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WHAT IS SELF-HARM?
When the term self-harm is used, it refers to behavior which produces immediate, unambiguous injury. This type of behavior has been given many names by professionals such as self-mutilation, self-injury, self-attack, para-suicide, deliberate non-fatal act, and symbolic wounding. I have decided to use self-harm because I feel that that term is more generally used and accepted.
So what actually constitutes self-harm? People who self-harm have described a large number of ways in which they have caused injury to their bodies including:
~Cutting
~Stabbing
~Scratching the skin
~Scraping/Rubbing the skin, removing the top layer to make a sore
~Placement of sharp objects under the skin or in body orifices
~Gnawing at flesh
~Biting the inside of the mouth, making sores and regularly re-opening them
~Picking at wounds
~Burning skin by physical means using heat
~Buring skin by chemical means using caustic liquids
~Pulling hair out - including eyelashes and eyebrows
~Hitting themselves hard enough to cause bruises, black eyes, or broken bones
~Tying ligatures around the neck, arms, or legs to restrict the flow of blood
~Ingesting small amounts of toxic substances or objects to cause discomfort and damage but with no intention to die
Of course, many of these will cause a visible wound to the body but many people tend to hide their cuts, bruises, and scars out of shame. If anyone does notice, the injuries are frequently passed off as accidents (There are a lot of vicious cats out there). People tend to accept this, often unlikely, explanation as it is easier to accept than to recognize the reality of the pain the person must feel in order to hurt him or herself in such a way. This guilt and shame resulting in the need to hide the behavior can begin at a very young age.
In 1989, a study was published of 240 women who self-harmed. One of the areas they looked at was where the women chose to inflict their injuries. The women interviewed indicated that they attacked certain parts of their bodies more often than others. They reported damage to:
~their arms (particularly the wrists).....74%
~their legs...............................44%
~their abdomen...........................25%
~their head..............................23%
~their chests/breasts.....................18%
~their genitals............................8%
Most research on self-harm has shown a similar general pattern. However, we have found that a greater proportion of people who have disclosed information have attacked parts of their bodies specifically connected to their sexual identity, such as faces, breasts and genitals. Some people particularly target these parts of their bodies as they have been sexually abused and have learned to hate the parts of their bodies connected with the experience. It is also a way of communicating the physical pain that they may have felt.
The vast majority of people who self-harm tend to do so repeatedly, although single episodes of self-harming behavior are unlikely to show up in statistics unless the injury has been so bad it requires hospital treatment. Most people also describe using more than one method to inflict harm on their bodies. The method they choose can depend on various factors including what is available at the time. Some people say that the way they harm themselves depends on what sort of feelings trigger the need to self-harm in the first place.
Virtually all people who self-harm tend to do so when alone. Some say that this is because they believe that what they do separates them 'from the rest of humankind and [they] let no one or almost no one know about an act that they regard as shameful.' This shame is often caused by other people being too ready to condemn, rather than trying to understand people who harm themselves. Some people may self-harm alone because they feel that this is something entirely personal, a need only they know about and only they can deal with. Like so many people, they cope with their own feelings privately in the only way they know how, developing an apparently tough outer shell and driving the pain, the anger and hurt, deep inside.
SELF-HARM AND SUICIDE
There is a mistaken belief that self-harm is the same as attempted suicide. However although self-harm causes direct injury to the body, usually these wounds are not directly life-threatening. These are not futile suicide gestures - the intention is to harm, not to kill. Only a very small percentage of people who self-harm have been found to commit suicide in later years. So self-harming behavior in itself is rarely evidence of suicidal intent. On the contrary, many people who self-harm say that they do so in order make it possible to live; to relieve the painful states of consciousness they feel so that they can cope with other aspects of living. In fact, at times a person may feel so bad that self-harm can be a way of averting a suicide attempt.
However, sometimes the emotional distress a person feels can become so unbearable that self-harm does not seem able to relieve the tension and a suicide attempt feels like the only escape. At such times people often say that they find themselves in the dreadful conflict of knowing that they should and need to talk to someone about these thoughts and feelings yet feel they do not have the words not the emotional ability to be able to communicate the intensity of their despair and distress. When you feel like this it is very hard to approach others; you may doubt that they will be able to hear what you are saying or be able to share the level of distress you are feeling. But it is precisely at these times that is it really important you find someone. Help-lines can be a good source of support in such times of crisis.
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WHO SELF-HARMS?
There is no one particular 'kind' of person who self-harms, nor is self-harming behavior restricted to any particular race. People who self-harm range from young to old; rich to poor; fat to thin; single to those with a partner; educated to uneducated; in a successful profession to being unemployed. But because the factors which contribute to the desire to self-harm are more likely to arise in certain circumstances, some patterns do emerge.
Because so much self-harm is carried out in secrecy, it is extremely difficult to gain any real picture of the actual number of people who have, at some time in their lives, caused deliberate harm to their body. A report from the first conference in Britain on self-harm stated that 100,000 individuals seek help from health services each year. This will, of course, be an underestimate as it counts only those who have actually gone for help.
Almost all the information that is available has come from hospital accident and emergency departments. In one study it was estimated that at least 1 in 600 people self-harm to such an extent that they need hospital treatment. The authors of that study recognize 'this is likely to be an underestimate since some deliberate self-harm will be concealed by relative, friends or the person themselves, or will not be judged sufficiently severe to require hospital assessment." The same study found that twice as many people who went to accident and emergency departments had self-poisoned compared to those who self-wounded. This is not surprising as many people have told that they rarely go to emergency departments when they have self-harmed but are more likely to do so if they have poisoned themselves. This is reflected in the findings of another study which noted that at least 80% of patients who went to a hospital for self-poisoning had also recently self-wounded and had not sought treatment for those injuries.
GENDER
Socialization leads to different expectations of men and women. Considering these differential expectations of our society helps us understand why women are much more likely than men to deliberately self-harm. Women in general are expected to hold less power than men and there are different expectations as to the tasks they will perform and the positions they will subsequently hold. Women tend to be offered less opportunities in life and are generally treated with less respect than men, although this is slowly changing. Women tend to receive less reward, tangible and intangible, for the work they do and the roles they play; they are often made to feel less important and their opinions less valid. Women are encouraged to compromise rather than question; to acquiesce rather than agitate.
Importantly, society's construction of the male does not automatically include the idea that men should be nurturing and caring, but it does assume the notion that men's needs should and will be catered for, and that men should actively express their feelings of anger and aggression. Women, on the other hand, are expected to meet the needs of others, often at personal expense. That are able to tolerate passively situations in which they feel used, abused and powerless. The predictable consequence is feelings of worthlessness, anger and frustration, yet they are so rarely encouraged to voice these emotions, that they often take them back into themselves.
Interestingly when men feel unable, for whatever reason, to exert power over their own lives, when they are put into situations which force them to be passive, some men begin to self-harm. Of course, this is the average and is not meant to imply that men do not self-harm for many reasons, including the same reasons women do.
Some studies do show equal number of males that self-harm to females. Perhaps this is because the statistics are collected from emergency departments and men are more likely to go for treatment for their injuries than women. Research on male suicide shows a similar pattern. Statistics indicate that more men commit suicide than women but this masks the fact that more women actually attempt suicide. The difference arises from the fact that when men try to harm or kill themselves, they tend to use more violent methods and consequently the more likely to succeed.
RACE
It is a lamentable fact that black individuals still suffer racial prejudice in this country. Racism and the resulting bullying and harassment, potentially increases the isolaton and stress suffered by black men and women. Institutionalized racism can lead to negative feelings about some aspects of black identity such as skin color, hair texture and the shape of facial features. This in turn can lead to attacks on these aspects of self deemed as indicative of 'blackness'. These 'attacks' are often sanctioned by the wider dominant white culture.
In terms of actual research, there has been little investigation into the incidence of self-harming behavior in any racial group other than Caucasian and more needs to be carried out. There has been found a relatively high incidence of self-harming behavior amoung young Asian and Black individuals. Given the connection between invalidating environments and self-harming behavior, it should not be surprising that Black, Asian, and other people from minority ethnic groups will show high levels of self-harming behavior.
AGE
From all that is written about people who self-harm, it would seem that the most typical age that this begins is at the younger end of the adult age range, between 16 to 25 years of age (60%). One reason for this might be that the type of injury caused at this stage is more 'recognizable' as self-harm. It could also be a reflection of the fact that with the onset of puberty, many people become more aware of the pressures, restrictions and demands on them. However, there is no absolute rule--people reported beginning to self-harm at all ages; the youngest age of onset was 6 years (I was four) and the oldest was 75 years.
Statistics would suggest that older people are less likely to self-harm than younger people. This may be because as people get older they tend to have less demands and pressures on them--personal and sexual--and they may have learned alternative coping strategies. Another contributing factor is that older people may be less likely to seek help, in part because the help they received in the past has been so inadequate and in some cases demeaning.
Many people do not recognize that young children can also self-harm yet many adults describe beginning to self-harm at an early age. Several adults have said that from a relatively young age they engaged in acts of deliberate self-harm which were not recognized as such, sometimes not even by the person themselves. They described harming themselves in different ways at different ages; one kind of self-harming behavior being replaced by another. This substitution is not unusual for example it is reported that 10-15% of children engage in head-banging behavior. That percentage decreases as children get older but they may just be substituting different behavior that is not so blatant.
Research from Oxford University reflects the fact that people can and do begin to self-harm when they are very young--5.3 per cent of all patients refered to a large general hospital for self-harming behavior were under 16 years of age and more than 1 in 5 of these had self-harmed before.
PEOPLE WITH DISABILITIES
A large number of people who have learning disabilities and other forms of disability self-harm, many of whom will never be able to tell us in words what it is they are feeling, nor what has happened to cause them such distress. However, even if a person has a disability that prevents them from speaking, they can usually communicate in other ways to people who are motivated enough to try and understand.
Often self-harming behavior is noted in institutional facilities. The explanations given in the professional literature have been various but most relate to the need of the person to stimulate themselves or to gain the attention of caregivers. Over the past few years, however, the emotional deprivation and neglect that people with disabilites have suffered in such institutions has begun to be recognized, as has the very large percentage who have been sexually and physically abused. In addition, whether or not they are in institutions, people with disabilites are very often excluded from society. They are often made to feel flawed and somehow less than human. They are treated as if they have few if any 'normal feelings' which leads to feelings of rejection, alienation, silencing and exclusion. These are the same feelings described by others who self-harm.
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If you're going to self-harm, please make sure to do it under the most sanitary and clean environments. This includes cleaning the object you are using with alcohol before and after self-harming, cleaning your wound with an antiseptic and taping the wound closed, if necessary. |
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TRAUMA IN THE LIVES OF THOSE WHO SELF-HARM
As we have seen, the circumstances of our lives have a profound impact on how we feel about ourselves, yet in many ways people who self-harm are significant for the differences in their circumstances rather than the similarities. Nevertheless, there is a common factor in the lives of all people who self-harm. When talking about themselves and their experiences, they all say that during their childhood years they have experienced trauma; physical abuse, sexual abuse, severe emotional abuse, repeated surgery and/or invasive medical treatment; and other forms of trauma such as witnessing violence. Many professionals still fail to make this link, while others state the connection very clearly.
Not everyone who has experienced childhood trauma responds by self-harming. What seems to affect whether or not they do, is whether or not the emotional care they received after that traumatic experience was appropriate. We are all taught, to a lesser or greater extent, to recognize and cope with our emotions by those who care for us when we are very young. A child learns to recognize and to reduce emotional arousal by his or her parent or caregiver noticing the child's emotional state, attending to the child, and accurately reflecting, mirroring, and verbally interpreting that emotion for the child. It is as if for a brief period of time that emotion is jointly held between the child and the adult. As the caregiver reduces his or her emotional state, the child follows, this time mirroring the caregiver. As the child is comforted by her caregiver, over time, she learns to identify her emotions, reduce emotional arousal and at times of great emotional distress when she feels she cannot deal with her emotional state, she learns to seek care and comfort from another person. The caregiver does not even have to get it right every time. The child can cope well with good-enough care.
A trauma is an inescapable stressful event or series of events, which overwhelm a person's existing coping mechanisms. Consequently, traumatic experiences give rise to emotional turmoil. If appropriate help and care are not given to children to help them cope with those feelings, they have to find their own solution; to cope the best way they can. Children find many ways to do this and some children do so by engaging in various acts such as sucking, biting, eating, temper tantrums, aggression to others, rocking, head-banging, all of which bring about calm feelings. This can help us cope but we do not learn about a) relying on other people for care-giving and comfort and b) how to cope any other way with distressing emotional states.
It also seems that the younger a child is when the trauma occurs for which she did not get the care she needed, the more likely she is to engage in self-harming behavior; 'behavior patterns originating in painful encounters...in the first years of life'. When we are young we develop patterns, which help us cope, and which quite often remain with us for the rest of our lives. It is during the first few years of our lives that we learn about being cared for and having our needs met but for some of us this can be when we first experience neglect and feelings of worthlessness. People who self-harm are much more likely to have grown up in families where, generally, their emotional needs were not met, or where they were neglected or repeatedly separated from those who did care for them. Some people may have had families who seemed to care very well for them; providing for them materially and practically but at the same time not recognizing, or providing for, their emotional needs. Other families may have responded inappropriately, even though they were doing so out of the 'best' of intentions.
It has been suggested that for people who start self-harming in childhood or adolescence the causes must lie in their early years. Those who begin to self-harm in adulthood often have also had negative childhood experiences, but the self-harm may have been triggered by a significant event in the person's adult life. The emotions arising from the original trauma have not been processed so they remain stored, as if in a capsule, along with all the events that were connected to it such as sights, smells, sensations, noises. Even though they appear to be pushed away and cut off from consciousness, any similar sights, smells, sensations, and noises can become reminders of, or triggers to, the trauma which can evoke intrusive images; a repeated replaying of distressing memories. Sometimes the memory of the actual event does not come to mind (and paradoxically we may not remember much of what happened), but there can be overwhelmingly powerful emotions or bodily feelings that seem to be totally unrelated to what is currently happening in our everyday lives. Triggers to the memory of the trauma may become increasingly more subtle and generalized and things that appear irrelevant can become reminders of the trauma. 'The personal meaning of the traumatic experience evolves over time and often includes feelings of irretrievable loss, anger, betrayal and hopelessness...one particular event can activate other long-forgotten memories of a previous trauma,'
The events people most commonly describe that trigger these states, are feelings or images directly related to a traumatic experience; or difficulties in relationships, particularly if those difficulties involve feelings of rejection, separations or abandonment.
It would seem that the most common events that lead to self-harm beginning in adulthood are rape and serious physical assaults. Other adults begin self-harming after the loss or death of someone close to them such as a partner, parent, or child.
When we are experiencing high levels of distress, it is vital for our well-being that we are able to communicate these feelings. But if these emotional signals are not heard and recognized, then we cannot obtain the care we need to comfort us and alleviate that intense pain. It is likely that people who self-harm have had to endure overwhelming levels of emotional distress, at some time in their lives, most probably during their formative years. Human beings are unable to tolerate such high levels of distress and thus produce an urgent need to find a way to reduce those feelings and an alternative means of communicating with others the nature of the feelings that are generating so much anguish. Harming oneself can become the response to such overwhelming experiences. It can produce a physiological change within the body biochemistry itself bringing about a sense of calm. The scars it leaves are visible evidence of the pain endured; a message to the outside world.
Whether you are someone who self-harms or you are reading this because you care about someone who does and want to help him or her, the first step in the process is to recognize that you are not alone. If you self-harm, it may help you to know that you are not that unusual and that it is a common practice.
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There is no magic potion or general answer as to how to help those who self-harm. The key to helping anyone, especially someone in distress, is to be accepting and supportive. That doesn't necessarily mean approving what they are doing, but rather letting them know that you are there for them no matter what may happen. |
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GENERAL SELF-HARM INFORMATION
Covenant House Nineline
1-800-999-9999
A national 24-hour hot line which provides people in crises with support, assistance and appropriate local referrals.
Self-Abuse Finally Ends Alternatives Program (S.A.F.E.)
1-800-DONT-CUT (366-8288)
The number is an information line (not a hotline) for finding our more about self-harm or admission into the S.A.F.E. Alternatives program, located in Oak Park, Illinois. S.A.F.E. offers many services including group and individual therapy, in- and out-patient treatment, and a day hospital.
S.A.F.E. in Canada
(519) 857-7259
A non-profit organization in Ontario that offers long- and short-term therapy and services, as well as peer counseling and support for self-harming men and women. The program conducts outreach in the form of workshops and speakers.
Bodies Under Siege Listserv
http://www.palace.net/~llama/psych/busfaq.html
Bodies under siege (bus) is a thriving, close-knit, vibrant community of people who all have one thing in common: self-injury has somehow affected their lives. Please visit website for full explanation.
The Cutting Edge
P.O. Box 20819
Cleveland, OH 44120
A self-injury newsletter. For a copy, send a SASE to the address. Be sure to check out these other sites, too!:
Self Harm Alliance: http://www.selfharmalliance.org/
Secret Shame: http://www.palace.net/~llama/psych/injury.html
The Self-Harm Community: http://www.selfharm.org.uk/
Tips of All Sorts-Self Harm: http://www.tipsofallsorts.com/selfharm.html
Self Harm Info and Resources: http://www.selfinjury.freeserve.co.uk/
National Self Harm Network: http://www.nshn.co.uk/
American Self Harm Info. Clearinghouse: www.selfinjury.org/
Self Mutilation in Psychiatry: http://www.bmezine.com/news/selfmutp.html
Silent Screams: http://www.geocities.com/bnl_jgk/mainpage.html
Overview of Self Harm: http://www.healthyplace.com/Communities/Eating_Disorders/peacelovehope/mutilation.html
Self Injury-A Struggle: http://www.self-injury.net/
Self Injury And Related Issues: http://www.siari.co.uk/
Self Injury, Trauma, Abuse Info.: http://www.self-injury-abuse-trauma-directory.info/
Christian Self Injury Resources: http://www.self-injury.org/
Self-Injury Support: http://www.sisupport.org/
Self-Injury Info and Resources: http://www.self-injury.info/
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