We all have battles that feel bigger than us sometimes and we all have characteristic ways of dealing with emotional pain, physical pain, shame, regret or guilt. There is a full bank of very normal human experiences and emotions that can threaten to break any one of us. Sometimes, they last for too long. When it feels as though there is no relief, it can drive even the strongest of us to try anything to get the pain to stop. 

What is self-harm?

Self-harm is any deliberate injury made to the self, by the self. It doesn’t include anything that is socially sanctioned, such as piercings or tattoos. People who self-harm don’t want to die. What they want is for the pain to stop. Most self-harm happens without any thoughts of suicide, but it can predict suicidal behaviour in the future. The problem is that while self-harm provides a temporary escape from emotional pain, it may feed a need for the escape to be more permanent.

Who self-harms? 

The group of people who self-harm is a diverse one. They are men and women of all backgrounds, races and ages. They are people like any one of us – the people we live with, work with and love. Some people who self-harm have anxiety, depression, an eating disorder or borderline personality disorder, but sometimes self-harm exists on its own. 

Self-harm appears to be more common among those who are homosexual, bisexual or questioning their sexuality.

There are a number of ways that people self-harm, including cutting, burning, scratching and banging or hitting. Women were more likely to use cutting, while men were more likely to hit themselves or burn themselves. 

Research of adolescents and young people who self-harm found that on average, they have about five non-suicidal thought of harming themselves each week. The thoughts tend to last between 1–30 minutes. On average, people who self-harm seem to hurt themselves on average between one and two times a week. 

Thoughts of self-harm rarely come with suicidal thoughts, but they do happen with thoughts of drug or alcohol use about 15-20% of the time, and thoughts of and bingeing or purging about 15-20% of the time. Despite these stats, most people who self-harm are not under the influence of drugs or alcohol when they hurt themselves. 

Let’s clear up a couple of myths.

The idea that self-harm is done for attention or to exploit the ones who care isn’t supported by the research. Although a very small number of people might hurt themselves for attention, this is rarely the case. Most people don’t disclose their self-harm. It is often done very much in private as a way to quickly relieve overwhelming negative feelings. 

Another common myth is that self-harm is often driven by (or caused by) childhood sexual abuse. Again, this has not been supported by the research. In an analysis of a number of studies, only a very small relationship was found between child sexual abuse and self-harm.

Why do people self-harm?

Everything we do is driven by a need. The needs we have are always valid, but the behaviours we choose aren’t always going to be the best or most effective way to meet that need. Needs can be voracious, relentless and compelling. When a need is powerful enough, as needs will tend to be for all of us from time to time, it is understandable that somebody might call on whatever means available to them to end the pain of that unmet need. 

Research has found that self-harm can be an attempt to fulfil a number of valid, powerful needs:

1. To provide relief from persistent negative thoughts.

   When negative thoughts are persistent and powerful, the pain can feel overwhelming. There is a growing body of research that claims self-harm is a strategy people use to distract themselves from negative, painful thoughts about themselves, things that have happened or about self-injury itself.

2. To provide relief from overwhelming negative feelings.

   People who self-harm tend to experience intense negative feelings immediately before they hurt themselves. In particular, feelings of anger, self-hatred or rejection have been associated with a significantly greater likelihood of self-harm. After an episode of self-harm, those negative feelings are decreased and there are increased feelings of calm and relief. The relief from the negative feelings, however temporary, can be powerful enough to drive future episodes of self-harm.

3. As an expression of anger towards the self, or a form of self-punishment.

   Self-criticism seems to play a pivotal role in self-harm. In a review of a number of studies, it was found that found that slightly more than half the people who self-harm do it as an expression of anger towards themselves or as a way to punish themselves. 

Why self-harm brings relief.

The experience of physical pain seems to soothe emotional pain. Images of the brains of people who self-harm have found that physical pain leads to less activity in the part of the brain that is associated with negative emotions (anterior cingulate gyrus and the amygdala). 

Research has also found something interesting that seems to happen when physical pain stops – emotional pain also starts to ease. For any of us, having a bad experience, and then having that bad experience taken away will bring overwhelming relief which feels better than before the bad experience. Let’s say that someone trustworthy tells you that you have one week to live. Then, the next day they tell you that they got it wrong and that you’re absolutely fine. The relief and joy you feel when the bad experience (thinking you’re going to die) is taken away, lifts you higher than you were before it.

The research has been done in people who have no history of self-harm, but it may explain why some people intentionally seek to hurt themselves. Emotional pain and physical pain activate the same areas of the brain. Relief from physical pain (when the self-harm episode ends) brings simultaneous relief from emotional pain. The greater the emotional pain, the greater the relief.  

This does not mean that people who self-harm are wired differently to the rest of us. They aren’t. When emotional pain feels overwhelming and unmanageable, it’s understandable that people who self-harm might tap into their own internal resources to find relief from that pain, even if it means first having to inflict intense physical pain. Intense emotional pain can feel as though it has a life of its own. It can feel out of control. Self-inflicted physical pain, on the other hand, is manageable and controllable.

When physical pain is inflicted deliberately, the beginning and ending of that pain is something that can be managed and used to bring relief to emotional pain. This is not something done to manipulate or control other people. For people who self-harm, physical pain which is under their control is more manageable and more tolerable than emotional pain which feels out of their control. It is a way to bring the self back into balance, which is something we are all driven to seek. When the need for balance is strong enough (brought on by an important unmet need), it will make the unthinkable – the deliberate infliction of pain – feel like an option.

If you are someone who self-harms …

Healing won’t happen by telling yourself that you need to heal. You’ve been doing that. It also doesn’t happen by telling yourself that you need to be brave, strong, resilient. You are already that. It happens when you start to trust. Trust that the people around you have what it takes to fight for you and with you against whatever it is that’s hurting you. 

We all need a hand from time to time, and if this is your turn to ask for help, be kind to yourself and let that happen. Whether it’s a parent, a friend, a partner, a counsellor, a doctor – there are people who want to understand and help you. There is a human connection between all of us, whether you can see it or not, feel it or not, or believe it or not. It’s there. You are not alone. There are people who have such a deep, unwavering, fierce commitment to helping things to better for you. Part of the struggle convinces you that there isn’t, but there is. Don’t let your struggle make you blind to them. Trust that they will cope with your story.

Asking for help is an almighty, incredible strength. You have proven that you are a fighter – brave, strong, beautiful and incredible. You wouldn’t have got through what you’ve been through if you weren’t. Open hearts will bring open hearts. Know that there are people who will always be ready to fight for you. 

If you or someone you love is struggling with self-harm: For Extra Support – When Being Human Gets Tough.

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