Self-harm: it's more than just attention-seeking behaviour

Here, we discuss the common misconceptions of self-harming, explore why people cause injury to themselves, and outline the support that's available to people who self-harm.

Self-harm is defined as the intentional injury to oneself, without suicidal intent. However, there's overlap between self-harming behaviour and suicidal behaviour, and people who self-harm are at increased risk of suicide. A history of self-harm is found in up to 60% of people who complete suicide and the vast majority of people who self-harm have attempted suicide.

The term 'attention-seeking' is often used negatively in relation to self-harm. The implication is that the person self-harms just to get attention, but it's important to understand that this is rarely the main motivation. 

Self-harm can be the first manifestation of a mental health disorder. It is most typically associated with personality disorders, in particular, borderline personality disorder (BPD), which is also known as emotionally unstable personality disorder (EUPD). There are, however, a number of other mental health conditions that self-harm can be a symptom of. These include:

• Depression
• Panic disorder
• Generalised anxiety disorder (GAD)
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Autism

If you're concerned about someone, the most common signs and forms of self-harm to look out for include:

• Cutting the skin with a sharp object
• Cigarette burning
• Scratching
• Picking
• Banging or hitting body parts
• Hair pulling
• Swallowing objects or toxic substances

Who self-harms?

It's been estimated that about 1 in 10 admissions to UK medical wards are the result of self-harm. While it's most often associated with angst-ridden adolescents, self-harming is known to occur in younger children right through to older age. It can occur at any age, however, it's more likely to be missed in older people.

Why do people self-harm?

In most situations, self-harm is a maladaptive coping mechanism used to modify painful feelings or to communicate distress.

Abuse in childhood is recognised as increasing the risk of self-harm, as well as early losses and troubled relationships.

In terms of personality disorders, it's been estimated that about three quarters of people who have EUPD will engage in self-harm at some time in their life. Autistic people may also engage in self-harm, often quite severely, and can include biting and head banging.

Understanding why people self-harm

Understanding why people self-harm is key to being able to provide them with the support they need. Potential triggers of self-harm are:

• Coping mechanism to provide relief from intense feelings
• Controlling emotional pain
• An attempt to break out of a dissociative state or a state of emotional numbness
• Making others feel guilty
• Alcohol can be a disinhibiting factor and many people who self-harm will do so in association with drinking

While for some people, self-harm may bring them back into reality from a dissociative state, for others it may take them away from and allow them to distance themselves from emotional pain, which they struggle to deal with in healthier ways. The physical pain replaces the emotional pain and allows them to, at least temporarily, free themselves from that state.

We know that our brain chemistry changes in response to physical injury; opioids are released and that could be one of the psychopharmacological mechanisms in which self-harm can modify inner feelings.

Treatment for self-harm

For people who are struggling with self-harming behaviours, the most effective psychological treatment is dialectal behaviour therapy (DBT). DBT is a modified form of cognitive behavioural therapy (CBT), which is focused on improving emotional regulation skills. It's usually done in a group setting with elements of individual support, and involves helping the person to understand their subjective state around an episode of self-harm or impulsive behaviour, which ultimately improves their regulation and reduces the chances of it happening again.

Alongside any intervention such as DBT, which addresses the act of self-harm directly, it's also important to treat any underlying mental illness, such as depression or anxiety. This can also be done using DBT, CBT and other therapies such as mindfulness.

Priory has a nationwide network of hospitals and wellbeing centres that are well-placed to support people and offer fast access to therapy for self-harming behaviour.