Self-harm is a complex issue that many of us find difficult to understand or deal with. We explore why people self-harm and how to take the first steps to recovery.
Self-harm is when a person injures or damages their body on purpose.
It’s very hard to know how many people in Ireland, or, indeed, internationally, engage in self-harm. In Ireland, for example, the National Self-Harm Registry Ireland is a national system which collects and monitors information on people presenting to emergency departments in hospitals after an episode of self-harm. Despite this registry, and other carefully compiled research and data, getting accurate estimates is difficult because a lot of people who self-harm don't present to either the GP or other services. However, one study from America suggests that 17% of people self-harm at some point in their lives, and that just over half of people who self-harm seek help, but largely just from friends.
This indicates that self-harm is something that affects a lot of people, yet remains an issue and behaviour that many of us don’t fully understand. Professor Paul Fearon, Medical Director here at St Patrick’s Mental Health Services (SPMHS), explores some of the reasons that people self-harm, before pointing towards the steps we can take to respond to it.
Why do people self-harm?
There are many reasons that people have for self-harming. At its core, self-harm signals some sort of internal distress, whether that’s recent or rooted in the past.
For some people, self-harm might be as way to express or to cope with internal, emotional distress. Other people can feel like they have no control whatsoever over any aspect of their life; self-harm might be on the one thing that gives them a sense, at least, of control, even if it’s unpleasant. Some people might be experiencing an overwhelming sense of numbness or even just feeling nothing. Here, self-harm can be a way of feeling something; it might seem to them that, even if it’s pain, it is better than feeling nothing. For others, self-harm can be about punishment, about dealing with a feeling of being somehow worthless, or about tension relief. Self-harm might, in some cases, also be an indirect expression that somebody needs help, or what might be called a cry for help.
None of the reasons for self-harm are mutually exclusive, meaning that they often overlap. Equally, most people who engage in self-harming behaviours don’t actually want to do this; it’s just a better alternative to how they’re feeling.
Are there treatments for self-harm?
In dealing with self-harm and all its reasons or causes, it's very important to remember that there are supports, treatments and strategies to help.
Self-harm is not something a person wants to do; it is a reaction to distress the person is experiencing. It is therefore important to seek out these supports for self-harm.
Professor Fearon notes that a lot of people still feel shame or stigma around self-harm. This can mean not only that it’s hard for others to recognise, but that the person might feel themselves that there’s a barrier in seeking help. For example, things might look great from the outside and the person might have great support systems in their families. Inside, however, a person might be feeling very distressed, emotionally drained, and unsure or embarrassed about disclosing self-harm.
However, even just sharing the load with a friend or family member and starting the process of finding the right help can lead to not only a reduction in the self-harm itself, but a boost in the way the person feels and an improvement in their overall wellbeing.
For a lot of people who self-harm, there may be an underlying mental health difficulty that is very treatable. This is something that a lot of people might not realise, and, again, reminds us as to why it’s important that a person engaging in self-harm talks to a doctor or GP, discusses how they’re feeling, and learns what supports and treatments might help.
What should you do if you are self-harming?
Professor Fearon shares some guidance for people who are self-harming on beginning the journey towards recovery.
He advises that the first thing to do, if you haven’t talked to anybody, is to make a decision not to keep it to yourself. For the vast majority of people who experience self-harm, they do want things to change, and that’s going to have to involve talking to someone.
You might find it helpful to start by thinking whether you want to carry on self-harming. From here, you have two options. The first option is not to tell anybody, which would mean things stay the same and you are likely to continue self-harming. Deep down, that’s probably not what you want to do. The second option is to seek help. This can still be difficult at first, but it is the option that can help things to change.
You might talk to a trusted friend, spouse or family member first. However, if you’re afraid or reluctant to talk to someone who you know, remember that appointments with your GP are confidential; you might prefer to go straight to them instead.
In all cases, it’s really helpful to see your GP. They might know you well, for other reasons, and can often offer you the best initial source of knowledge on how to form an initial care plan or point you in the direction of the most appropriate care.
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We have some general information about mental health and supports available in our Frequently Asked Questions. You can find out more from the Health Service Executive (HSE) about self-harm and supports available.
If you are in crisis or in urgent need of support, know that help is available: contact your GP or call the emergency services by dialling 999. You can find more out-of-hours supports here.
