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What is self-harming behaviour? Intentional self-harm, including cutting, burning, head banging, non-lethal overdoses etc. is best understood as a non-functional way of relieving anxiety, fear and other painful emotions. Repeated self-injuries and overdoses are frequently associated with other, more indirect, self-destructive behaviors such as eating disorders, prescription, street drug addictions, and alcohol abuse. Found in people of all economic and educational backgrounds, self-harm usually declares itself in early adolescence and may be one of the manifestations of the long term effects of severe trauma in childhood. Self-harm is a destructive coping strategy which usually leads to many admissions to emergency rooms and inpatient psychiatric facilities. These admissions rarely result in the control or discontinuation of the pattern of self-injuring. Frequent admissions to psychiatric facilities rarely limit the self-harming behaviors. Even when they are not intentionally suicidal, those who self-harm are in danger of escalating their self-harm to lethal levels and may eventually die from the illness. DSM-IV includes self-harm as one of the criteria needed for making the diagnosis of borderline personality disorder and most those who self-harm have been diagnosed as having this condition. People suffering from dissociative identity disorders are also known to self-harm. While the coping style of those who self-harm may seem grotesque to many healthcare professionals, it is imperative to appreciate that some people who have experienced abuse and neglect from their caretakers in childhood find it easier to hurt their bodies than to experience profoundly disturbing emotions of fear, rejection and abandonment. Although difficult to fathom, the self-injury actually appears to relieve the acute and painful emotions that result from current life stresses in these individuals. In talking to men and women who self-harm, I have found that control of racing thoughts, feelings of relaxation, feelings of realness, relief of loneliness and the establishment of personal control to be commonly offered grounds for the behaviour. Several of my clients have described themselves as able to "turn emotional pain into physical pain" by injuring. Many people explain that physical pain is easier to manage than emotional pain. In addition, these consumers find healthcare workers more compassionate when dealing with physical injuries. The frequent injuries, calls and visits to doctors, hospitals and other helping agencies "burn-out" even the most compassionate and experienced caretakers who eventually lose the endless patience which is needed to weather the constant storm. Success or failure in managing self-harm People who self-harm should have significant and appropriate interventions being offered in the community in which their problems occur. Support of family and friends is very important. Self-harm and its accompanying self-destructive behaviours are symptoms resulting from disturbances that affect the developing personality of a child. However, since the trauma may have been inflicted by untrustworthy caretakers the person may be unable to trust new caretakers in the guise of professionals and experts now in charge of their treatment. They frequently resist the treatment suggestions, and repeatedly test both the caring and the authority of the helpers. Physicians, nurses and therapists who attempt to use persuasion or coercion will find them involved in endless control battles with their self-abusive patients. In the end everyone will lose. Medications have been effective in stopping self-harm, but all provide an additional and convenient way to abuse. The person, in rejecting the physician's authority, can be relied upon to misuse, abuse and overdose the prescribed medications. |
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