While suicidal behaviour is one category in a range of self-harming behaviours, it is important to understand that many people engaging in self-harming behaviours do not intend or expect to die.
The terms self-harm or deliberate self-harm relate to any self-injurious behaviours (eg self-poisoning, self-mutilation, self-injury), regardless of the intention to cause death or not.
However, recently the term self-harm has become synonymous with intentional but non-lethal self-injury, and cutting the skin in particular. To make the discussion in this page clearer and less confusing the terms suicide and self-harm will be separated, to refer to self-injury with the intention to cause death (suicide) and self-injury without the intention to cause death (self-harm).
Common Forms of Self-Harm
Skin cutting is the most common form of self-harm; but the term also covers a wide range of behaviours including, but not limited to: burning; scratching; banging or hitting body parts; interfering with wound healing (dermatillomania); hair-pulling (trichotillomania); and the ingestion of toxic substances or objects.
Bodily injuries that are caused by substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect. However, damage done in these ways could be considered self-harm if the damaging behaviours were engaged in to intentionally cause tissue damage.
Suicide is not always the intention of self-injurious behaviour – in fact, some people report that self-harm protects them from suicide. The relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening. For example with skin cutting, there is the potential for unintentional death from blood loss. Statistics show an increased risk of suicide in individuals who self-harm, with one study citing a history of self-harm in 40–60% of suicides.
A chronic desire to self-harm has been identified as a common symptom in Borderline Personality Disorder (DSM-5), but other diagnoses where self-harm may be a feature, include depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders. However, the behaviour is not exclusive to those with a diagnosable psychological disorder. Self-harm is also seen in people who appear to be high functioning with no underlying clinical diagnosis.
Why do People Self-Harm?
People who self-harm are a varied group and thus the reasons for self-harm are also diverse. Some of these motivations and functions include:
- to relieve tension;
- provide distraction from painful feelings;
- decrease dissociative symptoms;
- block upsetting memories;
- communicate distress to others.
Unfortunately, because self-harm does work temporarily for most of the above functions, it is reinforced as a useful coping strategy, and can become the “go to” strategy when the motivation arises again.
Treatment for Self-Harm
Treating a person who is self-harming relies on understanding the motivations and functions of the behaviour. For example, if someone self-harms because they feel they cannot cope with strong emotions, treatment focuses on teaching skills to cope with these emotions, along with building self-confidence in the individual to cope without self-harm.
The most important component of treating self-harm is managing risk, and strategies to address the riskiest behaviours are given priority to ensure the safety of the client.
Psychological interventions that can be helpful to address the underlying psychological dysfunction and skill deficits associated with chronic self-harm include Dialectical Behaviour Therapy and Cognitive Behaviour Therapy.
Greta Neilsen is a Loganholme psychologist, experienced in the treatment of depression and anxiety in adults of all ages. She endeavours to provide her clients with a safe space to understand the challenges they face, as they develop ways to overcome their difficulties.
To make an appointment with Loganholme Psychologist Greta Neilsen, please call (07) 3067 9129 or you can book online today.
- Haw, C. et al. (2001), Psychiatric and personality disorders in deliberate self-harm patients. British Journal of Psychiatry, 178, 48–54.
- Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542.
- Hawton, K., et al. (1998). Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition, British Medical Journal, 317 CS1 maint: Explicit use of et al. (link)
- Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226–239.
- Muehlenkamp, J. J. (2006) . Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 28.