Self-Harm Awareness Month

March is National Self-Harm Awareness Month.  Self-harm is a topic that is rarely talked about, but is an important one to address. Non-suicidal self-harm or self-injury is when a person intentionally and repeatedly harms him/herself without the intent to kill him/herself. An estimated 2 million Americans intentionally harm themselves each year, although the number is probably higher due to the fact that many cases aren’t reported to doctors. Teenagers and young adults are most affected, but the behavior can continue into adulthood.

While self-harm itself is not a mental illness, the behavior is often a symptom of a psychiatric disorder such as an eating disorder, depression, anxiety, post-traumatic stress disorder, or borderline personality disorder. Cutting is the most common form of self-injury; other methods include scratching, punching, picking skin, pulling hair, and burning. The goal of these behaviors is not to kill oneself; instead self-injury is used as a coping mechanism to deal with intense emotional pain. Research has shown the most common reasons people injure themselves are to stop bad feelings, relieve feelings of loneliness, emptiness, or isolation, distract from other problems, decrease feelings of rage, release tension, and to control racing thoughts. The brain feels relief from psychic pain by feeling physical pain.

Over time, self-harm behaviors increase in frequency and intensity as the immediate relief decreases.  Additionally, the short term benefit of relief from emotional pain is replaced by the long-term consequence of shame and guilt.  Self-harm is not used to manipulate others; rather, the person often hides the behavior and does not want to be discovered lest he/she will be forced to stop.  Self-harming behaviors can quickly escalate into a dangerous cycle, and without treatment, people are at a higher risk of suicide.

Warning Signs

• Fresh cuts and scratches
• Scars, burns, bruises, cuts appearing in the same place over and over
• Wounds that don’t heal
• Hair loss or bald spots
• Keeping sharp objects around
• Wearing long sleeves and long pants even in hot weather
• Mood changes
• Social withdrawal
• Change in school performance
• Inability to handle stress
• Claiming to have accidents frequently (trips, falls, etc.)

If you notice any of these warning signs in a friend or loved one, you should talk to them and express your concerns; let them know that help is available. Remember that the person is already experiencing emotional pain, so it’s important to be caring and compassionate. Don’t judge them or make them feel bad about their behavior.

Treatment
To treat self-harming behavior the person needs to address the problem(s) and situation(s) that led them to hurt themselves in the first place and then develop healthy coping mechanisms to deal with future stress. Treatment can usually take place on an outpatient basis, but inpatient treatment should be considered if a person isn’t showing improvement. Following an evaluation by a mental health professional, psychotherapy and medication are usually recommended. Dialectical Behavior Therapy (DBT) has proven to be a very effective treatment. DBT teaches skills to help reduce the intensity of emotions and provides alternative ways to cope with urges to self-harm. One example of this is holding ice cubes on the skin. The cold ice provides an initial shock, similar to a cut or scrape, without doing damage.

Resources

• National Alliance on Mental Illness
• Mental Health America
• WebMD
• 5 Facts About Teen Self-Injury