Self Harm

Abstract

Self-harm involves intentional self-poisoning or self-injury. Self-harm is a growing problem that requires urgent attention. This article discusses the risk factors associated with self-harm and methods of self-harm. The article also discusses the signs of self-harm and suggests treatments that help with it.  

Keywords - self-harm, self-injury, dialectical behavior therapy

Self-harm is defined as intentional self-poisoning or self-injury irrespective of the apparent purpose of the act. Methods of self-harm can be broadly divided into two groups - self-injury and self-poisoning. Self-injury is more common than self-poisoning, especially in the teen population. However, 80% of those who get admitted to the emergency departments after self-harm, will have consumed an overdose of prescribed medication or over-the-counter medication (Horrocks et al., 2003). A small percentage of people will have consumed a large amount of some illicit drug or some other substance to poison themselves. 

Cutting is the most common method of harming oneself (Hawton et al., 2002). Other not-so-common methods include burning, hanging, stabbing, swallowing objects, insertion, shooting, and jumping from heights or in front of vehicles. 

Many acts of self-harm may not be attempts to end life. These acts may be attempts to communicate to others, to influence or obtain help from others, or a way of obtaining relief from a difficult situation or an emotional state (National Collaborating Centre for Mental Health (UK)., 2004). 

A paper by Hetrick et al. 2020 has identified triggers of self-harm that were consistent across participants in their study. These triggers revolved around six themes - distressing emotions, a sense of isolation, exposure to self-harm, relationship difficulties, social comparison and school/work difficulties. 

It has been found that among the people who harm themselves, many are either diagnosed with or meet the criteria for certain types of mental disorders. Self-harm is one of the characteristic features of borderline personality disorder (Hooley et al., 2017). The risk of self-harm is also significantly high among the patients diagnosed with schizophrenia (Jakhar et al., 2017). Certain psychological factors such as being impulsive, having poor problem-solving skills and experiencing a sense of hopelessness are common among people who harm themselves (Madge, 2011). 

Certain demographic traits make a person vulnerable to self-harm. This includes belonging to a lower socioeconomic group (please note that self-harm occurs in all sections of the society), being single or divorced, being a single parent, or having a lack of social support. Though self-harm can occur at any age, these acts are more likely to happen among adolescents and young adults. In general, women are more likely to harm themselves than men. The rates of self-harm are especially higher among teenage girls (National Collaborating Centre for Mental Health (UK), 2004). 

There is a strong positive correlation between the number of adverse life events experienced by a person and the chances of committing self-harm. The risk is significantly higher for those who have experienced bullying, physical or sexual abuse (Madge, 2011). Rates of self-harm are also significantly higher among people who are gay, bisexual, and lesbian (Swannell et al., 2015). The reason for the high rate among people belonging to the sexual minority can be that these individuals are more likely to be subjected to bullying. This experience might lead some individuals to self-harm.

The rates of self-harm are also high among people who abuse alcohol and drugs. One study has found that the presence of injecting drug use and cannabis dependence were significantly associated with self-harm (Gupta et al., 2019).

The acts of self-harm can result in a long-lasting negative impact on a person’s health. Cutting can damage the tendons and nerves permanently while scarring causes disfigurement. Overdose of paracetamol can result in acute liver failure. More violent forms of self-harm can result in hospitalization or permanent disability. Additionally, there are several economic impacts of self-harm as well. The most conspicuous is the increased financial burden on the individual’s family due to the treatment costs. The indirect effects include low attendance at work and workers’ productivity and legal costs (National Collaborating Centre for Mental Health (UK)., 2004). 

People who self-harm are very careful about hiding their behavior from other people. However, there are certain red flags that pinpoint the fact that a person might be doing self-harm. These warning signs include - frequent cuts and bruises on a person’s body, having blood stains on belongings, having many bloody bandages or tissue papers in the trash, wearing concealing clothes that hide the injuries (for example, wearing long sleeves during hot weather), having an unusually large collection of sharp items like needles, razors or bottle caps,  shutting oneself in the bathroom or bedroom for a very long period and isolating oneself from people and social events in general (GoodTherapy Editor Team, 2019). 

A person who shows any of the above-mentioned behaviors may or may not be doing self-harm, but the mere presence of these behaviors is cause to worry about. It is important to help such a person get in touch with a mental health professional. 

Psychotherapy is the most common treatment for self-harm. Therapy can address the emotional pain that is associated with self-harm and can also help the person develop alternate coping mechanisms. Dialectical behavior therapy (DBT) is mostly practiced with people who harm themselves. It is a type of cognitive behavior therapy that mainly helps people regulate their emotions, develop healthy ways of coping, and improve their relations with others. Other than DBT, group therapy, family therapy, and relaxation training are suggested for people who self-harm (Sadock et al., 2014). 

An article published in The Times of India has reported that the rates of self-harm have increased in India significantly. This rise is especially alarming during the Covid-19 lockdown enacted in the year 2020. Unemployment, financial crunch, loneliness, among other causes may have worsened the situation along with existing mental health problems (Madaan, 2021).

Self-harm is a growing concern. Therefore, it has been added in the DSM 5 and is named nonsuicidal self-injury (NSSI). NSSI has been added in section III of DSM 5, which is used to describe conditions that need further research. This move is expected to stimulate research on the topic and will help in developing better treatment protocols and means to prevent the occurrence of self-harm (Hooley et al., 2017).

References

GoodTherapy Editor Team. (2019). Self-Harm. GoodTherapy. Retrieved January 15, 2022, from https://www.goodtherapy.org/learn-about-therapy/issues/self-harm

Gupta, R., Narnoli, S., Das, N., Sarkar, S., & Balhara, Y. (2019). Patterns and predictors of self-harm in patients with substance-use disorder. Indian journal of psychiatry, 61(5), 431–438.  Retrieved on 15th January 2022 from NCBI.. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_578_18

Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: self report survey in schools in England. BMJ (Clinical research ed.), 325(7374), 1207–1211. https://doi.org/10.1136/bmj.325.7374.1207

Hetrick, S. E., Subasinghe, A., Anglin, K., Hart, L., Morgan, A., & Robinson, J. (2020). Understanding the Needs of Young People Who Engage in Self-Harm: A Qualitative Investigation. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02916

Hooley, D. M. C. J. B., MIneka, S., Butcher, J., & Dwivedi, C. (2017). Abnormal Psychology, 7Th Edn (7th ed.). Pearson India Education.

Horrocks, J., Price, S., House, A., & Owens, D. (2003). Self-injury attendances in the accident and emergency department: Clinical database study. The British journal of psychiatry : the journal of mental science, 183, 34–39. https://doi.org/10.1192/bjp.183.1.34

Jakhar, K., Beniwal, R. P., Bhatia, T., & Deshpande, S. N. (2017). Self-harm and suicide attempts in Schizophrenia. Asian journal of psychiatry, 30, 102–106. Retrieved on 15th January 2022 from NCBI.  https://doi.org/10.1016/j.ajp.2017.08.012

Madaan, N. (2021, November 11). Self-harm and violence cases rose drastically during lockdown: Study. The Times of India. https://timesofindia.indiatimes.com/city/pune/self-harm-and-violence-cases-rose-drastically-during-lockdown-study/articleshow/87634943.cms. Retrieved on 15th January 2022.

Madge, N., Hawton, K., McMahon, E. M., Corcoran, P., De Leo, D., de Wilde, E. J., Fekete, S., van Heeringen, K., Ystgaard, M., & Arensman, E. (2011). Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European child & adolescent psychiatry, 20(10), 499–508. Retrieved on 15th January 2022 from NCBI. https://doi.org/10.1007/s00787-011-0210-4

National Collaborating Centre for Mental Health (UK). (2004). Self-Harm: The Short-term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care (NICE Guidelines) (1st ed.) [E-book]. RCPsych Publications.

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Swannell, S., Martin, G., & Page, A. (2016). Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study. The Australian and New Zealand journal of psychiatry, 50(2), 145–153. Retrieved on 15th January 2022 from NCBI. https://doi.org/10.1177/0004867415615949