Please note - Some may find the content in this article distressting or triggering. For support or information please make contact with the support phone numbers listed below.
On the surface, deliberate self-harm and suicidal behaviours can seem pretty similar. But mostly they’re not. And unless we’re clear on both the differences between the two, and the relationship they can possibly share, things can get even more confusing.
Self-harm is also commonly known as self-injurious behaviour (SIB), self-mutilation, non-suicidal self-injury (NSSI), para-suicide, deliberate self-harm (DSH), self-abuse, and self-inflicted violence. As one would expect, having multiple terms of self-harm begins the multitude of misunderstanding and confusion in the academic research and clinical settings – let alone in the community.
Self-harm (and all the other terms) refer to a range of behaviours, but not a stand-alone mental illness or disorder. People who engage in self-harm behaviour deliberately hurt their bodies. Most commonly this is done by cutting, burning, hitting, picking at skin, pulling hair, or biting.
The majority of those who self-harm do not have suicidal thoughts when they are self-injuring. And here lies the difference between self-harming and suicidal behaviours. It is one of intent. Whilst this may seem counter-intuitive, the person who is self-harming, does not intend for this harmful behaviour to be fatal. Instead, there are a number of reasons why a person may self-harm (Klonsky, 2007):
- To alleviate intense emotional pain or distress, or overwhelming negative feelings, thoughts or memories
- As a form of self-punishment (some people damage their bodies to punish themselves for what is going on in their lives. They may lack the appropriate coping skills and suffer from low self-esteem so feel they are deserving of what they are doing to themselves).
- To feel euphoria (When we experience pain, endorphins are released into the blood stream, resulting in a ‘natural high’ or a feeling of euphoria. Sometimes self-harming behaviours can become addictive and habit-forming.)
- To experience dissociation or numbness from overwhelming negative experiences.
So although self-harm is not the same as suicide, self-harm does have the potential to escalate into suicidal behaviours. The intent to die can change over time. One study found that almost half of people who self-harm reported at least one suicide attempt.
Self-harm has also been found to lead to suicide when:
- Self-harm is no longer an effective coping method. It ceases to assist in helping the person deal with the feelings cause by stress or trauma.
- In a crisis situation, people who engage in self-harm and have become desensitized and habituated to pain through repeat harming episodes may view a suicide attempt as less threatening.
For some of us, when we engage in things for a while and these behaviours have a positive effect on our mood (i.e., release our anger, alleviate boredom, ease stress, reduce pain) such behaviours can eventually take on a repetitive and almost compulsive and habitual quality when used in response to regulating our mood. Something similar to how we might conceptualise substance-use disorders. And this can come with an increasing tolerance – having to engage in the behaviour more often and with more intensity to get the same effect – and withdrawal – difficulty ceasing the behaviour.
So whilst not initially intended to be fatal, the potential for harm with deliberate self-harm is great and should be taken seriously. Many people may try and hide their self-harming behaviour and only around 50% of people who engage in self-harm seek help – other through informal sources such as friends and family, rather than professionals.
While all the people are different, there are some warning signs that someone may be self-harming. Aside from the obvious signs such as exposed cuts or bruising, some less obvious signs might include:
- Appearing withdrawn, or more quiet or reserved than usual
- Social withdrawal - Stop participating in their regular activities
- Rapid mood changes
- Get angry or upset easily
- Have experienced a significant event in their lives (e.g., a relationship break up)
- Suffer poor school/work performance when they usually do very well
- Wearing clothes that are inappropriate for the weather (e.g., wearing long sleeves on a hot day)
- Strange excuses provided for injuries
- Hiding objects such as razor blades or lighters in unusual places
If you think that someone you know or love is engage in self-harm, the very best thing you can do is talk to them about it. I’ve worked with a number of people who have overcome self-harming behaviour. There are heaps of excellent services and supports to help. Here are some ideas for how you might be able to get the conversation started:
- Ask them how they are feeling
- Try not to be judgmental
- Be supportive without reinforcing their behaviour
- Educate yourself about self-harm
- Acknowledge their pain
- Try not to avoid the subject
- Do not focus on the behaviour itself
- Encourage the person to seek professional help (a good place to start is with the person’s GP).
As always, talking and learning about self-harm and suicide is so important but it can bring up some really tough emotions. Please take care of yourself and reach out to a trusted family member, friend or one of the suggested crisis lines below if you need to talk about how you’re feeling.
Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au