Why Do People Self-Harm? Is There More Than Just Cutting?

This article will explore the different kinds of self-harming behaviour some young people and adults report. It will explore the emotional aspect of self-harm and other relevant issues that might be behind the behaviour, as well as look at the addictive element of self-harm and compare similarities to substance addictions in its powerful pull.

As a professional counsellor who works with clients who self-harm I have noticed how different self-harm can be and how compulsive the behaviour can feel. Many people associate self-harm with cutting the skin in order to feel pain and the relief that comes with it. This is often associated with nursing and taking care of the wound and this may be the only time that the person shows themselves compassion. There are also subtler and less talked about forms of self-harm, for example:

Hair Pulling, where the person pulls one strand of hair at a time out of their head. This can lead to bald patches, which in turn cause shame and guilt.

Activity addiction, where a person can become very immersed with activity as a way to not feel their uncomfortable feelings and harm themselves. The harm comes in the form of being busy to the point of burning out which then requires them to nurse themselves back to health only to repeat the cycle again.

Skin Pulling, where the person pulls bits of skin around their fingernails to the point of bleeding. This can start off with fingernail biting and progress onto the skin.

I have observed a pattern with these behaviours which begins with an experience of low self-esteem that borders on self-hatred. From this low self-esteem, self-abandonment begins to appear. This is where a person does not want to be by themselves and needs a constant connection with others in order to feel OK. Without release the behaviour escalates:

• The act of harm and the rush and relief of pressure this brings
• The private time where the person is in the moment with the act
• The healing process after the act
• Shame and guilt at the harm act
• Feelings of doing it again to cope with the feelings

A person can stay in this painful cycle until it becomes so painful they can no longer stand it. At this point, the healing can begin. Progress can only be made when a person is able to admit they have a problem. They can then talk about how it felt to be triggered into wanting to self-harm. From this, they start to look at what might have happened during the day, previous week, or years that may have contributed to them wanting to harm.

The next step is to look at actions that need to be taken when their strong feelings of harm occur. Actions that seem to be most helpful are:

Ringing a trusted friend, someone who isn’t going to advise or judge but just listen and be there for them. I must emphasise how many times clients have shared with me that they phoned someone when they had strong feelings to harm and at some point, within the phone call, experienced the urge fade away and then disappear.

Changing the environment is also a great technique. Getting out of the house and going for a walk, away from the ritual place of harm can greatly help the readjustment of mood and help ground the person in reality.

Self-harm can offer relief from stress that has built up, like a blocked dam on a river. Something has to give, either the dam breaks or there is relief in the amount of water being held. Self-harm can bring temporary relief, but its only through exploring their past in therapy that the pressure can be healthily released and the dam can once again begin working in a healthy way and not continue to block up.

Once clients begin this healing process they can start to explore what might be going on emotionally for them. It is helpful to look back in the person’s history to explore where this behaviour first started and what might have been happening in the person’s life at the time. At this stage, it can be helpful to explore, with the client, what feelings they might associate with their early childhood and growing up. For a person to use self-harm as a coping mechanism, it normally indicates a great deal of internal pain and as a counsellor, my job is to is to walk alongside them to help to find out the cause for this pain.

As a final point, I have noticed that it is helpful to talk about how addictive the process of self-harm can be. Just like other addictions, it can seem extremely hard when people stop self-harming behaviours. There is no denying that stopping these behaviours can lead to painful withdrawal- like feelings. However, with time, and using the tools mentioned above, the obsession with the act starts to lift and it becomes easier not to self-harm as time goes by. This knowledge is important because it can be easy to believe it will be difficult forever, especially in the early stages of healing, which is not true. It does get better.