The Alternative Story

Self-Harm: Understanding Non-Suicidal Self Injury

Emotional pain can emerge in very intense and confusing ways. In certain situations, the pain can be debilitating and difficult to manage. Some of the ways it can manifest are through crying spells or extremely high anxiety. It may feel like our entire body is experiencing the pain. Tension or heaviness may emerge in certain parts of the body. When we experience such pain, our body tries to cope with it. Experience of pain, anxiety or any form of distress over a long time can lead to a reduction of our body’s resources. We start feeling exhausted. At this point, many of us might experience numbness or a state in which we are unable to feel anything. 

There are different ways to cope with distress, and we try to find ways to reduce the pain we experience. One of the ways in which people cope with pain or numbness is by harming themselves.

Self-harm is not an attempt to suicide, it is an attempt to harm oneself to manage the distress one is experiencing. Self-harm can occur in several ways, including scratching, cutting, hitting, scabbing, bruising, bone-breaking, and burning, among others (Claes et al., 2015).

Self-harm is only the harm that is done to oneself without the intent of suicide. It is also referred to as Non-Suicidal Self Injury (NSSI). Claes et al., (2015) stated that non-suicidal self-injury is deliberate and direct harm done to one’s body tissue without suicidal intent. 

Harming oneself can be a way to feel more in control of the situation. It could be a way to make our pain more tangible, by converting it to physical form. It could also be a way to make ourselves feel something, even if it is feeling pain. Harming oneself is a way a person has learned to deal with the painful or intense emotions arising. When we can’t verbalize it or the environment doesn’t let us express it without harmful consequences, self-harm can be resorted to. 

 After injuring oneself, fears about this urge escalating in the future might emerge. There also might be feelings of guilt for putting oneself at risk or shame about someone finding out. Self-harm is a coping strategy that can put one at risk, and make one feel unsafe. 

The relief that comes with harming oneself is only temporary. This is because the emotion hasn’t been addressed or the problem remains unsolved.

Hence this forms a loop or a cycle in which there is emotional distress, over time this leads to an emotional overload. One copes with this by harming oneself. Unlike other coping strategies, self-harm most often brings up shame. The fear, guilt, and shame that follows might then add to the already existing distress. 

Both suicidal ideation and self-harm can put a person at risk. Hence, while talking about suicide, it becomes important to address NSSI as well. Suicidal behaviour is when one injures with the intent to die, whereas the intent of NSSI is to cope with emotional distress or pain. However, NSSI and suicidal behavior can also occur simultaneously in the same individual (Butler & Malone, 2013).

The journey that the emotional distress takes can be filled with urges and attempts to not give in. It can be a very exhausting process. One can feel very helpless while trying to understand ways to cope with the situation. If we know someone who self harms, we might not know what can be done about it. Here are some starting points for our journey to deal with the urge to self-harm:

  1. Finding safer ways to cope with distress – Self-harm is a coping strategy. If we had other ways to cope with situations and our distress, the possibility of resorting to self-harm reduces considerably. Grounding or relaxation techniques might help reduce the distress or anxiety that we are experiencing. At times, techniques to distract ourselves and engage in a completely different task might be helpful. One can make a list of activities that help relaxing or to distract yourself.

  2. Reach out for support – When relaxation or distraction doesn’t work, it might be helpful to reach out to people we trust. Engaging in a conversation might help divert our attention from our distress. Identify who you can reach out to during distress by writing down names of supportive and trustworthy people in your life, If we know someone who might be harming themselves, we can check in with them to see how they are doing and if they would like to be supported in any way. Having a conversation about what support would look like for them might help understand what they need at the time.

  3. Ride the wave of the urge – We might feel an urge to harm ourselves when we are feeling very vulnerable. The journey of any urge is just like a wave. It increases in intensity and once it reaches its peak it might be very difficult to resist. However, after it reaches the peak, it reduces in intensity over time. While it is at its peak, we can try to find ways to ride the wave and buy time until it passes. We can remind ourselves that this is going to pass, or distract ourselves in moments of distress. Alternatively, we could find safer ways to address the urge. For example, we could hold an ice cube in our hand, colour the part of the body with sketch pens that we feel like injuring. Holding an ice cube or colouring the part of the body can help in feeling sensations in that part of the body while reducing the harm involved.

  4. Self-care after harming oneself – It is important to take care of the wound or hurt after it is done. It is helpful to have first aid accessible so that we don’t have to struggle to arrange for first aid after the injury has happened.  

  5. Forgiving oneself – Many of us might feel guilty for not being able to take care of ourselves in times of distress. Our distress, pain or anxiety is not our fault. There would be times we feel overwhelmed and try different ways to cope with it. The point to focus on is that we are trying and putting effort to cope differently. We can find ways to be kinder to ourselves for those distressing times in which we struggled to take care of ourselves. 

  6. Access mental health care – Self-harm is often viewed as a “cry for attention”, whereas it is an indicator of a person dealing with intense internal turmoil. It is okay to reach out to a mental health professional to understand your distress better. You and your therapist can find healthier ways to cope with distress. Each of the above aspects can be discussed in detail in therapy, which could be a safe and supportive space. Mental health care is every individual’s right, and everyone deserves it!

By Naina Shahri

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