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Understanding and Identifying Self Harm

Author: Jennifer Keenan

31st Oct 2013

Understanding and Identifying Self Harm
Self harm is a term used to describe an act where a person deliberately injures themselves. The way in which that person chooses to injure themselves can vary but can include - hitting, slapping, punching, scratching, cutting, bruising and deliberate burning.
In most instances the individual is trying to cope or manage an emotion or range of emotions that they find difficult to process or deal with. Often, people who engage in self harm feel as though they have no other outlet for their feelings. Other times they can report feeling overwhelmed by them - as though they all come together making it difficult to distinguish one emotion from another.
In many instances self harm is an exterior expression of an internal emotion or reaction. Sometimes but not always, self harm can be seen in people who have a pre-existing mental health condition such as depression, anxiety, an eating disorder or bipolar disorder.
It is important to keep in mind that because someone is self-harming this does not automatically mean they have any of the other issues outlined above. Self harm, in most cases, is a person's attempt to manage their feelings and not 'attention seeking' behaviour, as is sometimes though.
Even when self harm is displayed openly - that is not hidden from view or from friends and family - it is still very difficult for the person engaging in self harm to discuss. Typically not all who engage in self harm will feel the need to hide it or to cover it up, albeit that this can add to the distress of those around them.
It is important to remember that most instances of self harm are discovered by accident and not deliberately disclosed. It is also hugely important to remember that self harm is an exterior expression of an inward pain on discovery of a loved one self harming.
It is my experience that people who engage in self harm usually tend to be very bright as well as high achievers, who put a lot of expectations on themselves in every aspect of their lives from personal interaction with friends and family members to their academic and work performances.
I have found that people who self harm often struggle to identify their feelings, to name them or to identify where they experience them in their body. Many times a client who uses self harm as a coping mechanism (for that is what it is - a way that they have found to cope) have explained that they experience their feelings as building up to a point where they can no longer tolerate them.
By engaging in self harm it helps to release some of the pressure they feel - I often use the analogy of a pressure cooker with clients. While in most instances they have developed a coping mechanism that seems to work, self harm is one that is only useful in the short term.
What once worked and helped, over time diminishes, sometimes resulting in more frequent or more intense self harm. For example someone who cuts themselves may well feel that in order to maintain the same level of relief, they may have to cut more frequently, with more force or deeper in order to gain the same level of satisfaction as before.

In therapy we work with the person to help them identify their feelings, to begin to know what they feel and where they experience it in their body. Many times, for instance, clients have identified difficulty in allowing themselves to experience anger.
It is of course important that we are able to experience all our emotions, both positive and negative, without judgement and to have an outlet for those emotions in ways that are healthy for us and the people around us.

Often people who self harm or self injure as it is also known, are very self-critical and have an inner voice with little tolerance for mistakes. Typically they take pleasure in helping and supporting others, but find it incredibly difficult to show this same concern, empathy and compassion towards themselves.
So when we discuss or talk about self harm what exactly do we mean? It is most often associated with cutting but any of the following could be a form of self harm:

 - Binge drinking
 - Smoking
 - Burning
 - Inserting or swallowing objects
 - Picking or gouging
 - Nail biting
 - Substance misuse
 - Extreme exercising
 - Hitting
 - Scratching
 - Head banging
 - Food restriction/obesity/binging and purging

Many of the above list may well be a surprise and not what many would consider self harm. but there are two main differences between self harm as a result of cutting or burning and self harm as a result of food restriction or purging.
These being the results of self harm through cutting or burning are immediately obvious and visible, while the results of food restriction may not be noticed and side effects may not be detected for a significant period of time. Smoking, binge drinking and even to some degree food restriction are all socially acceptable to some degree.
Self harm can be called many things - self-injury, self-mutilation and even self-abuse. Self harm is, by definition, the intentional injuring of body tissue without in the majority of cases, suicidal intent.
Self harm is often lumped in together with suicide. Although most people who self harm will tell you that they are not suicidal and that their self harm was not an incident of suicidal intent. The type of behaviour described above as self harming behaviour is usually hidden from family and friends. There is a great deal of secrecy with self harm which leads us to think it is more wide-spread than currently reported.
When exploring with someone why and how they began to self harm, the answers may well vary - some will have had prior knowledge or have witnessed it through a friend or peer. Others may have become aware through television or media. For others it will have been instinctive and they will be unable to report how they first became aware of it.

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 "Types of Harm, Some Facts and Misconceptions". Click on the title to read the article.

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