Self-harm is a subject many people think about when they are considering people with trauma or mental illness, but it is rarely discussed publicly. This is because there is a lot of stigma around self-harm. Many people consider it shameful, and this can make it very hard to talk about. The hesitancy people have about being open about self-harm helps to give a lot of room for myths about it to spread.
Self-harm is when someone cuts themselves.
True/False. Cutting is a form of self-harm, but it is far from the only form of self-harm. Self-harm can include an array of things including: sex, binge drinking and other substance abuse, overeating, undereating, and excessive exercising (to the point of pain, dehydration or extreme exhaustion). It can also include burning, hitting oneself and intentionally eating things that are not food like toxic chemicals and other harmful items. These are some examples but this is not a full list. Self-harm can include any deliberate action that is intended to cause harm. Things that may be normal or healthy for one person (for example, engaging in lots of casual sex for fun and enjoyment, or a professional athlete training for hours every day) could be self-harm to another person. Intent and outcome, like if harm occurs or if you were trying to harm yourself, are bigger factors of determining self-harm than the action itself.
It’s only done for attention.
False. While some people may engage in self-harm as a cry for help, it is not the only reason that someone may self-harm. Some other reasons include: to feel something when numb, a coping mechanism that helps to “release” emotions when overwhelmed (similar feelings to a weight being lifted), to provide themselves with a distraction, because the person feels like they deserve it, or because it gives them a sense of control.
Someone may self-harm for multiple reasons, or reasons that aren’t listed here.
I want to take a moment to talk about “seeking attention.” People are often shamed for it, but needing attention is a very normal thing. Feeling a need for attention could be a result of feeling lonely (thinking attention would make you less lonely), low self-esteem (thinking attention would make you feel better about yourself, perhaps that if someone pays attention, it shows you matter), jealousy (perhaps because someone else is getting a lot more attention) or simply because the person may not be getting much attention. I used to seek attention a lot when I was younger because I wanted someone to help me, but I had been silenced for so long, and because of that I didn’t know how to ask for help in a healthy way. When I self-harmed, it was initially done to try and get someone to notice me. However, as time went on, it became something I hid and used to release pent up emotions.
You're valid if you use self-harm to communicate emotions and distress that you can't find the words to express, and you're valid if you use self-harm as a cry for help when you don't have healthier tools to get your needs met.
It always means someone is suicidal.
False. While someone who self-harms may be suicidal, it does not mean that someone is suicidal. Many self-harm acts are done in carefully controlled ways that do not fit at all with an intent toward suicide. They may be done with precautions taken to decrease risk or hide evidence, both of which would be of little importance to a person if they intended the act to end in death.
It’s a choice someone makes that they could stop doing if they wanted to.
Self-harm can be addictive and it is often related to emotional issues the person does not completely understand themselves.
When it comes to handling self-harm, a lot of people give advice which is to “just stop.” For many, it is not so simple. Even if someone genuinely wants to stop, they may not be able to at the moment. In such a case, advice to “just stop” can be more harmful than helpful, as it can make a person feel extra shame for not being able to do it. For many people, this is no more realistic than telling a smoker to “just stop smoking.”
If you can’t stop, focusing on harm reduction can make a difference. I want to make it clear that I am not promoting self-harm nor encouraging it, but if someone is not ready to stop, trying to reduce harm may be helpful in the meantime.
The harm reduction someone may try will differ depending on what the self-harm is. For example, if someone is using sex as self-harm, it is important to make sure to use protection from both STIs and pregnancy. When it comes to things like cutting or other marks, doing research and making sure to not do it in really risky areas is important. Sterilizing self-harm tools and cleaning cuts and/or marks as soon as possible can be key to preventing infections.
It is also possible to work on reducing the intensity of the self-harm. For example, if you regularly cut, trying to go to “scratching” instead is less risky and may serve as a stepping stone to stopping. For some, harm reduction means reducing the frequency, or if they are self-harming in more than one way, stopping one of the methods.
Harm reduction is a really valid approach, and if you are seeking therapy, focusing on finding a therapist that has or supports a harm reduction approach as opposed to abstinence only could be helpful.
It’s valid if you are not ready to stop self-harming, or if you don’t want to stop at this time. Please try and practice harm reduction if you can.
If you do want to try to stop, one of the most important things to do is to figure out why you’re self-harming. This can help you figure out how to stop, and may also make it a much easier and less painful/frustrating process. It can also help prevent relapse. If you try to stop without addressing whatever needs self-harm is meeting for you, then the pain of those unmet needs may push you towards relapse. Even if you do not relapse, you could face other problems until you get those needs met. Identifying healthy alternative ways to meet needs prior to attempting to stop or reduce self-harm is a good start to setting yourself up for success. It’s important to note that even if you do identify needs and figure out other ways to meet them, you are not weak or a failure if you relapse. Relapse is a normal part of recovery and can happen for lots of reasons. Maybe there’s a secondary need you didn’t notice before. Maybe your new coping technique doesn’t fully address the original need. Maybe your self-harm has become a habit that will take some time to unlearn - when forming new habits, it can take a lot of time to reinforce them.
Another important part of stopping is to identify self harm triggers and avoid them where possible. When you self harm, try filling out an emotional worksheet or journal entry where you talk about what you were feeling, and if something led to that feeling, what that was. This can help in identifying patterns. Other potential patterns to be aware of are if you tend to do your self-harming in a certain location or at a certain time of day. If you do it in a certain location, when you feel an urge to self-harm, try getting up and leaving the place where you tend to do it. If you do it at a certain time of day, try to make a point of finding something else to be doing when that time of day is approaching - if that time of day passes with you busy at something else, that could help to break the habit.
Below is a list of possible reasons a person may self-harm, and potential alternative coping strategies which are tailored to each reason. It’s possible that there isn’t an alternative that works for you here. These will hopefully serve as examples that can help you think of your own ideas as well. Please note that each of these ideas could be useful for coping with more than one of these reasons for self-harm, and that this is more of a list of suggestions than a rigid set of rules.
Learning that needing attention is not shameful and being able to ask for attention in a healthy way
Reach out to someone you like to talk with
Send a text or similar message, and hopefully you can get attention from them
Find a group of people who share something in common with you, possibly online
When you need attention, you can go to whatever space they share and it’s likely at least one if not many would enjoy talking about your shared interest (or, for that matter, possibly just about regular life or other subjects)
This may also include a support group for other people who have gone through things that you have gone through, such as trauma
Feeling something when numb:
Exercise - it can bring a rush of endorphins, just as self-harm can (try to be safe and not overdo it)
Do something that gives you a lot of physical sensations
Some examples include washing your arms or face, or rubbing something fluffy or scratchy
For some, watching something really sad or listening to something really sad can help bring feelings through. (Or another strong emotion, like watching something joyful.)
This numbness may be due to dissociation, in which case grounding techniques may be effective
Releasing emotions when feeling overwhelmed. .
not everyone can let go enough to do it, but crying can be a very strong and helpful release, and there is absolutely nothing wrong or shameful about it (despite what some might say)
if you don’t have the privacy to do this without upsetting others, try screaming into a pillow
Hit something that won’t hurt you
try punching a pillow, or getting a punching bag if possible
Replace self harm with self soothing activities
Some good possibilities are taking a shower, playing with a pet or hugging a stuffed animal you love
Listen to a playlist of music that really captures your attention
You can create playlists for specific feelings, if you find there are different feelings you tend to get strongly at the time you have the urge to self-harm
Take up a task, such as reorganizing your dresser or washing the dishes
There may be a feeling of satisfaction from completing this
It’s hard to self-harm when your hands and mind are occupied by a task
Feeling like you deserve it.
Name what you’re feeling, and respond to it. Like, tell yourself “No, this happened because this person decided to do something. It’s their fault, not mine.”
Feeling a sense of control
Clean and/or organize a space. It may sound strange, but cleaning and organizing can be excellent ways to feel in control.
Do a craft or start a new hobby.
Bake or cook - learn a new recipe
Focus on breathing exercises
Try unfollowing blogs or people that you may follow for the “depression aesthetic.” While these blogs may feel validating, they can also affect your mindset. When you see the negative posts, it’s very likely it triggers negative thoughts. Try curating your online space to have more things you love, whether that’s puppies, a show you love or just overall vibes you enjoy.
Therapy is a valid option for a lot of people and may be worth considering if it’s accessible to you.
Even once you have figured out alternatives, it is possible that you still can’t just “stop” because to a lot of people, self harm is addicting. You are not a failure if you relapse, or are unable to stop at this time. Harm reduction is really valid. Do what’s best for you, even if others don’t agree with it.