Today, the 1st of March, is the World Self-injury Awareness Day (SIAD). This is the day we sit down and contemplate how difficult life can be to some people that the only way to cope is to hurt themselves. There have been misconceptions about self-harm or self-injury (SI) that has left quite a stigma in our society.
Very often, life challenges, stress depression and anxiety lead to self-harming behaviours. You have probably never heard of SI before as self-harming behaviours are always swept under the rug, out of view. The acts themselves are normally kept secret and done in private. It is a taboo to many, and self-harm or self-injury always have negative connotations perceived as precursors to suicidal attempts.
Self-harm is the act of deliberately injuring oneself. The behaviour is also called non-suicidal self-injury, or NSSI. It is a sign of intense anxiety or extreme distress. Afflicted individuals self-injure themselves to numb the emotional pain with the hope of maintaining a feeling of control. Although the acts of self-harm do not indicate intent to end one's life, if left untreated for many years, it may endanger one's mental and physical health.
There are teenagers who chose SI as their coping behaviours in order to reduce the distressing affect (Roberts et. al, 2011). While SI is always associated with mental health issues like Bipolar, Borderline Personality Disorder, and others, the truth is SI can occur in people with or without mental health issues.
While we have different views on this issue, I think we must first correct certain myths about SI.
First and foremost, it is important to note that not all self-injury is suicidal. Most people who self-injure do not have the intention to die by suicide. Diagnostic and Statistical Manual of Mental Disorders provides has made a distinct line between self-injury and suicidal intent. The majority of clients who self-injure, have expressed no interest in ending their lives (Counseling Today, 2020).
Secondly, people self-injure not to gain attention. Sadly, sometime it is perceived as intentionally manipulative. Most often, self-injure clients seeking counseling, did it because they do not know how to communicate and express their needs and distress more effectively.
SI activities may start as early 12 – 15 years old and the behaviours reduced toward early adulthood (Ammerman, Jacobucci, Kleiman, Uyeji &McCloskey, 2018). In Malaysia, many studies conducted locally had shown similar trend. Early teenage years can be rough for the young as they are going through the transitions in their growth and development.
This is a crucial stage when they are forming their own identity; identifying themselves with their chosen role models and searching for the values suited to their own self. They may see conflicting views from adults as non-supportive.
Friendships and relationship seem to be the major themes behind SI behaviours found in counseling. These include bully/cyberbullying, name calling, teasing, body shaming, abusive/broken relationships, self-image and self-confidence. Some may have experienced family issues at home and academic challenges at school.
Unrealistic expectations of oneself and by others can lead to stress and anxiety. As being in a crowd is not easy, they take to social isolation as refuge – a conducive environment that lead to SI. By not getting timely support, and faced by the urge to release the stress, they choose the quick immediate escape by committing SI.
When helping someone who self injure, screening is important in order to rule out the suicidal intent. Professional helpers will discuss the intent, means, frequency, severity, and emotional antecedents and consequences. If it is suicidal, the client must be referred immediately for suicidal assessment and interventions to take place.
Individuals having difficulties in communicating pains and managing feeling are prone to be associated with self injury (Kim. Et.al, 2015). Other reasons include: to cope with negative emotions (e.g. sadness, anger, negative thoughts), (a way) to punish themselves and to gain sense of control.
There are always underlying issues behind self-harming behaviours. Self-harm individuals use physical pain to address emotional problems. Yet, the relief self-harm offers some individuals is only temporary. Normally, the first objective to help clients is to stop the self-harming behaviour. However, to stop immediately may be a challenge.
SI works as a coping behaviours for some clients, and asking them to stop without any alternative ways to cope can leave them feeling scared and helpless. So reducing it may be the first step to treating SI. SI itself is only the presenting issue, a way to cope. The real issues behind SI need to be explored and identified. Safety plans (as opposed to no-harm contracts) are an effective way to build the counseling relationship and minimise client risk.
These include identification of warning signs, internal coping strategies and positive distractions. Even if a person's injuries look mild, self-harm behaviours are dangerous that can be risks of both, accidental or intentional death. Treatment for NSSI can ultimately save a person's life.
Family members are probably the last to know. Good friends will always try to help, yet at times may get overwhelmed if not traumatized when witnessing it. If we know someone who self-harm, convince them to get a professional help to cope better with life challenges.
Help us create the awareness among the public. Visit PERKAMA International Facebook or Instagram. Join a roundtable discussion on self-harm today at 8.30pm organized by Persatuan Kaunseling Malaysia. There will be a line of experts sharing counseling strategies & interventions, ethical and legal concerns, medical & clinical treatment & assessment, and cases among the youth: children, teenagers and young adults.
Learn about the Butterfly project as a way to cope with self-injury. Together we want to stop & prevent the occurrence and educate the public that help is always available when things are rough in life.
The writer is a counselor educator at the Educational Psychology and Counseling Department, Kulliyyah of Education, IIUM and a crisis counselor volunteer/executive committee of Perkama International.
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times