Self-harm, also known as non-suicidal self injury (NSSI), involves repetitive, intentional, direct injury to the body, often done without suicidal intent. The most common forms of self-harm include cutting the skin with a sharp object, overdosing on prescription medications, severe scratching, burning, and banging or hitting body parts. It is most commonly seen in adolescence and young adulthood between the ages of 12 and 24 years old. Self-harm can occur in both sexes, although females engage in more frequent self-harm behaviours than males.
Although self-harm is usually carried out without suicidal intent, it can sometimes lead to a serious medical emergency and can be life-threatening. There is also an increased risk of suicide in individuals who self-harm.
Causes of Self-Harm
Despite the common belief that self-harm is an attention-seeking behaviour, this is usually an inaccurate or insufficient explanation. Most people who self-harm are actually very self-conscious about their wounds and scars and may try to conceal them with clothing.
Self-harm may be used to fulfil a number of different functions, including:
- To manage negative emotions such as anger, depressed mood, anxiety, etc.
- To end periods of dissociation or depersonalisation
- To avoid suicide
- To communicate a need for help and support
- To deal with poor body image, low-self-esteem or self-hatred
- To punish themselves for something they’ve done
- To get a feeling of ‘high’ (versus emotional numbness)
- To feel more in control
Self-harm has been associated with other psychological problems, such as depression, anxiety disorders, post-traumatic stress disorder, eating disorders, personality disorders (especially borderline personality disorder), a history of physical, emotional or sexual abuse, substance abuse, and interaction problems with peers and family.
Although the motivations to self-harm can be varied, individuals who self-harm appear to have one or more of the following in common:
- A tendency to use avoidant strategies to cope with problems
- Difficulties tolerating strong emotions
- Problems with regulating and manage emotions
Experts believe that self-harm is a response for managing intense aversive emotions and this represents a dysfunctional emotion regulation strategy.
Treatment for Self-Harm
Given that emotion dysregulation is believed to be the primary mechanism behind self-harm, psychological treatments such as Dialectical Behaviour Therapy (DBT) have focused on improving emotion regulation in individuals who self-harm.
- An awareness, understanding and acceptance of one’s emotions
- The ability to inhibit impulsive behaviours (such as self-harm, reckless behaviours or physical aggression) and to engage in goal-directed behaviours (e.g. attend classes, go to work, engage in social relationships) when distressed
- Use of appropriate strategies to manage the intensity and/or duration of emotional responses
- Willingness to experience negative emotions as part of pursuing meaningful activities in life
In addition to emotion regulation skills, DBT also teaches mindfulness, distress tolerance skills and interpersonal effectiveness skills. The efficacy of DBT with individuals who self-harm is now well-established.
It is important to note that some injuries resulting from self-harm may require immediate medical attention, and presentation to the Emergency Department may be necessary.
If you are concerned that you may seriously harm yourself it is recommended that you call Lifeline on 13 11 14, speak to another responsible adult, or take yourself to the Emergency Department at your nearest hospital, rather than wait for an appointment.
If you would like to find out more about our treatment for self-harm and emotion regulation, or to book an appointment with one of our clinical psychologists who provides treatment for these difficulties, please email or call the clinic on 02 9438 2511.