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Types of Self Harm, Some Facts and Misconceptions

Author: Jennifer Keenan

31st Oct 2013

Types of Self Harm, Some Facts and Misconceptions
Mention self harm and most people will think of someone in a very agitated state and that the act itself may occur in a state of frenzy. In my experience the opposite seems to be true. The act itself in most cases at least seems to be quite controlled, precise as to how and where the person chooses to self injure. Most people will report feeling a sense of calm afterwards as if their feelings have become manageable again.
It is important to remember that all harmful behaviours serve a function whether it is to combat anxiety, poor body image or to dull social anxiety. We all can use behaviours that could be deemed unhealthy. There are many self-harming behaviours that may go undetected by parents or care givers because they do not fit with what is perceived as self harm. Some of these may include:
 - Nail picking or biting especially at the edge of the nail, in extremes causing the nails to bleed.
 - Hair pulling. the medical term for this is 'Trichotillomania'. This is deliberate hair pulling from the head, eyebrows or eyelashes.
 - Deliberate self harm such as punching, bruising, throwing themselves down stairs or constant accidents resulting in broken bones. This form of self harm can go undetected especially in boys as it can often be dismissed as a case of a clumsy teen or as a result of sport or horse play.
 - Ingestion of objects, this can include objects as well as the ingestion of cleaning fluids such as bleach or other cleaning liquids. With this type of behaviour there are obvious risks such as choking or poisoning. With other objects which may require surgery, there are risks with anaesthetic and post-operative infection.
 - Burning: Easily explained away as an accident unless there are recurrences. Special attention should be paid to burns that are slow to heal as these could be indicators of an incident of self harm and not just an accident as it could be an indicator of someone picking or re-injuring the burn. Obviously the dangers of this approach are serious injury and disfigurement.
 - Cutting: The most common approach and the one most people would connect with self harm. It is also the form most likely to start at a younger age. Sometimes through picking or scratching with an instrument such as a compass. Progression to larger instruments such as knives, scissors or blades is common. The risk here being a person in distress may cut too deeply or more than they had intended. There is also the risk of cutting a vein or artery.
Without support and understanding of what causes someone to self harm it is possible for it to continue and even to become exasperated as they do not develop better coping skills to deal with the emotional distress they are experiencing.

Some Common Misconceptions

There are a number of ill-informed myths attached to self harm. The first being that self harm is of itself a suicide attempt. Most people who use self harm as a coping skill do not see the behaviour as a way to end their own life. That is not to say that someone who is suicidal will not have engaged in self-harming behaviour prior to making a suicide attempt.
Attention seeking: Self-harming for the vast majority is a secretive, hidden behaviour often only discovered by accident. If someone is choosing to display their injuring they are attempting to show to us the pain they are in and the help that they need.
Self harm does not hurt the person doing it: While many report feeling numb or not quite present when engaging in an instance of self harm, they will experience the consequences of such injuries. The immediate pain is displaced because the emotional distress is so great at the moment for them.
People who engage in self harm are mentally ill: Due to the secrecy attached to self harm, people are often surprised to learn that someone they saw as very on top of things is a self harmer. People who self harm are not mad, crazy or deranged they are just very emotionally distressed.
People who self harm must be violent: Rather the direct opposite is true. People who self harm tend to be quiet, shy, sensitive people who experience things deeply. They also like to help others, making it difficult for them to discuss their own distress. They tend to be sensitive and feel things deeply.
 Self harm is addictive: It may appear that way from the outside but often to someone in distress, self harm is their only way of expressing deep emotional pain.
 Facts Regarding Self Harm
Self harm is used as a way of expressing and or releasing overwhelming, often times, built-up feelings. In many cases self harm has distracted the person from suicidal thoughts or has acted as a stop gap.
Often, a person self-harming will experience a dissociative state. They may report feeling 'out of it' or not quite in their bodies at the time of their self-harming. We believe that almost certainly people who self harm disassociate as a way to separate the mind from the physical experience of hurting themselves. There is also a belief that people who self harm have a higher pain threshold than most and this would certainly seem to be the case.
As already discussed, most instances of self harm are disclosed by accident and can be distressing for the person who engages in self harm, but also for their parents or care givers. It is understandable for a parent to experience a range of emotions on disclosure such as anger, disgust, confusion, upset, disbelief, frustration and shame.
While each of these responses are understandable reactions, it is important to hold onto the knowledge that for whatever reason your child has turned to this way of coping because they are experiencing huge emotional turmoil and feel unable to express it in any other way. Many times initial feelings of concern can turn to anger.
You, as a parent, may find that you are angry at them for behaving in this way or for adding to a list of problems you are already struggling to deal with. You may also find yourself annoyed for the questions that may be raised about your parenting skills.
This new knowledge may well impact on how you and your child engage in the future, you may become acutely aware of what you say and how you speak to them - afraid that a disagreement or harsh word will result in another bout of self harm. While these reactions and fears are normal and will subside with time, it may also be an opportunity for everyone involved to look at how you communicate and to make changes if that is what is deemed necessary.

Jennifer Keenan is a Dublin based psychotherapist who deals with a wide range of issues including self harm.

To get in touch with her you can visit her Dublin Holistic Centre counselling and psychotherapy page or visit the Jennifer Keenan Counselling & Psychotherapy website.

The next article in this series is titled “Signs your Child might be Self-Harming, Why they Might be Doing it and How to Help”. Click on the title to read the article.

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