You may be more familiar with the term ‘self-harm’ than ‘self-injury’. ‘Self-harm’ is more of an umbrella term for all actions that a person might take which causes them harm. This might include suicide attempts, non-suicidal self-injury, substance misuse, over-eating, over-exercising, over-work, deliberately mismanaging medications and many other self sabotaging actions.
We are going to focus on self-injury. Self-injury is not an illness in its own right, but a maladaptive coping strategy. The most common forms of self-injury are cutting, scratching, deliberately hitting the body on hard surfaces, punching, hitting, slapping, burning or biting themself.
People may self-injure themselves for lots of reasons but the main reasons are to manage painful feelings or to punish themselves. The psychological distress is so intense and they feel that the only way to self regulate is to injure themselves. Over time, self-injury can become the central strategy for coping with problems, making it very hard to use more adaptive ways of coping. Self-injury is rarely used as a means of seeking attention due to the intense shame most people feel about their scars and wounds.
What should I do if I suspect someone is self-injuring?
Before you talk to them about the self-injury, acknowledge and deal with your own feelings about self-injuring behaviours. If you don’t feel able to talk about self-injury, try and find someone who feels more able to talk to them.
Choose a private place for the conversation and a time that works for both of you. Directly express your concerns in a way that makes it clear to the person that you understand a bit about self-injury.
Self-injury is a very private thing so don’t force the conversation as it may not be the right time to talk. Do not use strong emotional responses such as anger or frustration.
Keep in mind that ‘stopping self-injury’ should not be the focus of the conversation. Instead, focus on the underlying psychological issues that are causing the distress in the first place. Think about how you can assist to make the person’s life more manageable, or their environment less stressful.
Behave in a supportive and non-judgmental way. Be supportive without being permissive of the behaviour. Be aware of what your body language is communicating about your attitudes.
Use a calm voice, be comfortable with silence and allow time to process what has been said. Be prepared for the expression of intense emotions.
Express empathy for how they are feeling. Validate the person’s emotions by explaining that these emotions are appropriate and valid.
Use ‘I” statements and not ‘you’ statements to express concerns and to actively listen to them. For example: “I am worried about you” rather than “You are making me worry”.
Don’t promise to keep the self-injury a secret as it is best that they get the correct support that they need.
Go with them and assist them to access professional support.
Encourage them to have alternatives to self-injury. It is good to have a few alternatives to self-injury. Ask the person to think of what might work for them, as it is helpful for them to have some ideas available when they are under pressure.
Suggest that they talk to someone. They could tell a friend or family member when they are feeling the urge to self-injure, or even just talk to someone for a distraction in the moment.
Three things they can do the next time they feel the urge to self-injure:
Delay – The urge to injure does not last forever.
Are you alone? Is there someone that you can talk to?
Wait 5 minutes, congratulate yourself, then wait another 5 minutes or longer. Your level of distress will reduce.
Are you in the place where you have previously injured yourself, ie bedroom? If so, remove yourself and go for a walk or do something else.
Distract yourself – Do something.
Do some exercise – Exercise boosts endorphins that can make you feel better.
Do something creative – Maybe find a different way to express negative emotions, such as art, music or creative writing.
Watch a film or YouTube video that makes you feel good or makes you laugh.
Do something else –
If you need to feel something, this can be fulfilled by holding ice or touching different textures.
If you need to punish yourself, try looking for way to forgive yourself or do something kind instead.
If you are feeling overwhelmed by negative emotions, maybe expressing your anger against a pillow.
If someone you know engages in self-injury, try and talk to them and get them connected to the professional support they deserve.
For more information about how to support someone who self-injures you may want to take one of our courses, either Youth Mental Health First Aid course or our Conversation Series workshop on how to support someone who engages in non-suicidal self-injury. We also have a 2-hour awareness session about self-injury.
Please contact training@positivewellbeinghk.com for more information.