“Stay at home, protect the NHS and save lives” has been the residing public health message for almost a year. Many people have been left to cope alone, isolated from support. As a result, incidents of self harm have increased. Coping strategies come in many different forms and for some, self harm is a tried and tested method. It is hidden, carries stigma and can affect people of all ages and walks of life.
Commonly when we think of self harm, we may conjure up images of someone cutting themselves. In fact, self harm involves many different ways of causing physical damage to yourself. It sits on a sliding scale and is a symptom of underlying issues.
On one end, there are behaviours which are seen as more “socially acceptable”, such as someone over spending and deepening their debt. Or, by “pulling the pin” at the weekend and drinking to excess. The other end of spectrum includes the more severe types of self harm which involves intentional injury to the body e.g. cutting, hitting or inserting objects.
Self harm is secretive and hidden. Where people have physically injured their body, they are often afraid to present at A&E or their GP through fear of being judged.
Essentially self harm is a way of coping by either cutting the person off from emotions or releasing it as form of catharsis. For example, excessive exercise can take someone away from the thoughts in their head. They dissociate from themselves and drive the emotion into a physical act. In the case of exercise, the release is the endorphins which then rush round the body. Where done in a measured and proportionate way, we can all benefit from exercise. But where it is being used as a primary form of control, that can be problematic because it becomes a crutch.
Whilst the act of cutting/hitting/inserting things/hair pulling may seem extreme and upsetting, the thoughts and feelings driving that behaviour are no different to the ones featured in my example of excessive exercise.
During this COVID pandemic , the Lancet reports incidents of patients presenting with self harm were 38% lower in April 2020, compared to the previous year. For more information visit Effects of the COVID-19 pandemic on self-harm – The Lancet Psychiatry. They identity women, people under the age of 45 years and those from deprived areas as less able to seek physical and/or psychological support. This is most probably due to the public health message focussing on the protection of the NHS, as well as fears around catching the virus.
Engaging in therapy enables people to gain insight on why they use self harming behaviours to manage. A good counsellor will affirm it is s a way of coping and with support which is free from judgement, help the person to understand the emotion behind the act such as pain, fear, anger. Early relationships with parents and other significant caregivers are often core to this understanding. Bowlby, a prominent psychiatrist in childhood development found monkeys separated and isolated from their Mothers showed signs of self harm. This suggests childhood experiences are linked to self harm. They are derived from a place where the needs of the child were unmet or where the caregiver was unable to help the child understand their emotions and find ways to contain them in a safe way.
I understand many counsellors are unable to see clients face to face and online therapy is not for everyone. So where therapy is not an option right now, here are my top tips to manage in the interim:
- You are valued and of worth – Low self esteem and self worth are common in self harm. What can you do to remind yourself you are of worth? Can you connect with experiences you are proud of or connect with people who believe you are enough?
- Engage in creative writing – Writing down your feelings and emotions can be a powerful way of getting them out of your head, leaving you less burdened.
- Understand the self harm cycle – By having an awareness of what is driving and perpetuating the behaviour, it gives power and control to stop it. There will be a video available on my website to take you through this cycle.
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Photos by Dylan Ferreira , Jonathan Rados and Tim Goedhart on Unsplash