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Young man lies curled up with painful emotions.

Self-harm is a range of acts that people do to deliberately harm themselves due to the emotional turmoil that they are experiencing. Often the emotional pain and turmoil is far deeper than the visible physical harm Some self-harming actions include cutting or carving on the skin, burning or peeling skin till it bleeds, pulling hair, hitting one’s body or banging it against a hard object.

Self-harm affects about 13 to 25 percent of adolescent often between the age of 14 to 16 years

In Singapore people who self-harm tends to be:

  • Female rather than male in a 7:1 ratio
  • Begin in teen years and persist to late twenties
  • From upper middle and upper socio-economic classes
  • Intelligent and well-educated.

When self-harm persists more than one or two occasions, it indicates that the person is struggling with psychosocial problems which is an added risk to completing suicide.

 

Why do people self-harm

 

Have a sense of control

Circumstances are beyond their control so they find any way to get back that sense of control by hurting themselves. Thought behind: “I can’t control the situation but I can control what I do to myself.”

Punish themselves

Something bad may have happened to them in the past and they believe they are responsible. So self-harming becomes a way to punish themselves. Thought behind: “I hate myself for letting that bad thing happen, it’s my fault.”

Helps them feel alive

Persistent trauma may have caused them to feel numb and detached from reality. Self-harming helps them to feel alive. For some people it gives a high, the feeling of euphoria. Thought behind: “I see blood, so I’m alive”

Communicate their pain to others

They may not know how else to talk about their pain. Sometimes the reason being self-harming is a biological disorder. Alexithymia is an inability to recognize one’s emotions and so the person suffering from it, expresses it through a physical and somatic manner. This can lead to self-harm as a way to express their pain.

Distract themselves

Self-harm can be a way to distract themselves from emotional troubles and prevent something worse from happening like suicide.

 

 

Myths of self-harm
MythTruth
They are out to seek attentionOften done secretly as these acts done in secret gives them a sense of control
Dangerous to be around themThey hurt themselves as they do not want to hurt their loved ones. Self-harming helps to release pent-up emotions.
They are emotionally weakNobody wants to hurt themselves deliberately.

They have probably been struggling with their problems for a long time and are in tremendous emotional distress.

They crave the painThe pain from self-harm is a diversion and substitute from an emotional pain that would not go away.

 

 

Difference between self-harm and suicide

The motivation and intention of self-harm and suicide may be different. Self-harm actions are used to release tension and pent-up feelings while Suicide often stems from the feeling of hopelessness and having no way out of their problems.

However, self-harming is a negative coping mechanism and is not a solution that would lead a person out of the problems. Persistent self-harming can lead to attempts at suicide.

 

Warning signs of self-harm

Physical

  • Disturbed sleep
  • Insomnia or hypersomnia
  • Deterioration in personal hygiene and grooming
  • Poor appetite
  • Binging on food
  • Chronic fatigue and lethargy
  • Unexpected scars and wounds

Social

  • Withdrawal from friends and family
  • Avoiding contact with people
  • Loss of interest in things they used to enjoy

 Academic

  • Deterioration in school grades
  • Lack motivation in study

Psychological

  • Frequent crying episodes
  • Depressed moods
  • Persistent anxiety
  • Irritable moods
  • Poor concentration
  • Excessive negative thinking
  • Talk of giving up
  • Sense of hopelessness

Conduct

  • Increased impulsivity
  • Increased defiance and opposition to authority
  • Increased minor offences and disciplinary problems
  • Use of alcohol and drugs

 

Protective factors against self-harm

 

A person who is self-harming will need to learn, problem solving skills, impulse control and proper conflict resolution in a non-violent way. Seeing a mental health professional is necessary especially if the behavior is ingrained. The family will have to ensure the person is kept safe and receive support from friends and community. Sometimes religious beliefs can help to discourage further self-harm and suicide.

 

Should you stop a person from Self-harm behavior

According to Dr Ong Say How, “you should not coerce the young person into stopping the behavior as the only person who can stop the self-harm is the sufferer himself. But he can set limits to the self-harm and exert control over when and how much to self-harm”.

 

Alternative to self-harm

What to do to reduce self-harming behavior:

Develop a sense of control and self-mastery – 15-minute game

Play a game where the urge to self-harm is postponed for 15 minutes. When the time is up, postpone another 15 minutes. This continues for as long as possible. This helps to develop emotional tolerance and build a sense of control.

 

Positive distraction – Personal emergency toolkit

Put together a tool kit with all the things that are enjoyable. When there is a need to self-harm, take this kit out as a distraction.

 

Find better coping mechanism

Find acceptable reaction to feelings. Allow them to act out their anxieties and negative emotions in a safe and non-self-harming way. E.g.:

– smack a rubber band tied around the wrist

– squeeze an ice-cube in their hand etc.

– Squash an empty drink can

– Slash a cardboard box

– Hit a pillow

– Tear up newspaper

– Break sticks

– Go for a run

– Exercise

 

Self-soothing

Find ways to soothe the negative emotions

– Take a hot bath

– Listen to soothing music

– Use aromatherapy

– Apply body lotion on the skin

– Speak with a friend

– Eat your favorite snack

– Write down your feelings on paper. Identify the emotions such as disappointment, sadness, anger etc. This helps to link triggers with emotional reaction so that you will know how to avoid the triggers or prepare to handle them.

 

A person who is self-harming should get professional help

 

Adapted with permission:

Ong, S.H.( 2015). Living with self-harm behaviors. Marshall Cavendish Editions.

Dr Ong Say How is currently practicing at the IMH Child Guidance Clinic, Health Promotion board. 
This publication is available at National Library Board and all leading bookstore. 

 

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