A rough guide to self-harm

The New York Times has a concise article that discusses adolescents who self-harm through cutting, burning or deliberately damaging themselves. Self-harm is curious because it is one the most psychologically complex of behaviours and yet we have a simple but largely inaccurate cultural stereotype – attention seeking teenagers.

There are many, many types of self-harm, some more culturally acceptable than others. Self harm is often accepted as part of fashion or ritual (piercings, scarring), or can be due to genetic abnormalities (e.g. Lesch-Nyan syndrome), or as a result of learning disabilities or brain injury.

It can be because of delusional or psychotic ideas; OCD type urges, like hair pulling or skin picking, which people often want to resist but can’t; or can be an indirect result of other difficulties, such as damaging the body through drugs, alcohol, or an eating disorder.

The type discussed in the article, and what we normally think of in our cultural stereotype, is often an adolescent or young adult who cuts or burns themselves.

The motivations vary, and yes, a minority do give ‘wanting attention’ as a reason. Sometimes this is a learnt response when they’ve been in an environment where the only time they have been given any care or attention is when they’ve damaged themselves.

However, the vast majority try their best to hide what they do and it can be a source of significant shame.

As noted in a recent review on the area, this group tends to use self-harm as a way of managing strong emotions and cutting is associated with a build-up of tension and the feeling of relief at the time of committing the act.

People who self-harm are more likely to be depressed, impulsive and poor at problem-solving and self-harm is often a way they’ve found, at least temporarily, to control otherwise overwhelming emotions.

Although the risk of suicide is increased in adolescents who self-harm, only a minority will go on to kill themselves. Just over 1% in a recent study with a 26 year follow-up.

There’s still not a great deal of research on which are the best treatments with the biggest reviews being inconclusive, but recent findings suggest that self-harming problems can be treated with psychological therapy.

Link to NYT article on self-harm.