The phrase “self-harming behavior” may call up images of troubled teenagers with cuts on their arms. But self-injury can occur for people of any age, in children, adolescents and adults, whether male or female. This is not at all a teenage fad!
People who self-harm or cut are people who are in pain. We have to notice that. The important thing is to notice the emotional pain — not just the outward expression of it — and view the person using self-harming behaviors with understanding and compassion.
Prevalence and Statistics
Accurate statistics about self-harm are hard to find because so much goes unreported. Estimates vary widely; between 3% and 38% of adolescents and young adults report engaging in self-harming behavior, says the Refuge, a treatment resource.
What is Self-Harming Behavior?
Cutting is the most often recognized form of self-injury. But self-harm comes in many forms. It is any self-injurious behavior that is harmful, that is used as a coping skill. Some specific examples include:
- Breaking bones intentionally
- Piercing the skin with pins or other objects
- Burning or scalding parts of the body
- Pulling out hair, fingernails, or pieces of skin
- Banging the head, hands, feet, knees or limbs against hard surfaces
- Slapping or punching oneself
It is natural to feel shock or disbelief when seeing self-injurious behavior. It seems unbelievable to those who are not experiencing such emotional pain, that someone could take a razor to their arm or burn themselves to cope with overwhelming emotions.
It is important to see self-harm as a kind of meta communication around someone’s emotional pain — the behavior has meaning or value for the person doing it and that meaning or understanding is so important to move toward healing.
Why People Use Self-Harming Behavior
Self-harming behavior is both a mechanism for self-regulation and, for some people, a mechanism for self-punishment. Sometimes people will injure the parts of themselves they feel ‘bad’ about. It’s as if those parts can be ‘punished,’ to help people feel less ashamed or less badly about themselves.
Other people say they use self-harming behavior as a distraction. It hurts, and that’s the intention. The physical pain helps a person dissociate from the emotional pain that is overloading their ability to cope and therefore, feel as if they are more emotionally regulated.
Unfortunately, the behavior can also consume the attention of those people who care about someone who self-harms. It’s heartbreaking to watch a loved one using these behaviors. It can be tempting to judge them or yell at them for acting in a way that seems senseless to others. But focusing on the behavior alone keeps the deeper pain from being understood. What’s important is an awareness that the person is just doing the best they can to cope with a world that feels terrifying or overwhelming.
Tuning Into the Overwhelm Beneath the Behavior
It takes time and intention to tune into the emotional pain of someone who self-harms, rather than the behavior itself. Writer James Hunt describes coming to terms with his son Jude’s self-harming behavior after Jude was diagnosed with autism.
Around age 2, Jude began having meltdowns, and would slam his knees onto the hard floor, or stomp his feet. Later he would use his hands, “slapping his arms, legs, and feet over and over until they were raw,” and even slapping and punching his face.
“I’d do anything to help him relax and stop hitting himself,” Hunt explains. “I’ve gotten angry with him, I’ve shouted, cried, begged him to stop. ” But over the years, Hunt came to accept that autism was part of Jude’s life, part of his struggle with sensory overload.
Now Jude is 7, and self-harms less often. His father sees himself responding better when it does happen: “I’m calm and I do my best to reduce or remove whatever stresses are overwhelming him at the moment. I know the best way to help him calm down. I’m more in tune with what may cause a sensory overload for him and try to prevent him from being exposed to it as much as I can.”
Working With the Person Who Self-Harms, and With Their Loved Ones
Treating self-harm means bringing a compassionate, self-caring attitude to the behavior.
The person is using the behavior to cope with anxiety or emotional pain that is outside their window of tolerance of emotions. Physical pain has become their way to calm emotional pain; either overwhelming hyper-arousal or numbing hypo-arousal, which feels unsafe and unstable.
In therapy, stabilization is our first goal. We set up a compassionate, understanding relationship that acknowledges their emotional pain, and assures them they are not alone in facing it. They can feel sure they are not going to be judged or shamed for it.
In therapy, we work on grounding, or stabilizing by bringing awareness back into the present moment and the body they live in. As a therapist, I might use a variety of approaches to help the client feel more grounded in the present. For example, we might use verbal ones, such as noticing things in the room that correlate to the senses, such as what do you hear, see, smell, etc.
At times I may use more physical or sensorimotor/somatic exercises, like tossing a pillow back and forth to help a client bring their awareness back to the current moment if they get triggered or dissociate. I may ask the client to talk about what’s going on for them. How do they notice being in the room with me? How are they noticing their emotions?
Lisa Ferentz’s self-care technique called CARESS (for communicate alternatively, release endorphins, and self-soothe) is a great teaching tool to help clients with self-regulation. See More Resources below for additional information.
In later phases of treatment we will process their trauma history and the feelings that are associated with what happened during experiences that led to unbearable stress. A trauma-Informed approach is so important here, to avoid re-traumatizing the client. Trauma-informed therapists know that naming all of the details of their trauma is not necessary for healing.
But at the start, it is most important to help the person feel safe enough to start listening to their body, and become open to learning ways to self-soothe without using self-harming behavior.
The Importance of Self-Care in Recovery from Self-Harming Behavior
In therapy, I teach both clients and loved ones about taking care of wounds that happen because of self-injuring behavior. We guide children and adolescents to show injuries to a parent or primary caregiver. We help parents or loved ones support their loved one in treating the injury so it heals well, and to evaluate whether any cuts or wounds needs stitches or other medical care.
Safety also means making sure injuries do not get infected or that people who use self-harm do not unintentionally endanger their lives. Self-harming behavior is not usually a suicidal act. The loved one’s role in wound care allows the person who self-harms to experience acceptance of what they feel, and to feel cared about. Attention and understanding from a loved one can help reduce the risk of accidental death or more serious harm.
Compassion for Parents and Partners of Those who Self-Harm
Therapy for self-harming behavior means having a lot of compassion for the parents or partners as well. The parents and loved ones are trying their hardest to help but they don’t always know what to do.
Many parents and loved ones attempt to control their own hyper-aroused anxiety by hiding everything and anything the self-harming person might use. It is natural to want to control the outward mechanism their loved one is using to cope, especially when it’s dangerous to life. Safety is of course, the most important thing. That said, we want to help loved ones focus on helping to heal the underlying pain.
It’s hard to be compassionate if you don’t yet understand the person’s struggle to manage their emotions. Yet it is possible — and healing — to circle back to an initial reaction that may have temporarily made things worse (e.g., “Are you crazy? What did you DO?”).
Parents and loved ones can help the healing process by returning with new compassion to that moment: “I’m so sorry I was taken by surprise. I just want you to know that I love you and I understand that there’s something going on for you.”
If you love someone who uses self-harming behavior, it’s okay if you don’t get it right the first time. You can bring healing and repair by noticing the alarm in yourself, and taking care of calming it. Showing another how to self-soothe in a healthy way is a gift especially when their emotions are so overwhelming.
Self-care helps trauma survivors discover how to calm themselves and find healthier relationships. Far from being selfish in a negative way, self-care helps trauma survivors let go of behaviors that don’t serve them well, and take part in healing both internal relationships with themselves and externally with others.
In time, the regulation that they once tried to find through self-harm, they can now find in healthy connections, and good self-care.
Project Semicolon, a movement to bring hope and wider conversation about self-harming behavior, suicide, mental illness and addiction
To Write Love on her Arms, a movement supporting people who struggle with self-injury related mental health issues
Letting Go of Self-Destructive Behaviors, by Lisa Ferentz, LCSW-C, DAPA, a workbook for people struggling with self-harming behaviors and for clinicians
Treating self-Destructive Behaviors in Trauma Survivors, a Clinician’s Guide, by Lisa Ferentz, LCSW-C, DAPA
Article was originally published HERE and was republished with author’s consent.
Robyn E. Brickel, MA, LMFT is the director and lead therapist at Brickel and Associates, LLC in Old Town Alexandria, Virginia, which she founded in 1999. She is deeply committed to clinical practice, professional education and better public awareness of mental health issues. You can connect with her via her website HERE, on Twitter @RobynBrickel and on Facebook.