Article

Understanding and Overcoming Self-Harm

This article first appeared in the Fall 2014 Shalem Digest, published by the Shalem Mental Health Network. It is reprinted here with permission.

There are times when I’m left a little dazed and confused by my kids’ decisions; they seem completely convinced that their choices are appropriate, yet from my vantage point, their decision-making seems impulsive and focused on immediate gratification. Granted, they are young, and their internal systems of deciphering information and making conclusions are age appropriate. My job as mom is to guide and influence where I can, keep them safe, and cheer them on as they experience both ups and downs in life. I have to admit, though, that watching our young ones experience the challenges, aches, and pains in this life can be excruciating. As parents, we’re learning that we are unable to protect them from the hurts. That’s a tough pill to swallow.

I think of parents, grandparents, teachers, pastors, coaches, and others involved in the lives of youth today and I wonder if they can relate to my story. I think about how each person uniquely experiences successes and achievements, as well as life’s inevitable pressures, adversity, and struggles.

The Why of Self-Harm

I’m not naive to think that life’s struggles are new, yet I do often think about how each generation seems to cope with these struggles in very different ways. Some ways are healthy and helpful; others are maladaptive and damaging. This generation of young people is no different in that respect, but it seems that many more youth today are trying to cope with difficulties by choosing to injure themselves intentionally. Seeking a way to cope with deep emotional pain, some harm themselves by cutting, burning, hitting, biting and/or carving themselves, and induce a very real physical pain. Perhaps you are engaged in this yourself, or you’re wondering how to help someone who is.

Let’s listen to Jessica’s story. (“Jessica’s story,” like her name, is completely fictional; no resemblance of any kind to a real story is intended.)

Jessica has been a successful student for many years. Growing up, she was noticed in her class, swimming lessons, and church choir as motivated, warm, and friendly. Her family enjoyed her company and never had to worry about her. Jessica was always happy.

Something changed in grade 9. Her start to high school brought the expected jitters, but Jessica reacted in a way that surprised her family. Instead of bouncing back and diving into new friendships, she withdrew. She quit her swimming club, and refused to find another extracurricular involvement. She was reluctant to spend time with friends, and preferred to be in her room at home, appearing to avoid even her family. Her sleeves become longer, even on warm days. Her mother noticed her avoidance, wondering if the teen years were bringing a new appetite for privacy. But when her daughter began avoiding eye contact, she became worried.

One night her mother was cleaning the washroom and found a smear of blood behind the sink faucet. She confronted her daughter, as gently as she could, about the blood. After a difficult conversation about the changes her mother had noticed, Jessica reluctantly revealed her forearms, covered with an array of cuts at various levels of healing. After many tears from both, they agreed that Jessica would meet with their family doctor the following day to talk about her cutting.

This story is not unlike many I’ve heard from young people I work with. And while there seem to be common threads, a real question arises: Why? Why do some young people (almost two out of ten in Canada according to a recent study) intentionally hurt themselves in this way?

Self-harming seems to provide an instant, quick escape from the intense, out-of-control emotions one is experiencing into a different kind of intense experience—one that the individual is now controlling. The effect is short-term; the distraction is temporary. But for those who self-injure, the few minutes of experiencing something different that self-injury provides are worth the pain and the scars.

People may self-harm to:

  • Get relief from painful or distressing feelings
  • Deal with an overwhelming feeling of numbness that is masking pain (reassuring oneself that “I am alive; I can feel something!”)
  • Communicate pain or distress to someone else

These are actually healthy motivations; it’s just that self-injury is an unhealthy way to achieve them. The changes in brain chemistry caused by self-harm create a “rush” that can become addictive and dangerous. For whatever reason, expressing intense feelings appropriately through communication, creative expression, exercise, or leisure activities is too difficult.

Different Than Suicide

It’s very important to distinguish between self-harm and suicide. The intent of suicide is to end one’s life; the intent of self-harm is to cope with life. Assumptions that they are related are dangerous and need to be clarified. For those struggling with suicidal thoughts, immediate crisis response is necessary, due to the life-threatening risks involved. But for most people who engage in self-harm, there is no immediate threat to life. Responding to their needs is very different than responding to the needs of people experiencing an acute suicidal crisis.

Let’s pick up Jessica’s story again:

What Jessica was unable to tell her family and friends was that she had been assaulted by a peer the previous summer. While hanging out at a movie party at a friend’s house, the friend’s older sibling had cornered her and assaulted her. It was terrifying. She was scared, ashamed, and very sad. She experienced a profound feeling of disgust and pain, and found herself longing to find a way to soothe herself. Somewhat to her surprise, the idea of cutting her skin sounded like a good idea. When she cut, she felt an emotional release from the horrible knot she carried all day in her body. She wanted to cry all the time, and the stark physical pain helped her find some relief.

However, she soon found she was ashamed of both her assault and her cutting. She found herself in a very private world; she worked to hide from her friends and family, who she feared would reject her and punish her for her actions. She also feared what God was thinking—how could God love her, someone so far from righteousness? No longer pure or godly.

She longed for a way out. Her mother’s discovery and loving reaction, her tears of love and her promise to find help was the best relief Jessica had felt in months. In fact, it was the turning point in her story of real healing.

A Hopeful Story

Witnessing self-harm is frustrating and confusing for us as bystanders. But once we peel away the “strangeness,” the reality of self-injury is actually a hopeful story. The motivations that lead to self-harm are healthy, even if the practice is harmful. Stopping a habit of self-harm can be challenging; the patterns can resist change stubbornly. But with the love of a parent, friends, or caregivers, and sometimes with the support of a caring therapist, self-injury can be overcome (see “What Can We Do To Help?”). Recovery comes through learning the “triggers” that lead to self-harming, finding new ways of dealing with stressful situations, identifying one’s feelings and handling them in healthy ways, changing unhealthy thoughts and learning to work through conflict successfully.

Thanks be to God, who has wired us for healing through caring, loving relationships with others.

Warning Signs of Self Harm

  • Many cuts on the wrists, arms, legs, back, hips or stomach
  • Wearing baggy or loose clothes, long sleeves on hot days
  • Always making excuses for having cuts, marks, or wounds on one’s body
  • Finding razors, scissors, or knives in unusual places
  • Spending long periods of time locked in a bedroom or bathroom
  • Isolation and avoidance of social situations

(Taken from “Understanding Suicide and Self-Harm,” Psychology Today.)

Self-injury behaviours usually start between thirteen and fifteen years of age, and happen most often in teenagers and young adults. Self-harm behaviors are twice as common in girls and young women as compared to males.

What Can We Do to Help?

What can we as family and friends do to help those who seem to be stuck in the self-injury cycle?

  1. Acknowledge the pain. Don’t minimize it; don’t condemn or judge. Be curious about it and have empathy. Recognize that everyone’s experience is individual; everyone’s story is unique. What may be tolerable for one person may not be for another.
  2. Encourage the person struggling with self-harm to get help. Some resources are immediate, such as the Kids Help Phone (1-800-668-6868, <kidshelpphone.ca>). This resource provides youth across Canada with free, anonymous, and confidential counselling services, 24/7. Your family doctor is also an appropriate contact and can provide more resources available to you in your area. If you are reading this and struggling with self-injury yourself, the first step to healing is asking for help. This takes real courage, but it’s also the best gift you can give yourself. Those who belong to a church that has Shalem’s Congregational Assistance Plan (CAP), call 1-866-347-0041 to receive free counselling support, contact the Shalem Counselling Centres (1-866-347-0041, <shalemnetwork.org>), or a local counselor for counseling. Self-harm responds well to professional counseling.
    1. Support and encourage your loved one through the recovery process. Learning new ways to cope with intense feelings is hard work; the “go-to” of self-injury needs to be unlearned and replaced with healthy, adaptive coping strategies. Celebrate successes! Provide positive feedback and acknowledge the difficulty.

To Learn More

Becoming informed about self-injury is another way that we can work towards breaking down the stigma so often involved in mental health struggles. The more we know about self-injury, the greater the positive impact we might have on those struggling with this harmful expression.

Want to learn more? Here are some good resources (some are specific to the United States or Canada):

  • <cmha.ca/mental_health/youth-and-self-injury/
  • <kidshealth.org/teen/your_mind/mental_health/cutting.html
  • <parenting.org/article/understanding-teen-cutting-and-self-harm
  • <human.cornell.edu/hd/outreach-extension/upload/CHE_HD_Self_Injury-final.pdf
  • <teens.webmd.com/cutting-self-injury>
  • <cheo.on.ca/En/selfinjury>
  • <mayoclinic.com/health/self-injury/DS00775
  • <girlshealth.gov/feelings/sad/cutting.cfm
  • <aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Self_Injury_In_Adolescents_73.aspx American Academy of Child & Adolescent Psychiatry>
  • <nimh.nih.gov/index.shtml>
  • <nami.org/>
  • <samhsa.gov/topics>

For a list of helpful books and resources on self-injury and teens, visit this resource page on the Children’s Hospital of Eastern Ontario web site.

Colleen Cullison, communications manager at Pine Rest Christian Mental Health Services in Grand Rapids, Michigan, assisted with the creation of this list.