Sangeeta, 16, has always been a bright student but lately her academic performances have dipped. Her science teacher noticed this and had also observed that Sangeeta had been a bit withdrawn lately. She also found it peculiar that Sangeeta was wearing long sleeves in the sweltering Delhi summer. After class, she took Sangeeta to her cabin and gently inquired about what was going on. Sangeeta broke down as she described the discord between her parents. On further probing, the teacher found that Sangeeta had been cutting herself on the upper arm.
This fictional narrative has been constructed to aid the understanding of this condition by placing it in a real life situation.
We have all read about young people who have tried to hurt themselves, either by cutting themselves, burning themselves, or by some other form of self-harm. This is called as non-suicidal self-injurious behavior, and is more commonly found in adolescents and young adults aged 14-15 years. Such behavior is challenging for caregivers and professionals because it is often difficult to detect.
People who engage in non-suicidal self-injury largely deny having any suicidal thoughts. Their behavior roots from an inability to cope with severe distress and negative emotions. Commonly, these emotional states are anger and depression, while sometimes it could even be because of a range of emotions. They find that such behavior helps them regulate their emotions. This is especially dangerous as it could result in them doing so again, although this is not always the case.
The most common misconception is that people who engage in self-harm are trying to draw attention to themselves or are being manipulative. This is far from true. People engage in self-harm because:
However, it is important to remember that self-harm is a complex phenomenon, often caused by many different reasons. Each individual has a unique set of reasons (often multiple reasons) and it is important to be sensitive to the indvidual in their time of distress.
Role of environmental and behavioral factors
As mentioned above, self-harm is a complex phenomenon, and is often associated with multiple factors. People who cut or burn themselves are commonly known to have had adverse childhood experiences. These include physical and sexual abuse, bullying, marital discord or domestic violence at home, and sometimes due to issues relating to their sexual orientation. This may also happen in young people with a perfectionist attitude, who self-harm to punish themselves. Irrespective of the reasons for distress, what the person needs is sensitive and understanding ear, free from judgment.
What are the signs one can look out for?
People who self-harm are very secretive about their habit and so family or friends of the person might find it hard to detect. However, there are some initial behavioral indicators that may suggest that an adolescent might be harming themselves. If someone frequently has bandages or dressing on frequently, you may want to inquire about the reasons for the dressing. If the reasons often seem hard to believe, then it could be a sign that they are harming themselves. Sometimes, they may wear long sleeves to cover their arms, which are a common target of self-harm. Realizing this, some people may harm themselves on the upper thigh or other areas, which are hard to detect. Children who lock themselves in their rooms or frequently absent themselves at school may also be harming themselves.
Note: The behaviors listed above do not necessarily indicate that the person is engaging in self-harm. They are merely indicative of how it may be hard to detect self-harming behavior.
How is self-harming behavior treated?
There is no single method to treat self-injurious behavior. It depends on the specific issues that a person is dealing with, resulting in self-harm. If the behavior is a result of other mental health issues such as anxiety or depression, then these issues will also need to be treated. This could require medication in addition to therapy. However, treatment of self-injurious behavior mainly revolves around helping the person deal with their emotional distress, and finding healthier ways to cope with difficult situations. Therapies such as Cognitive Behavioral(CBT) and mindfulness therapy help the person recognize their unhealthy thoughts, and replace them with more positive, healthy ones. In some cases, unrest in the family could also be a cause of distress; here it may help to have family therapy to solve the underlying issues.
What you can do if you know someone who is engaging in self-harm?
is a very sensitive issue so one must approach it with caution. One of the biggest problems addressing this issue is the lack of awareness about the problem and the common misconceptions that people have. It is essential to try and get the right knowledge about self-harm and approach the situation in a sensitive manner. People who cut or burn themselves require a patient listening; one must try and understand their problems rather than be judgmental about it. If you are unsure about how to broach the situation, talk to a mental health expert who specializes in self-harm.
This article has been written with the help of inputs provided by Dr Poornima Bhola, associate professor of clinical psychology, NIMHANS.