Self-harm is stigmatised. It is often considered to be as ‘bad’ as suicide and judged poorly. Self-harm is is actually a group of behaviours used as coping mechanisms and include voluntary harm inflicted on the body. These behaviours include scratching and cutting the skin, alcohol and/or drug abuse, burning, hair-pulling and self-medication. It’s often the result of mental distress and not a diagnosis in and of itself.
These behaviours have specific triggers. As coping mechanisms, they could reduce an individual’s vulnerability to greater harm. Diagnoses like borderline personality disorder, depression, post-traumatic stress disorder, eating disorders, etc. are often associated with self-harm.
For example, small cuts on one’s arm or putting cigarettes out on it can give the satisfaction of ‘feeling’ to someone who experiences numbness.
Also read: The Hidden World of Body-Focused Repetitive Disorders
Rituals of self-harm occur when a trigger is paired with the behaviour – e.g. cutting while experiencing heightened anxiety or pulling on one’s hair while experiencing another trigger. When emotion and behaviour occur together, self-harm becomes a coping mechanism.
Such rituals can also be organised and the organised pattern can provide order to someone’s anxiety or meaning to the emotions experienced when a trauma survivor is triggered. For some, it provides relief.
Individuals who harm themselves don’t think their behaviour is flawed. In fact, that they do it repeatedly proves that it is very normalised. But there are some warning signs that can help recognise patterns of self-harm. Friends might notice unexplained scars on the person’s body, ill-suited clothes like long sleeves on a summer day, ritualised substance use patterns, hair-loss on their eyebrows or new bald spots with redness and a tendency to isolate themselves.
If you notice these signs, it’s important you address them with caution. Your friend might not want to discuss their issues; if you force them to talk, you could also force them to distance themselves further.
Step 1 is to educate yourself. The way to reduce harm is to steer clear of causing serious injury while destigmatising self-injurious behaviour at the same time. Harm reduction is associated with behavioural strategies that a trained clinician can guide you through. But that isn’t all: it’s important to provide social and emotional support through the lens of harm reduction.
For example, suggesting that someone “stop self-harming behaviour because that isn’t good for them” could seem like you’re judging them and dismissing the depth of their experience. Providing effective emotional support means correcting your own bias against self-harm first.
Never say this: “’Why are you cutting yourself? Are you planning to commit suicide? Stop this attention-seeking nonsense and just move on”.
Instead, you could say: “I noticed some scars on your arm the other day. I just want you to know that I am here for you and it looks like you’re having a hard time.”
Also read: ‘Sharp Objects’ Plunges You Into the Conflicted Mind of a Self-Harmer
After this, ask your friend what help looks like for them. Emphasise the consistency of support and keep away from stigmatising language and actions. Validate their stressors, acknowledge their pain, introduce the idea of professional help and assure them that it will be available whenever they’re ready. Offer help but allow them to decide based on what they will find beneficial.
Before an individual gives up their self-harming behaviour, they need to have other equally beneficial coping strategies in place.
Your support must be unconditional, and you must not guilt-trip them into quitting their deleterious habits. You can create a safe space only by working with the person, in confidence. This is because it’s a journey of discovery and reduces feelings of isolation.
Self-harm is a challenging mental health symptom to overcome, and miseducation and ignorance can only worsen the habit.
Ruchita Chandrashekar is a licensed clinician in Chicago where she works with participants of a federally funded programme. Her expertise lies in LGBTQ+ mental health, sexual trauma and complex trauma recovery, mood disorders and personality disorders.