ESSLIN TERRIGHENA shares what research has taught us on self-harm.
What is self-harm?
Non-suicidal self-injury, more colloquially referred to as self-harm, can be defined as intentional direct damage, destruction, or alteration of own body tissue without suicidal intent. Such self-harm can occur in various contexts, including cultural rituals (e.g. transition to manhood), body modifications (e.g. piercings), political expression (e.g. self-immolation), or stereotypical injury associated with cognitive disabilities.
In talk therapy, self-harm is most associated with emotional distress. Methods can include cutting, scratching, and burning of skin, punching, or hitting self, deliberate starvation or dehydration, excessive exercise, breaking bones, engaging in risk-seeking behaviours, or provoking fights.
Who engages in self-harm?
Research indicates that around 1 out of 6 teenagers and college students report that they have engaged in at least one incident of self-harm. These numbers are much lower in children under the age of 10 years (1.3%), and adults over 25 years (5%).
Notably, while self-harm is frequently associated with girls and women, at least 35% of individuals engaging in self-harm are boys and men. However, there is a gender difference in methods used: while girls tend to cut or scratch, boys may rather partake in activities that create high risk for injury (e.g. dares, fights) or bruising.
The overall numbers suggest that self-harm occurs most frequently in adolescence and young adulthood, which coincides with a time of high emotional reactivity and often lack of healthy coping strategies.
Why do people self-harm?
Studies have identified avoidance of unwanted emotional experiences as the primary reason for self-harm. However, there is less agreement on how exactly this is achieved.
At first glance, hurting ourselves seems counter-intuitive to evolution, which is geared toward survival and should prevent us from engaging in anything that threatens this. Nonetheless, all of us can over-ride our instinctive withdrawal from pain if we think tolerating it has benefits. For example, we tolerate the pain of physiotherapy when we expect a positive outcome. Similarly, most of us have unhelpful coping mechanism we fall back on from time to time. For example, drinking a few glasses of wine to ease stress.
When individuals engage in self-harm, both mechanisms may contribute. Specifically, there may be an initial over-ride of withdrawal from pain which is reinforced by immediate emotional relief. Once the brain has made the association that self-harm leads to the desired outcome, the pattern becomes harder to break.
Emotional Soothing & Control
According to the affect-regulation model, self-harm allows the individual to express emotional pain by externalizing it and making it more tangible. Self-reports suggest that this enables individuals to soothe overwhelming feelings and provide temporary relief. Additionally, watching the injury heal can provide a sense of emotional healing. Sometimes, externalizing the internal pain can also be a means to express distress and need for help to others when individuals struggle to verbalize their inner pain .