Self-harm is the deliberate damaging of body tissue, more often than not, without conscious intent of suicide. It has also been described as "self-mutilation", "self-injury", "auto-aggression", "delicate self-cutting", and a number of other terms.
Little is known about self-harm and yet it is quite a common act of abuse. Most see it as "attention-seeking" or "manipulative" but it can be better described as the expression of an inner scream.
Cutting the skin with razors, scalpels or broken bits of glass are the most commonly seen methods of self-harm, although other methods include burning, scratching, carving the skin, interfering with wounds, punching oneself (or punching walls), and also pressing objects (including needles) into the skin. Often the body's natural 'pain killers' will take over so that when a person harms themselves they frequently do not feel 'realistic' pain.
This self-inflicted injury could be viewed as a symbolic way of expressing deep distress - a non verbal form of communication in which feelings are expressed through self-injurious actions, where they can be dealt with in a more visible way, yet because of its very visibility, self-harm is often treated with mistrust and prejudice.
If experiences were so painful they forced you to deal with your emotions by hurting yourself, you may now seriously doubt whether you can deal with them in any other way. But people do move forward, to grieve over past events or a lost childhood and work through the fear and confusion surrounding them. With plenty of support, they learn that they can cope with the pain, anger and rage which need to surface.
The important thing is to find ways to start talking to someone you trust. It could be to a friend, a family member, a professional counsellor, a psychologist or a psychotherapist.
A professional should have the training to listen to you and help you reach your feelings and manage them in a different way. Problems in the present and from the past all need to be addressed. If you can, find someone who specialises in treating people who self-harm, who have eating problems or who have been abused.
Your GP may offer you a number of treatment choices, including various forms of counselling or therapy. One option might be cognitive behaviour therapy (CBT), which is a practical treatment that involves looking at what happens just before you self-harm, encouraging you to keep a diary of self-harming episodes and finding other channels for your feelings. CBT does not usually explore, in depth, the underlying causes of self-harming (see Making sense of cognitive behaviour therapy).
If your self-harming is severe, you may be referred to psychiatric services for further assessment, treatment and support. In an emergency, you may be taken into hospital. People's experience of these services is very variable. Even though guidelines are designed to improve the treatment people receive, when time and resources are limited it may be easier for staff to make snap judgements, use diagnostic labels and offer medication, than to spend time looking for the underlying causes of distress. If you find that this is the case, you may need an advocate, who can speak for you and ensure you are properly treated. This could be a friend, relative or a professional .
What can parents and other adults do to help an adolescent who self-harms?
It may be that you've tried a number or alternatives to self-harming and they don't work - but perhaps there's something you've not tried, or it's just that you're not sure how best to do it. There's several ways you can cope with self-harming, whether it's by distracting yourself, or by finding a substitute for self-harm.
Using alternatives to self-harm will help you get through an intense moment when you may feel a strong urge to hurt yourself. But it's never going to be easy, especially when you're trying to break the cycle for the first time. Doing something like squeezing ice won't cure the roots of your distress, but it may help you to use a more productive coping mechanism and show you that you can cope with stress in a less harmful way. You'll have to make a conscious effort to not hurt yourself, but the important thing is that if you do decide to use an alternative, you've made that choice yourself.
If you feel an even stronger urge to self-harm, try the following harm minimisation tips:
"One of the reasons young people say they self-harm is that something has happened in their life that has made them feel contaminated or polluted by that event, whether it's physical or emotional," says Frances McCann, mental health practitioner. "It becomes a way of 'letting something out' and dealing with feelings of self-disgust or low self-esteem."
Often the best thing is to find out what has worked for other people who understand where you're coming from. TheSite.org asked young people from young people's mental health service 42nd Street to come up with some of the alternatives that help them.
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