Posted on: 1st June 2017, Beacon House.
“It’s like self-harm is the only friend I have who can make me feel better”.
Self-harming in a friend, a partner, your child or someone you work with is profoundly anxiety provoking. It brings up a range of overwhelming feelings – confusion, anger, helplessness, worry, and even panic. These feelings can lead those who are trying to support the person self-harming into rescuer mode (I must do everything I can to stop them) or into a place of well-meaning dismissiveness (they are attention seeking, if I ignore it, it will go away).
Why do they self-harm? Why can’t they just talk to me? How can I stop it? These are all questions that whirl around the problem of self-harm. Then of course, in the middle of all the panic and concern – there is the question of what is it like to be the person who is self-harming?
Self-harm is not a mental health disorder. Self-harming is a problem in emotional regulation. Emotional regulation means a person’s ability to (a) notice they have an emotional experience; (b) name and understand it; (c) express it to others in a healthy way and finally (d) manage the feeling so that it is less stressful. Some Children, teens and adults turn to self-harm because their ‘emotional regulation system’ isn’t sufficient to turn down the unbearable volume of their pain.
You can hear this in the way that people who self-harm describe what it feels like. This insight is so valuable to those of us trying to understand self-harm. Here is what we have been told by people who we have supported in therapy:
“It is like all the pain that has been building up for days just floats away in a single moment”
“when I cut, it is the only time that I feel real, alive, like I am here right now”
“It’s like self-harm is the only friend I have who can make me feel better”.
“I don’t want people to know, it’s not about saying “look at me”, it’s about me finding a way of feeling calm without hurting anyone else”
“It’s the only thing I can control in my life, so it makes my anxiety less”.
“If I didn’t cut, I would be dead. Cutting literally keeps me alive”
Individuals who struggle to tolerate pain and stress; and individuals with mental health difficulties often find themselves in a state of hyper-arousal (exceptionally alert, on edge, anxious) or in a state of hypo-arousal (feeling dead and numb inside). Self-harm is a powerful way to find the middle ground between the two extreme emotional states. When anxious, self-harm calms; and when dead inside, self-harm wakes up the body and mind. Self-harm becomes the person’s attachment-figure, their secure base. What becomes so hard for those who self-harm, is that it soothes the pain for only a little while; and then the stress builds up again, and the urge to self-harm comes back.
Attention-seeking or attachment-seeking?
As parents, friends, teachers, spouses – we try our very best to make sense of we know who self-harm. We may naturally see it as a way of getting attention; and then we may ignore it, minimise or criticise it, or worse – mock it.
There is another, more compassionate but also more effective way of seeing and understanding self-harm: and that is to see it as attachment-seeking.
A key milestone for a young child is to learn how to regulate emotions, and they do this with the help of their attachment figures (parents, carers, key others) regulating their feelings for them. Attachment theory has shown us that individuals who don’t quite master the skill of emotional regulation when they are little (because of family stress, parenting style, temperament, health problems and so on) find other, insecure ways, to bring their attachment figures close by. This then brings them comfort and safety. For some individuals, they hide their emotions and therefore keep others close by because they are ‘no trouble’; others may make their needs very loudly known, and this keeps others close by because they are trying to respond to the crisis.
So, what has this got to do with self-harming? Self-harming is an attachment-seeking behaviour. For the private self-harmers, it regulates emotions and keeps others at bay by dealing with their pain alone; this for them feels safest. For the open self-harmers, they feel safest when others are attending to them, either through nurture or through criticism. Any attention is better than no attention.
While ‘attention’ may be one consequence of self-harm, the purpose of it is to regulate emotion and/or to bring others closer, in order to meet an unmet emotional need.
So, what to do?
Experience working with people who self-harm has shown us that minimising, ignoring or criticising the person does not work. In fact, it makes it worse! These well-intended reactions from others increase a feeling shame and self-loathing in the person who self-harms, which increases their urge to harm.
Instead – connect and then reflect. Do what you need to do to feel emotionally connected – show them you care; show them you are there. Then and only then, can you help them to work out what next. Here are our top tips:
1. Talk about it. Let them know that you have noticed; that you are curious; that you wonder what feeling is behind the harming. Don’t let self-harm be an elephant in the room.
2. Stay calm and grounded yourself. Anxiety coming from you will create more anxiety in them. They need you to be steady, thoughtful and non-judgemental.
3. Take a guess at the emotional need behind the self-harming if they cannot put it into words. Offer them your ‘language of love’, whether that is a hug, acceptance, time together, kind words, acts of thoughtfulness, respect.
4. Show them that you ‘keep them in mind’ even when you are not together.
5. Help them to work out their ‘triggers’. What gives them the urge to self-harm? Work out together how those triggers could be reduced.
6. Choose carefully who you tell. Others knowing can bring on shame, but can also be a relief. Decide together.
7. Help them find other ways to cope. There are lots of alternative ways to regulate emotions which can be found in the website links below. Work with them to ‘test out’ other ways of coping and know that the urge to self-harm is a tough one to give up.
8. Keep an eye on safety. Self-harming does not lead to suicide; but people who are suicidal are more likely to have self-harmed. Encourage them to use clean blades and to attend to their wounds. Be sure to know what to do if you are worried about their safety, the GP can tell you what is available locally. If in doubt, dial 999 for an ambulance.
What help is out there?
There are many online resources for people who self-harm and their friends and family. See below for a few. If the person feels ready to find other ways of coping, then psychological therapy helps. The type of therapy will depend on whether the person also has a mental health problem; but the key therapy goal would be to help them to emotionally regulate without needing to self-harm.
For serious self-harm where the person is at risk, their GP will be able to refer them to a local NHS team for an urgent assessment.
For individuals local to Beacon House who do not need a crisis team, please see our child and family mental heath clinic or our adult mental health clinic for our range of treatments.
Written by Dr Shoshanah Lyons, Clinical Psychologist. Clinical Director, Beacon House
In moments of crisis or concern; individuals can contact:
• The Samaritans – 116 123 (open 24 hours a day)
• Mind – call 0300 123 3393 or text 86463 or www.mind.org.uk (9am-6pm on weekdays)
• Harmless – email email@example.com or www.harmless.org.uk
• YoungMinds Parents Helpline – call 0808 802 5544 (9:30 – 4pm on weekdays)
• Childline – 0800 11 11 or www.childline.org.uk
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