Cut From Within: Understanding Self-Harm
Updated: Sep 29, 2019
Tears in the skin Tears from your sins Tears in the mind Tears from what lies behind. Cut from within Cut in your skin Cut down your wrist Life is so brisk You like the risk.
What is Self-Harm?
Self-harm or self-mutilation, in scientific terms non-suicidal self-injury (NSSN) or deliberate self-harm (DSH) is deliberately causing harm to oneself by:
intentionally preventing wounds from healing
punching things in order to harm yourself
piercing skin with sharp objects
It is much more common than what may be expected, quite prevalent among adolescents and young adults aged between 13-25 years old. Studies estimate that around 18% of individuals have deliberately injured themselves in their lifetime, while 13-23 % of teenagers have resorted to this behaviour.
Self-harm is also one of the diagnostic features of Borderline Personality Disorder (although not all individuals with BPD self-harm) and it may be characteristic of other mental disorders too, such as depression, anxiety disorders, eating disorders and more.
Trauma survivors, individuals who have suffered sexual, physical or emotional abuse during childhood, are at greater risk to engage in self-injurious behaviour.
In some cases the self-harm may not be considered entirely deliberate, because it may be done while in state of severe dissociation (when one is completely out of touch with their Self and reality).
Reasons Behind Self-Harm
If you have not experienced profound distress and could not find an effective way to cope, self-injury may be a complete mystery to you. Indeed, it sounds confusing and bizarre- Why would someone want to injure themselves? But actually there are a few reasons.
1. Take away the pain
Coping with Negative Emotions
As absurd as it may sound, self-injury is a way of distracting yourself from intense inner turmoil, it is an act of avoidance.
For people who self-injure, often the intensity of negative emotions is so high, that the only way out of it is intentionally causing physical pain to themselves. There may be a mix of various negative emotions such as emotional pain, sadness, despair, anger, worthlessness, loneliness, panic, anxiety, guilt, shame, self-loathing and rage.
The person who self-injures is overwhelmed and wishes to manage and regulate all of these negative emotions and racing thoughts, so they cause pain to themselves. Then the focus shifts from emotional pain to the physical pain, thereby causing relief.
In addition, when we injure ourselves, the body’s response is the release of endorphins, our very own self-made drugs that bring about a pleasant blissful sensation to distract from the pain.
The release of endorphins together with the psychological reasons of regulation, relief and reduction of negative emotions is the reason why self-injury can actually become addictive and compulsive, exactly like the rest of maladaptive stress-management responses e.g. heavy drinking, drug abuse, binge eating episodes, and promiscuous sexual behaviour.
2. Make me feel something, anything
Coping with Numbness and Emptiness
Empty vessel under the sun wipe the dust From my face another morning black Sunday Coming down again empty vessel empty veins Empty bottle wish for rain that pain again Wash the blood off my face the pulse from My brain and I feel that pain again
One of the most devastating effects of trauma is feeling a deep sense of numbness and emptiness. Even worse than feeling sad and in pain, is feeling nothing at all. Just an inner void, a deep nothing. Nothing can touch you, nothing can affect you- you’re just numb and empty.
In situations like this, self-harm is an attempt to create some sensation and feel alive again, as if awaken from this state of emptiness. It doesn’t matter if the sensation evoked is actually painful- because now, you can feel something again. Then you welcome pain, even if it is excruciating; because this is still better than feeling nothing at all.
3. I am in charge now
Attempt to Exert Control
Deliberately causing pain can also be a way to exert control over your body. For instance, trauma survivors may experience pain that is completely beyond their control, since somebody else abused them against their will and often when they were too little to be able to defend themselves.
But the pain caused by self-harm is under their control, and the sense of being in control is empowering and soothing- especially when you feel when everything else in your life is spinning out of your control.
4. Help me
Request for Social Support
The emotional regulation and escape from emptiness described above are the two most prominent reasons behind self-harm. Although the request for help is a rather uncommon reason, as most self-harmers do so in secret and afterwards feel very ashamed for giving in to their urge, in some cases self-injury can be a call for help indeed.
This happens in an indirect way, by drawing attention of others to the need for help. Maybe you don’t know any other way or it feels very embarrassing and intimidating to directly admit to someone that you are suffering and want to find a way out- but if they see the scars, they will figure that out by themselves, without you having to get vulnerable straight up.
5. Look what you’ve done
Manipulation of others, attempt to make them feel guilty
Similar to the reason above, the attempt to affect and manipulate others through self-harm is uncommon, but it can still be a reason that it happens.
Think of the teenager that silently suffers in an abusive household, feeling as if there is no-one to turn to for help and comfort. Unspoken traumatic scenarios happen behind closed doors, and often the most violent perpetrators are beyond suspicion, since they may be the primary caregivers of the adolescent as well.
In those cases, you cut in order to express the pain you feel, and make the ones who are responsible for it guilty about the consequences of their actions.
It may be a last resort to make them actually care about you instead of keep hurting you- because you already hurt yourself, so do they really want to push your limits even further..?
Self-Harm and Suicide
Confusing self-harm with the intent of suicide is one of the most common misconceptions about self-harm. Although it is understandable, since in many cases people self-harm by cutting through their arms, wrists, thighs or torso, self-harm is most definitely not the same with suicide.
Suicide underlines an intention to end one’s life, while self-harm, as discussed above, is a way to preserve life. It is a coping mechanism or cry for help. It is dysfunctional, by no means healthy, but it is true that the intention of a self-harmer is rarely to end their own lives.
Since self-harm is an addictive behaviour, the actual and real risk that exists, is that self-harmers often want to gradually create more intense pain in order to get the same sense of relief and dopamine high out of their behaviour. This tendency to cut deeper may result in more severe wounds and bleeding, that may unfortunately prove fatal in some occasions.
Despite the fact that the intention of someone who self-harms is not to terminate their own life, unfortunately there seems to be an increased risk for suicide amongst the people who self-harm. This makes sense, since the pattern of inflicting harm to the body at times of distress is already established among people who self-harm.
Studies actually confirm that people who self-harm are more likely to commit suicide on purpose or accidentally. Moreover, it is estimated that at least half of the people that have died by suicide, have a history of self-harm.
Window of Tolerance and Self-Harm
The Window of Tolerance is a psychological term used to describe the zone of arousal in which a person is able to function most effectively. It is our comfort zone, where we can regulate our emotions smoothly and we feel calm, cool and collected.
Self-harm is a dysfunctional coping mechanism to move you back within the Window of Tolerance:
Hyperarousal State: When you are hyperaroused, you are overwhelmed by intense emotions such as anxiety, anger, despair, panic and then you tend to act impulsively, without much thinking. In such occasions self-harm is used to help manage negative emotions (the 1st reason of self-harm in this blog post), and bring the individual back in the Window of Tolerance.
Hypoarousal State: When you are hypoaroused, this resembles a low-energy state where you might feel disconnected, dissociated, numb, paralysed, as if you are not really present. You are shut down. Therefore self-harm may act as a means to move the person from this state back in the Window of Tolerance (the 2nd reason of self-harm in this blog post).
Coping Tips to Stop You From Harming Yourself
Self-harm is a destructive way of emotion regulation. Replacing this behaviour with other viable and healthy alternatives is your goal. Returning within your Window of Tolerance without hurting yourself in the process is your focus.
1. Know your Triggers
It is important to identify those situations, thoughts and emotions that urge you to hurt yourself. What emotions are you attempting to release, alleviate and soothe by cutting? By knowing the situations that put you at risk, you can take better action in order to help yourself.
2. Reach out
Self-harm often implies a great deal of loneliness. It is also a means of reconnecting to your senses and body when you feel disconnected. As has been often underlined, the opposite of addiction is connection. And self-harm is an addictive behaviour. Even if it feels threatening to talk about your struggle, you will most likely find out that the ones close to you are willing to help. Have at least one emergency contact, someone you trust and can reach out in a time of need. Agree to contact them when urged to harm yourself, and stay in contact until the urge has passed.
3. Wait it out
As with any other urge, it may feel unbearable to resist it. But if you can promise yourself or a trusted loved one to wait a designated amount of time until your urge fades, you will be surprised to realize that the need to self-harm is much lower now.
4. Find alternative ways of soothing your pain
If you use self-harm as a means to alleviate pain and calm down, replace it with other distracting activities that help you deal with distress:
Take a warm bath or shower. Visualize all your negative emotions washing away along with the water and let them go down the drain
Externalize your pain in art and painting
Journal down your dark emotions onto paper. It doesn’t matter if your creation doesn’t make much sense, as long as you express your pain in a way that is not directed towards harming yourself.
Hug yourself in a warm blanket
Cuddle your pet
Massage the body part that you would injure
Listen to calming music
5. Find alternative ways to release tension
If you use self-harm to release tension, anger and rage, you can find other ways to vent:
Go for an intense run or other form of intense exercise
Listen to angry music
Have a stress ball to squeeze
Use a red marker and draw lines at the places where you’d normally cut
Write your thoughts and emotions down, and then rip the page. Visualize that by doing that, you let them evaporate and get out of your body
Have a punching cushion just for times of distress
Place rubber bands on wrists, arms or legs (wherever you would otherwise injure yourself) and snap them instead of cutting.
6. Find alternative ways out of numbness
If you use self-harm when you feel numb, you can initiate different pathways of feeling alive and connected again:
Rub ice cubes on the parts of skin you would injure until you feel pain from the ice
Take an ice cold shower to bring you back to your senses
Eat something really spicy
Call someone and connect, talk about anything, not necessarily self-harm
Go online in self-harm support forums and groups such as Depression and Self-Harm Support Group on Facebook
If you feel you are spinning out of control and you are in risk of seriously harming yourself, if you feel suicidal, have the local suicide prevention numbers available to you. In the Netherlands, this is 0900-0113 (www.113.nl)
7. Seek professional support
Self-harm can have severe emotional and health implications, so do not hesitate to reach out and talk to a mental health professional if you feel you are on the edge. Therapy can be a precious addition to your support network on your path towards healing.
If Someone You Care About Self-Harms…
It can be devastating and frightening to realize that someone close to you self-harms. If you suspect this by seeing scars, bruises or other wounds, or if they often wear long sleeves and layers of clothing even in warm weather, it can be a sign they self-harm.
Do not just tell them to stop: Forbiding the behaviour or requesting a promise that they won’t do it again actually does not work. The focus should be on what is going on that makes them want to self-harm, on the emotions that are behind this.
Do not make them feel guilty or bad about it: Approach with compassion and concern, rather than accusations, judgement, threats and blame. Remember that the person who self-harms probably has plenty of shame and guilt to deal with by themselves; do not add up to that, because it can backfire.
Do not minimize or disregard their behaviour: Self-harm should not be taken lightly and the problems the individual who resorts to self-harm faces, are very real and not just in their head.
Encourage Support: Encourage your loved one to seek professional support for self-harm. Offer your help if they need it.
Comfort and Offer Solutions: Be gentle, compassionate and caring to your loved one. Offer your presence, undivided attention and willingness to brainstorm with them to find solutions and alternative ways to manage negative emotions
Encourage Communication: It is vital to convey the message that your loved one is not alone in this, nor should they feel ashamed to reach out. Help them foster the willingness to communicate with trusted friends or relatives, and develop an emergency contacts list. Offer to be in that list and be contacted whenever your assistance is needed, if you feel you can be there for them like this
Be Informed and Raise Awareness: The more you understand the reasons behind self-harm and the specific circumstances that trigger it, the better you can help your loved one heal. Standing against stigma of mental health issues is an incredibly significant step to take, that can only yield positive results.
Although self-harm can be a behaviour that someone will eventually grow out of, this is not a given. Self-harm indicates inner suffering and inability to employ healthy ways to manage negative emotions.
If you self-harm, it is important to realize you are not alone in this. Reach out and raise awareness. Remember, you are perfectly able to heal and to grow. Don't be ashamed of your scars; they indicate you are a survivor, and much stronger than whatever tried to hurt you.