown that Dialectical Behavior Therapy (DBT) is highly effective in treating borderline personality disorder. DBT helps individuals understand the underlying reasons behind their thoughts, emotions, and behaviors, offering valuable insights into their actions. By exploring the root causes and triggers, individuals can develop healthier coping mechanisms and learn effective strategies for managing distress. This therapeutic approach has proven to be immensely beneficial for individuals struggling with self-harm behaviors, offering hope and support on their journey toward healing and recovery.



Self-Harm and ADHD

Self-harm and Attention Deficit Hyperactivity Disorder, or ADHD, are two distinct conditions, but they can coexist in some individuals. However, having ADHD does not directly cause self-harm, nor does self-harm directly result from ADHD.


Individuals with ADHD may experience challenges with impulse control, emotional regulation, and managing frustration, which can contribute to difficulties coping with stressors. These difficulties could potentially increase the risk of engaging in self-harming behaviors as a maladaptive coping mechanism.



It’s important to note that self-harm is a complex issue influenced by various factors, including underlying mental health conditions, traumatic experiences, environmental stressors, and individual coping mechanisms. If someone with ADHD exhibits self-harming behaviors, it’s crucial to address both conditions comprehensively through professional evaluation, therapy, and appropriate interventions tailored to their specific needs.


Most importantly, we need to approach self-harm behavior with empathy and understanding, while also addressing any underlying mental health conditions through therapy and appropriate interventions. By providing them with the support they need, we can help them develop healthier coping mechanisms and improve their overall well-being.


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