Updated: Oct 10, 2020
Pain is there to let us know our body is in danger; that damage is being inflicted and we should do all in our power to make it stop. It is a survival mechanism. This may be why self-harm is so shocking and difficult to understand. Inflicting pain to oneself purposefully and with the intent of feeling better makes no sense at first glance. Self-harming behaviour is actually much more complex than that, both in terms of what causes it and how to help someone stop. The thing with self-harm is that it is like an addiction. It becomes a habit, something we run to when we need to cope. It is a tool for dealing with the challenges we face.
Self-harm comes in many forms; several destructive behaviours are in this category. The media and popular culture have familiarized us mostly with cutting. Cutting is especially prevalent amongst youth and has been portrayed in countless TV shows and movies. In some instances youth have even been influenced by peers, cutting themselves as a sort of statement and trend. Cutting can be dangerous as there are many risks associated with it, such as infection or cutting too deep and causing permanent damage. This compounded with the pain it causes may seem like reason enough to avoid doing it, however there are numerous reasons someone might cut. Despite the fact that cutting is an unhealthy habit, these reasons are very logical to the mind that is in a state to self-harm.
The most important component of helping someone stop self-harming for good is an understanding of the motivation behind it. There are usually both primary and secondary reasons. Secondary reasons are the surface reasons and are most often related to immediate results. Cutting hurts. The pain is often part of what is attractive about the habit. That pain is what the person self-harming is after and it is felt immediately. Sometimes, someone will feel as though they deserve that pain. Some feel it is appropriate punishment for what they perceive to be transgressions or inadequacies. It is a matter of self-esteem. For some the feeling of worthlessness that warrants this kind of destruction is connected to trauma. For some the pain reminds them they are alive or turns psychological pain into physical, which can be easier to process. The pain is the secondary reason. What is truly behind the behaviour, the primary reasons, are the psychological ones discussed above; a sense of worthlessness, trauma, self-esteem or identity issues. Essentially the primary reason is that psychological or emotional pain. Breaking the habit requires identifying and addressing this pain. Some psychologists have even told patients that addressing the ‘why’ is more important than stopping the behaviour right away.
When supporting someone who is trying to stop cutting, it is crucial to validate the primary reasons and not focus on the shocking or scary nature of the behaviour. By recognizing the emotional pain the person is in, we give them a safe space to start working through it. It is also important not to let cutting be a manipulative behaviour. Most crisis phone lines have a policy in place stating that someone cannot be self-harming while on the phone. This is a way to make a clear statement that they do not condone the behaviour.
In terms of concrete things one can do to help, the first step is to ensure the person’s safety. The first question one should ask is whether the cutting is a coping mechanism or a suicide attempt. This distinction could save a life. Once it has been established that the person is not suicidal, if they are reaching out to you after having cut make sure the cuts do not require medical attention and are cleaned and bandaged. The next step is to remove the person from the place and the tools that help them cut; removing blades and knives and moving to a different room or area.
Next would be to create a safety plan. This will look different from person to person but includes essential components. Firstly, ensure the person will continue to be separated from their cutting implements. Make a plan not to be alone and/or to tell another trusted person who can check in should you be unable to. You can also plan for alternative coping methods. Some coping options even mimic the results of cutting. One option is to hold ice. If done within reasonable limits, this can cause pain without inflicting damage. It also activates the sympathetic nervous system, which regulates the body’s fight or flight preparedness, making the body focus on a problem other than the pain or anxiety the person is feeling. For those who are more visual, there is the option to use red marker or food dye to draw or paint across the usual cutting site. We can also use techniques that are broader by choosing anything that is calming or distracting but positive. This would include things such as reading, writing, making art, taking a bath, etc.
Cutting is a habit that is hard to understand. If someone shares this behaviour with you, it means they trust you, are most likely scared and want help stopping. When we are approached with this information, we need to remain calm and remember the reasons behind the self-harming as well as the ways we can help. Self-harm is motivated by complex emotions but with some support, it is possible to break the habit.