Understanding and Assessing Self-Harm: What You Need to Know

Self-harm, the intentional and direct harming of one’s own body, is a serious problem that can profoundly impact a person’s life. This can include a variety of behaviors, such as cutting, burning or scratching oneself. There are many reasons why someone might self-harm. It is often a way to cope with severe distress and overwhelming emotions, like sadness, anger or shame. It can also be a way to relieve boredom or loneliness. For some people, self-harm is a way to feel in control of their bodies and lives.

Self-harm is a serious issue that can lead to severe injury or even death. Therefore, it is crucial to identify the signs and symptoms of self-harm to provide the appropriate care and treatment for your clients, friends or family members.

Key Signs to Look For

Many risk factorsfor self-harm include mental health conditions, substance use, a history of trauma or abuse and impulsivity. It is often a coping mechanism for individuals struggling with difficult life circumstances or experiences. You can also look for the following:

• Sudden changes in appearance. If someone wears long sleeves or pants in the middle of summer, this could be a sign that they are hiding cuts or bruises.
• Mention of self-harm in conversation. People struggling with self-harming behaviors may talk about it jokingly or as if it is not a big deal.
• Sudden changes in mood or behavior. For example, a person who is harming themselves may become withdrawn or depressed, or they may start acting out.

Ways to Assess

If you are concerned that a person may be harming themselves, getting them help as soon as possible is vital. You can start by:

• Asking them directly if they have ever harmed themselves.
• Looking for physical signs of self-harm, such as cuts or bruises.
• Asking them about any suicidal thoughts or behaviors.

Resources are available to individuals struggling with self-harm and getting help can make a big difference:

• National Suicide Prevention Lifeline: You can call or text the National Suicide Prevention Lifeline at 988 to speak with a trained counselor who can provide support, resources and referrals to local services.
• Crisis Text Line: You can text HOME to 741741 to connect with a trained crisis counselor who can provide support and resources.
• The NAMI HelpLine: For information, resources and referrals, you can reach the NAMI HelpLine Monday through Friday, 10 a.m. – 10 p.m., ET by calling 1-800-950-NAMI (6264), texting "HelpLine" to 62640or emailing us at [email protected].
• SAMHSA National Helpline: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline provides free and confidential treatment referral and information services for individuals and families facing mental and/or substance use disorders. You can call them at 1-800-662-HELP (4357) or visit their website for more information.
• Your health care provider: If you have a health care provider, they may be able to provide resources or refer you to a mental health professional who can help.
• Online resources: There are many online resources available for those who are struggling with self-harm, including forums, chat rooms and online support groups. However, it's important to be cautious when using online resources and to ensure that the information is coming from a reputable source.

Offer Support and Encouragement

Because self-harm is often used as a coping mechanism, it can be difficult to stop. However, with the proper support, people can recover and live healthy lives. If you are worried about someone who is self-harming, the best thing you can do is to approach them, carefully, about your concerns. Let them know that you are there for them and offer to help them get the help they need. You can also call a suicide hotline in your area to get more information on how to support someone who is self-harming.

Here are a few tips:

• Listen without judgement. It is important to listen to the person who self-harms without being judgmental. This means providing a safe space for the person to express their thoughts and feelings.
• Encourage them to talk about their feelings. People who self-harm often have difficulty expressing their emotions. Encouraging them to talk about their feelings can help them identify and process their emotions, which can lead to finding healthier ways to cope.
• Help them find other ways to cope with emotions. Since self-harm is often used as a coping mechanism, helping the person to find alternative ways to cope, such as exercise or mindfulness, can be beneficial.
• Encourage them to seek professional help. If they aren’t already receiving professional help, encourage the person to seek therapy or counseling. Mental health care can be a key part of their recovery.
• Be patient and understanding. Recovery from self-harm is a process that takes time. It is important to be patient and understanding as the person works toward recovery.
• Avoid making assumptions. It is important not to make assumptions about the person’s behavior or emotions. Each person is unique, and it is important to understand and respect their individual experiences.
• Be open-minded. It is important to be open-minded and willing to learn about self-harm and how to support someone who self-harms. This includes being willing to seek out information and resources.
• Provide support. Providing support can be as simple as being there for the person, checking in on them or offering to accompany them to appointments or support groups. Showing support can help the person feel cared for and understood.

Treatment Options

Several different types of treatment are available, and the right one will depend on the person’s needs. Cognitive behavioral therapy (CBT) is a talk therapy that can help someone manage their thoughts and feelings and help them cope with difficult situations. CBT can be done one-to-one, in a group or online. Medication can also be used to treat self-harm.

DBT (Dialectical Behavior Therapy) is another type of psychotherapy that can be used to help individuals who struggle with self-harm behaviors. DBT aims to help individuals develop skills to manage their emotions in a healthy way and reduce the frequency and intensity of self-harm behaviors. This is achieved through a combination of individual therapy sessions, group therapy and skills training.

While self-harm is a complex issue, there are things that you can do to help a person manage it. If you know someone who is struggling with self-harm, reach out and make sure they know they are not alone.
 

Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York State, both as a clinician and as a peer. Max is the owner of Recovery Now, LLC, a psychotherapy private practice and is the Editor-in-chief of Mental Health Affairs, a website for the prosumer.