Is self-harming, as it is sometimes seen, a dramatic and dangerous way of seeking attention? Or is it, as people who self-harm say, a way of coping with mental ill health? And if you or somebody you know is self-harming how can we seek help to stop or reduce risks?
People who self-harm are often dismissed as attention seekers. Some even experience being dismissed as time-wasters by experienced medical professionals, for example in A&E departments where there is still not a proper understanding of what drives self-harming behaviour.
So how can we better understand self-harm? Emily Gajewski is a psychotherapist and occupational therapist who has worked extensively with women in supported housing who self-harm. She describes self-harm as a continuum.
At one end of that continuum are behaviours like smoking, drinking too much, being excessively self-critical and spending money we don’t have to lift our mood – all things we might do in response to feelings of stress.
At the other end of that continuum, is a point where people become so overwhelmed with distress that they resort to behaviours which involve self-injury, such as cutting or burning.
Why would we respond to stress or distress through self-injuring? When we are cut, either by accident or through self-injury, the body releases endorphins, the pleasure chemicals which give us an experience of calm or euphoria. Endorphins mask pain and so the act of cutting gives a person immediate control over how they feel. It’s easy to see how cutting to release endorphins could be very soothing in the face of distress.
However, as well as the risk to physical health from injury or infection, there is also the risk that the person becomes dependant on self-injury as a means to manage stress and strong emotions. Whenever a behaviour triggers the release of feel-good chemicals, the brain quickly learns to promote doing more of that behaviour. The brain does this by triggering the release of dopamine, the brain chemical which encourages reward-seeking behaviour and which is involved in addiction.
There is therefore a risk that the person gets stuck in a cycle of self-harming behaviour, triggered by stress, which triggers dopamine to seek relief from stress and the reward experienced from the release of endorphins. This can become an addictive behaviour; whether that means smoking, drinking too much, gambling or self-injury – which is returned to whenever a person feels overwhelmed by stress.
So what can we do to reduce risk and self-harming behaviour? Well stress is the starting point. Those readers involved with the work of Suffolk Mind will understand that stress occurs in response to unmet emotional needs; whether for security, to have a sense of control over our lives, to give and receive attention, to feel an emotional connection to others and the wider community, to have privacy and time out to reflect or to be involved in activities which are stretching and give us a sense of meaning and purpose.
Understanding that we have emotional needs which have to be met is the starting point for improving mental health and wellbeing and recovering from addictive behaviours. So if self-harming behaviours provide a short-cut to get control over the way we feel, we need to start by identifying another way to meet that need. Learning to do exercises like 7/11 breathing can help to calm strong emotions, and aerobic exercise can both burn off stress hormones and release endorphins. Indeed, many people who reduce or cut out self-harming behaviours altogether, have done so by taking up exercise.
Another barrier to meeting needs can be intrusive thoughts or memories. If a person is self-harming to gain relief or to distract themselves from unpleasant or reccurring thoughts, then they should seek professional help, initially from their GP, and then from a psychotherapist or counsellor who is trained to treat these symptoms.
How should we help or support somebody who is self-harming? Firstly, we need to listen to them and avoid the impulse to judge or criticise them, even if we are doing so because we are concerned or want to try to get them to stop. If they already feel guilt, criticism may make them feel worse and trigger the cycle of stress and self-harming to seek relief again. Encourage them to seek help from a professional, with the aim of harm reduction or, if they are ready to do so, to stop self-harming behaviour altogether. The key thing to remember is that self-harming behaviour, wherever it is on the continuum, is best addressed by a lifestyle which meets emotional needs in a healthy balanced way.