Author: Claudia M. Elsig, MD

Self-harming is now one of the most shocking mental health epidemics of our time. It is much more common than we think, and incidents of self-harming amongst teenagers are on the rise.

Studies suggest around a quarter of 14-year-olds have self-harmed.¹ The problem is likely to be much worse than these figures suggest. Many statistical analyses are based on the frequency of people presenting to emergency care. But most people who self-harm don’t seek medical attention. Rather, it is a secretive behaviour that goes unreported.

Non-suicidal self-harming (NSSH), as it is referred to in scientific literature, is a complex and multifaceted behaviour with a myriad of antecedents and drivers.² It urgently needs to be better understood and addressed.

This blog explains the complex nature of self-harming, highlights some of the causes and considers treatment options for a behavioural condition that is frequently misunderstood.

What is self-harming?

Self-harm is the infliction of injury on one’s body with the intention of causing harm. People self-injure as a way of dealing with difficult feelings, painful memories, or overwhelming situations and/or experiences. It can happen following a series of thoughts or may be completely impulsive. It most frequently takes the form of cutting, burning, or non-lethal overdoses, but it can be any behaviour that causes injury. Eating disorders, for example, are serious psychosomatic illnesses that represent a form of self-harm.

The ways people self-harm include:

• Scratching
• Cutting
• Banging or hitting
• Pulling out hair
• Overdosing on medication
• Biting
• Scalding with hot water
• Burning
• Eating or drinking poisonous substances
• Not allowing wounds to heal
• Starving oneself, binging or purging
• Participating in dangerous behaviour

Why do people self-harm?

Research shows that individuals at risk of self-harm often report experiencing chronic emptiness, alienation, and isolation in combination with intense, overwhelming negative emotions.³

Kim L. Gratz. Professor and Chair, Department of Psychology, at the University of Toledo, has written extensively on borderline personality disorder (BPD), non-suicidal self-injury and emotion regulation. In her work on self-harm, she writes, “Theoretical literature on the development of self-harm suggests specifically that it is childhood experiences that take place within the context of the family that are most likely to be associated with self-harm.”³

The type of childhood experiences associated with self-harming, according to Gratz, include a dysfunctional family background, father-daughter incest, abuse in the context of pathological family relationships, or some other childhood trauma, neglect, or insecure attachment.

The point is this – while self-harming may be triggered by a present event or current circumstances, there is usually a more complex life story behind it.

People self-harm as an outlet for emotional pain they can’t deal with. This may have built up over several years. The link between earlier childhood trauma explains why not everybody resorts to this behaviour under the same stresses. Not everyone self-harms.

When a person is challenged emotionally, and they feel unable to seek help, some will turn to alcohol, lose themselves in a video game, turn to food (or limit food intake), or take drugs. They may even resort to a combination of these harmful behaviours. Self-harming is one way someone copes with or manages upset when they are unable to express feelings. It is a way to assert some form of control.

Another mediator now is the COVID-19 pandemic, which has triggered a 25% increase in prevalence of anxiety and depression worldwide, according to the World Health Organisation (WHO).⁴ Lockdowns have exacerbated situations of family abuse and violence in the home, and disconnected people from their usual support networks, such as work, college or school.

The global coronavirus pandemic has particularly affected the mental health of young people, who are disproportionally at risk of suicidal and self-harming behaviours. Research shows there has been an increase in incidence and severity of deliberate self-harm injuries presenting to the ED during this time.⁵

Social media also plays an increasingly relevant role. Other research shows that the use of social media by people with mental health problems, and especially those who are prone to self-harm, has potential advantages and disadvantages. “Different people are likely to be affected differently by their online experiences, and the same person may be affected differently on different occasions.” It poses a dilemma about how and by how much the content of social media sites should be regulated.⁶

Who is at risk?

A meta-analysis of community-based studies 1990-2015 looked at one hundred seventy-two datasets of self-harm in 597,548 participants from 41 countries.⁷ It found the following:

• Overall lifetime prevalence of self-harming was 16.9%
• Girls were more likely to self-harm
• The mean age of starting self-harm was 13 years
• 47% reported only 1 or 2 episodes
• Cutting was the most common way to self-harm (45%)
• Suicidal ideation and attempts were significantly higher in adolescents who self-harmed, and this was higher with more frequent self-harm

There are lots of different reasons contributing to the will to self-harm. For some people, inflicting harm on oneself is a way of gaining control. For others, it is a punishment, or to do with feelings of sadness, guilt, self-loathing or rage. It is often used as a way to stop feeling numb or disconnected.

One proposed mechanism for deliberate self-harming in adolescents is disassociation.⁸ Disassociation is a natural response to trauma and can be experienced in lots of different ways, but generally involves a feeling of disconnection. With disassociation, a person feels detached from themselves and the world around them, and experiences gaps in memory about their life.

Self-harm and disassociation often go hand in hand. Studies show that those with a high level of dissociation measured with the Adolescent Dissociative Experiences Scale had a higher risk of self-cutting and other self-harm behaviour.⁹

Other risk factors include autistic tendencies, and/or being a victim of bullying. There is a substantial increase in odds of self-injurious behaviour and suicidality in children and adults with Autistic Spectrum Disorder (ASD).¹⁰ Research also shows that victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviours.¹¹

How do you know if someone is self-harming?

As can be seen (and this blog is only touching the tip of the iceberg), the reasons for self-harming are complex. Most people who resort to self-harming keep it hidden, so it can be difficult to spot.

But there are some flags to look out for. Depression or anxiety can be precursors to self-harming, so look out for changes in mood and behaviour. This could manifest as a lack of motivation or interest in anything or seeming withdrawn. People who are perfectionists or those who have difficulty setting boundaries can also be attracted to self-harming.

Other signs to look out for are:

• Unexplained cuts, burns or bruises
• Covering up in hot weather, such as wearing long sleeves and trousers or thick tights
• Changes in eating behaviour (over- or under-eating)
• Exercising excessively

How do you support a loved one who is self-harming?

There is nothing more shocking than finding out someone you love is self-harming. It can be hard to know what to do, especially if you don’t understand why they are doing it. It starts with being patient and understanding.

Let the person you are supporting know that they don’t have to tell you everything at once. It can be overwhelming for a person to find the words to explain, especially as the reasons are complex. They may not even fully understand themselves why they are doing it.

Try not to be judgemental. Relate to the person as a whole, and don’t just focus on the self-harming behaviour. Try to have empathy. Don’t make decisions for them – let them be in control of their own decisions. The most important thing is for them to seek professional help. You can offer to help them find the right support. This could be from a helpline, a support group, or a specialist therapist.

How do you get help if you are self-harming?

It is extremely difficult for people to reach out for help when they self-harm because they often feel ashamed. If this is you, the first step is to recognise there is a problem and that help is available. There are many helplines, support groups, counsellors, psychiatrists, and therapists who can help. A good place to start is to tell someone you trust.

Treatment at CALDA

Professional specialist treatment for self-harming is critical because this form of self-destructive behaviour won’t go away on its own. Deliberate self-harm is an important risk factor for subsequent suicide, so getting treatment as soon as possible is essential.

Most of the current therapies for individuals who self-harm use psychotherapy and psychiatric drugs. But at CALDA we take a much more holistic approach. As a client of the CALDA Clinic, you will receive 1:1 therapy tailored to your needs based on the CALDA Concept.

The CALDA Concept is a tailor-made and highly effective precision therapy that combines scientific methods from classical medicine with specially tested treatment methods from complementary medicine, traditional Chinese medicine (TCM) and orthomolecular medicine.

We treat the causes not the symptoms for lasting results. Our treatments are designed to liberate you from self-destructive behaviours and give you your life back. If you would like to know more, please get in touch.

References/sources

1. Website: BeHeadStrong.co.uk. Christian Youth charity in the UK. Self-harm Statistics.
2. Borschmann R and Kinner S A. 01Jul2019. Responding to the rising prevalence of self-harm. The Lancet. Volume: 6. Issue: 7, page(s): 548-549
3. Gratz K. Jun2003. Risk Factors for and Functions of Deliberate Self-Harm: An Empirical and Conceptual Review. Clin Psychol Sci Prac 10: 192–205, 2003.
4. World Health Organisation. News Release. 2Mar2022. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide.
5. Henry, N. et al. 15Dec2020. The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room. The International Journal of Psychiatry in Medicine. Volume: 56 issue: 4, page(s): 266-277.
6. House A. Aug2020. Social media, self-harm and suicide. BJPsych Bull. 2020 Aug; 44(4): 131–133.
7. Gillies D. et al. 21Aug2018. Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990-2015. J Am Acad Child Adolesc Psychiatry;57(10):733-741.
8. Černis E. et al. May2019. What is the relationship between dissociation and self-harming behaviour in adolescents? Clin Psychol Psychother 26(3):328-338.
9. Tolmunen T. et al. Oct2008. Dissociation, Self-Cutting, and Other Self-Harm Behavior in a General Population of Finnish Adolescents. The Journal of Nervous and Mental Disease: Volume 196 – Issue 10 – p 768-771
10. Blanchard A. et al. 1Oct2021. Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open; 4(10):e2130272
11. John A. et al. 19Apr2018. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res;20(4):e129.