Trying to understand deliberate self-harm
Deliberate self harm can be very distressing, both for the people who have hurt themselves and for their family and friends. It can very hard to understand for everyone involved, and those who self harm do not always know why they do it, only that it can make them feel better in the short term.
Deliberate self-harm can result from a number of different reasons. People may have experienced a distressing event such as the death of a loved one, breaking up with a partner, losing their job, or being abused. People who deliberately self-harm generally do not have the words to express how they are feeling or perhaps cannot even work out their emotions. All they know is that they are experiencing very intense emotional pain and they very much want it to end. It can be their only way of knowing how to ask for help. Deliberate self-harm is often a means of emotional regulation and suicidal thoughts are not always present.
The following tip sheets can help you understand either your own deliberate self-harm or someone else’s:
Worried about a friend who is self-harming
How do I stop or help someone else stop self-harming?
Deciding to stop harming yourself can be a very difficult decision. If you are self-harming you need to find your own reasons for reducing the deliberate self-harm that you are engaging in. Talking with a professional can help you to work out what those reasons could be. For some people being able to wear any clothes that you want without having to cover your scars can be a reason to stop, you may not want to have to go to your doctor or the hospital to receive treatment for your injuries anymore, for others you may want to be able to work through their emotional distress by talking to people instead of harming yourself. It is also really important to know that slipping up is a normal part of recovery. The trick is to see the lapse as (normal) and not to catastrophise it. Reminding yourself of this can help when you slip or return to familiar patterns of behaviour.
How do I help someone else stop self-harming?
It is important to take the self-injury by someone else seriously. You may experience feelings of anger, panic and an urge to ignore the self-harm in someone else. Unfortunately, these reactions might increase the distressed feelings in the other person so it is really important to try to stay calm and non-judgemental. You can help them to use their coping strategies or to get professional help. It can be a really difficult time for family and friends so it is imperative that you have your own network of support (either professional or personal) at this time as well.
Further information for friends and family can be found on the following fact sheet:
Deliberate self-harm and suicide
But how can someone who deliberately self-harms actually stop themselves from harming?
One of the most effective strategies for those that deliberatively self-harm is to use coping techniques to avoid deliberate self-harm completely, or to postpone it or minimise it. Marsha Linehan (1993) developed a range of coping techniques that increase the possibility that a person will be able to tolerate their emotions and reduce the need to engage in deliberate self-harm.
Examples of the specific techniques that can be used are as follows:
In the short term it may be necessary to distract from your feelings to be able to get through the situation. Unfortunately, distraction does not work well as a long term option! Some ways you can distract yourself in the short term are (try to remember the acronym ACCEPTS):
- Activities: Go to the movies, catch up with a friend, or do some gardening.
- Contributing: Do some volunteer work, donate to a charity, give blood.
- Comparisons: Be mindful of this one but some people can find it useful to compare themselves to someone else who they are doing better than. If this makes you feel worse please don’t use it!
- Opposite Emotions: Watch a funny movie if you are feeling distressed, listen to happy music if you are feeling sad.
- Pushing away: Imagine pushing the distressing thought or event out of your mind for a while, imagine putting the distress in a box and shutting it temporarily and reminding yourself that you will come back to it later.
- Other Thoughts: People often find that things that require attention such as completing Sudoku or counting backwards distract from distressing thoughts.
- Sensations: Have a hot or cold shower, patting your dog or cat.
Becoming aware of and using our five senses can help when attempting to tolerate distress and reduce the risk of deliberate self-harm. Try out some of the following suggestions to help comfort yourself, or even better, come up with some of your own suggestions that work well for you:
- Vision: Find a beautiful scene to look at, find a painting that you find particularly interesting or beautiful.
- Hearing: Listen to the sounds of waves at the beach or rainforest sounds, sing your favourite song.
- Smell: Put on your favourite perfume, light a scented candle, or other smells that you find comforting like coffee.
- Taste: Have a piece of chocolate, or a cup of tea or coffee.
- Touch: Touch your pet, have a massage, or hug someone.
Improving the moment
The following ideas can help you create something positive to give you some respite from the negative event or feelings (remember the acronym IMPROVE):
- Imagery: Think of a safe place for you, or a place that evokes pleasant feelings or memories.
- Meaning: Looking for the silver lining in what you are experiencing (if there is one).
- Pray: This can be to your God whatever religion you may be, or some other spiritual being to help you to manage your situation.
- Relaxation: This can be really helpful for people and a good thing to do on a regular basis. Relaxation techniques include calm deep breathing, progressive muscle relaxation, or meditation.
- One thing in the moment: This can be really helpful for people when they are feeling overwhelmed. It helps you to being your attention back to what you can do in the moment rather than ruminating about the past or worrying about the future.
- Vacation: This doesn’t necessarily mean a holiday somewhere but just some time out, you could do something like taking five minutes to have a cup of tea.
- Encouragement: Marsha Linehan (1993) talks about using cheerleading statements to help yourself get through tough times. You can even imagine cheerleaders saying things like ‘You can do it’.
The following worksheets can also help you get through those urges without acting on them:
Wise Mind worksheet
Full booklet for those who would like to work through the skills in more detail:
Dealing with distress workbook
The following sites provide a comprehensive list of resources available to support those who are deliberatively self-harming or know people who are:
Lifeline self-help links lifeline.co.za
Deliberate self-injury (PDF)
Scars on the Inside (PDF)
Where can I go for more help?
- Life Line’s 24 hour telephone counselling for general trauma. Call their National counselling line on 0861 322 322 or visit their website for more information at lifeline.co.za