Imagine that you are a fourteen-year-old who has a history of parental abuse or neglect, is struggling at school, has few friends and is vulnerable to peer pressure. You are in frequent conflict with your parents. Some of your friends are known to intentionally harm themselves and say that they find relief in doing so. Do you have the skills to manage intense emotions? If you do the same by cutting your arms and legs, is it a cry for help, or a precursor to suicide?
What would lead someone to harm themselves? These are people who have problems regulating emotions. They don’t know how to cope with intense or overwhelming emotions and find relief through damaging their skin. It is most common among adolescents with an onset around age 13 or 14 and increases as they reach older adolescence up to age 17. It offers a temporary escape from intolerable feelings. The intent is survival rather than death.
How does creating pain by hurting your body help someone who is already in psychological pain? The self-injury may provide a distraction for someone who is better able to tolerate physical pain than emotional pain. It may give them a sense of control over their feelings. It is an attempt to express internal feelings in an external way. It may communicate intense emotions to the outside world. And it may serve as punishment for perceived faults.
Most people who harm themselves are not doing so for attention or making a cry for help. They typically wear long sleeves or long pants to hide the scars or cuts.
Self-injury is the deliberate destruction of body tissue without suicidal intent. It is listed in the DSM 5 as a diagnostic disorder. Its criteria are five or more days of self-inflicted harm over the course of one year without suicidal intent and, the individual was motivated by seeking relief from a negative state, resolving an interpersonal difficulty, or achieving a positive state.
However, a spectrum of behavior exists from self-injury on one end progressing to suicide attempts on the end. Self-injury is a strong predictor of future suicide attempts. It is important not to assume that someone who harms their body wants to kill themselves, but keep in mind that there is increased risk for suicide.
The goal of therapy is to help clients learn to tolerate uncomfortable feelings and find healthier means of managing overwhelming emotions. They can benefit from learning to control impulses. Increasing family and social support is a buffer against these intense states. Research shows that strong parental bonds can differentiate those who think about suicide from those who actually attempt suicide.
If you know someone who self-injures don’t panic or become angry. Although this behavior is alarming, understand that this is someone who is struggling emotionally. Ask them what you can do to help them from injuring themselves. Realize that this is a coping strategy, not a weapon against you. Model healthier coping skills. It is a treatable condition.