Self-Harm Awareness: Why People Self-Injure and How Therapy Can Help
Have you ever experienced a situation when you felt overwhelmed by your emotions?
Perhaps you were overcome with intense anger, frustration, or sadness about some situation or person in your life. Possibly you felt deeply ashamed about yourself or guilty about something you did. Or on the other hand, maybe you felt emotionally numb and desperate to experience some sort of sensation, whatever it might be.
In your situation, what did you do to work through your difficult feelings? Did you use a positive coping strategy like getting some exercise or practicing mindfulness to redirect your thoughts? Did you turn to a trusted person in your life to help you feel better? Or did you try something else?
When we encounter emotional challenges, we can cope in ways that are constructive—ways that solve the problem and make us more resilient to future challenges—or destructive—ways that solve the problem but cause harm to our mind or body. For some people, self-harm is an effective method for coping with intense emotional pain. Unfortunately, self-harm is a destructive coping strategy that can ultimately cause more suffering than it alleviates.
To better understand self-harm, we spoke with Tara Wilkins, one of our outpatient therapist who has helped many consumers who struggle with self-harm. In this blog post, Tara explains some common reasons why people self-injure—and how therapy can help them find more constructive ways to cope with their emotions.
Tara Wilkins, MSW, LSW, a Master's-level therapist at our Marion County outpatient office
What Is Self-Harm, and What Does It Look Like?
Mental Health America defines self-harm (which may also be called self-injury, self-mutilation, or self-abuse) as occurring “when someone intentionally and repeatedly harms themselves in a way that is impulsive and not intended to be lethal.” Although self-harm can sometimes result in death, most people do not self-injure with the intention of ending their life.
Many people associate self-harm with skin cutting, which is one of the most common methods of self-injury. However, the specific behaviors involved in self-harm may vary from person to person. For example, other common types of self-harm include:
- Burning the skin, such as with lit matches or heated objects
- Excessive scratching, often to the point of drawing blood
- Hitting or punching oneself, or hitting/banging one’s head
- Piercing the skin with sharp objects
- Inserting objects under the skin or into body openings
- Intentionally breaking bones
- Ingesting harmful chemicals
Tara agrees, “A lot of people think of self-harming as cutting, but it’s different for every person. I work with someone who will pick at their skin until they bleed. Some people might pull their hair out or bang their heads. There are a variety of ways someone might self-harm.”
According to Mental Health America, as many as 4% of U.S. adults struggle with self-harm. However, rates of self-harm are even higher for adolescents and young adults. Approximately 15% of teens report engaging in some form of self-injury, as do 17–35% of college students.
What Causes Someone to Self-Harm?
It can be difficult to understand why a person would intentionally injure themselves in the ways we’ve described. After all, most people dislike pain and do not typically seek to experience it. So why do some people willingly harm themselves, sometimes to the point of serious injury?
As we mentioned above, a person may choose to self-harm when they are experiencing great emotional pain and do not know how to cope with this pain. As Tara explains, “I see people come in with what I call maladaptive coping skills. They struggle to properly cope with difficult things—with trauma, with anxiety, with depression, whatever it is they’re facing. Self-harming is one of those ways that they cope.”
In some cases, self-harm helps to distract a person from an emotional pain they are feeling by focusing their attention on physical pain instead. In other cases, self-harm may help a person feel something—anything—when they are experiencing an unpleasant state of emotional numbness. Through self-harm, a person may be attempting to do one or more of the following things:
- Distract themselves from painful emotions like worthlessness, loneliness, panic, anger, guilt, rejection or self-hatred
- Achieve relief from severe distress or anxiety
- Feel a sense of control over their body, emotions, or life situation
- Feel anything, even physical pain, when experiencing emotional numbness or emptiness
- Express internal feelings in an external way
- Punish themselves for perceived faults or wrongdoings
In addition, Tara explains that some people may use self-harm as a way of legitimizing their emotional pain to themselves and others:
“Mental health has such a stigma to it. People are often told, ‘It’s all in your head.’ Because of that, they might not know if what they’re feeling is ‘real’ or if whatever they’re facing is valid. By contrast, physical pain is sometimes easier to deal with than emotional pain. If you have any kind of physical ailment, you go to a doctor and get treated. We never question any kind of physical pain. So, these injuries can kind of prove to the person that their emotional pain is real and valid. In a way, self-harm can validate this pain, or transfer this emotional pain to physical pain, so to speak.”
How Treatment Can Help Someone Who Struggles with Self-Harm
Fortunately, behavioral health treatment can help many people reduce and manage their urges to engage in self-harm.
In many cases, people turn to self-harm as a coping strategy because they suffer from unresolved psychological challenges. For example, self-harm behavior sometimes co-occurs with borderline personality disorder, post-traumatic distress disorder, eating disorders, depression, and anxiety disorders. The ultimate objective of treatment is to address a person’s root causes for engaging in self-harm behavior.
Until this long-term goal is achieved, therapy can also help someone replace self-harm behaviors with less destructive coping strategies. “There are a lot of alternatives for self-harming if someone is looking for a physical outlet,” Tara explains. “For example, rubbing ice on the skin instead of cutting, or flicking their wrist with a rubber band. There are also tactile balls out there that can be kind of pointy, and they can squeeze those.”
Ideally, therapy can even help someone replace self-harm with constructive coping skills like exercise or mindfulness. However, Tara cautions that even constructive behaviors can become destructive if they are used excessively, which is why it’s important for a person to have a full “toolbox” of strategies:
“I use the metaphor of building a house. If we were to build a house, we wouldn’t want to use just one or two tools. We use multiple tools when building a house, and when we’re using coping skills, it’s the exact same way. We want to make sure we have a well-rounded toolbox so that we have many tools to use when we’re needing to cope, and when we reach in there, we’re going to have different things to use at different times. For example, if we’re only using a hammer to build a house, that hammer is not going to be useful at some point, or we’re going to use it too much. In the same way, if we’re only using exercise as a coping skill, we’re either going to use it in excess, or we’re going to get tired of using it to the point that it’s not going to be effective anymore. I usually say that we need to have five to seven different skills that we know are going to be effective. That doesn’t mean you have to use them all in one day, but you need to have at least five to seven that help you.”
Finally, some individuals may have more success refraining from self-harm if they identify a trusted individual to provide support and hold them accountable to their goals. “I like to encourage everyone to have what I call an ‘accountability partner,’ “ Tara says. “One person they can talk to if they’re having a really tough day, to say, ‘I tried all these things and it’s not working. I’m really thinking about self-harming, and I’m struggling, and I need to talk to somebody.’ And that somebody needs to not be a paid provider, because sometimes your therapist or your skills specialist isn’t going to be able to pick up the phone right when you need them.”
The persistent urge to injure oneself, while not a distinct psychological disorder, is nevertheless a very real mental health challenge that especially affects adolescents and young adults. Although some individuals may “grow out of” these behaviors with age, they still pose a serious risk to their physical and mental well-being. If left untreated, self-harm behaviors can result in long-lasting bodily and psychological injury.
Fortunately, many people can recover from self-harm tendencies with the proper treatment and support. If you or someone you know is struggling with self-harm, we encourage you to reach out to a behavioral health professional. You can call us at (888) 714-1927 if you’d like to discuss options for treatment with Cummins Behavioral Health.
If you’d like to learn more about other issues related to self-harm, we recommend reading our blog posts on suicide prevention myths and trauma-informed care!