WHY DO PEOPLE SELF-HARM?
Many reasons. Self-harm may be cutting yourself, drinking excessively, engaging in risky behaviour, excessive tattoos and piercings (sometimes), or taking drugs. We all do things that are not in our own best interest but “self-harm,” strictly speaking, are things that cause the body pain rather than pleasure. Like cutting. This is a form of self-annihilation, like a mini-suicide. Something’s wrong with how the person feels. Perhaps a nihilistic world-view contributes; hopelessness does. It’s contagious: having peers who self-harm, seeing media reports and internet exposure are known contributors.
These things increase the risk of self-harm: low SES, LGBTQI victimization, death of someone close, parents separation or divorce, abuse (especially sexual), bullying, borderline, bipolar, perfectionism, unrealistic expectations, impulsivity, and a lack of belonging. Instability in all its forms is a risk factor: an unstable family environment, unstable view of one’s sexuality, and – as is normal during teenage years – being unsure of who you. People self-harm to express distress, gain control and to stop feeling bad.
In my office, I get to hear deeper reasons for self-harm: I deserve it, I’m bad, I need to punish myself, and physical pain is easier than emotional. Self-harm reflects self-loathing and may symbolically re-enact childhood trauma.
19 year-old Tammy was cutting for more than six years: It started after my parents’ divorce. I felt responsible. I know I wasn’t, but my mother was very distressed & I couldn’t talk to her; she was going through enough. Since then, I still do it whenever I need to.
24 year-old Trevor told me how he used to cut himself: I was being bullied and was too embarrassed to tell anyone; but the cutting relieved the tension.
WILL IT GO AWAY?
For the vast majority of people, it won’t persist into adulthood, but studies suggests that it may continue in some females as a coping mechanism.
What doesn’t go away are the deep physical and emotional scars. Arm and wrist scars can be a life-long legacy, and people who hide their self-harm by cutting their abdomen or thighs end up regretting those. Self-harm accounts for about 5% of emergency department presentations: wounds needing sutures, broken bones, injured tendons, blood vessels and nerves, infections and sepsis. These can be fixed by our wonderful medical system, but the feelings of shame, stigma, self-loathing, low mood, difficult social relationships, and poor sense of self, can be longer issues. Suicidal thoughts, too, are a problem.
The self-harm may stop, but problems may remain.
HOW to STOP IT
Dr Heim, why do I do this? It’s really strange. Weird. I wish I could stop. I have to stop. It’s just not right. So we worked on it by understanding emotions and finding better coping mechanisms.
Self-harm is a coping mechanism. It alleviates emotional distress. Physical pain is easier than emotional pain, you feel in control for the moment, and can make you feel alive, like a drug. It becomes a habit or even an addiction as the brain associates self-harm with I’m in control … this feels good. Like drugs, it gratifies short-term only.
The way out of self-harm involves understanding and facing your emotions, and finding better coping mechanisms to deal with distress. The next posts will address these.
Listen to more details about self-harm on our podcast:
 Whitlock, Janis, John Eckenrode, and Daniel Silverman. "Self-injurious behaviors in a college population." Pediatrics 117.6 (2006): 1939-1948.
 Hawton, Keith, et al. "Deliberate self-harm in adolescents in Oxford, 1985–1995." Journal of Adolescence 23.1 (2000): 47-55.
 Jarvi, Stephanie, et al. "The impact of social contagion on non-suicidal self-injury: A review of the literature." Archives of Suicide Research 17.1 (2013): 1-19.
 Hawton, Keith, Kate EA Saunders, and Rory C. O'Connor. "Self-harm and suicide in adolescents." The Lancet 379.9834 (2012): 2373-2382.
 Lloyd-Richardson, Elizabeth E., et al. "Characteristics and functions of non-suicidal self-injury in a community sample of adolescents." Psychological medicine 37.8 (2007): 1183-1192.
 Moran, Paul, et al. "The natural history of self-harm from adolescence to young adulthood: a population-based cohort study." The Lancet 379.9812 (2012): 236-243.