LEARN TO UNDERSTAND SELF HARM

COUNSELLING AND PSYCHOLOGICAL SERVICES (CAPS)

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Self-harm or self-injurious behaviours occur when a person deliberately inflicts physical harm on his/her body. This often happens in secret and generally without suicidal intent. Self-harming behaviours most commonly include; intentional cutting of the skin, scratching, burning, pulling or picking at skin or hair and self-bruising.

Reasons for self-harming vary – as do the types of people who self-harm. These pages will help you to understand more about deliberate self-harm as well as providing some practical tips to help cope with difficult emotions and to avoid self-harming .

Generally self-harming is about trying to cope with overwhelming feelings but is not a suicidal act. If you are seriously thinking about suicide please seek help immediately – some resources are listed in our e-book on Coping with Suicidal Thoughts

CONTENTS

01 Why do people self-harm?

01 Who self-harms?

02 Is self-harming a suicidal act?

02 Seeking help

02 Identify the situations and feelings that trigger self-harm

03 Delay and distraction strategies

05 Grounding and mindfulness strategies

05 Further grounding strategies

06 Other alternatives to deliberate self-harm

http://www.ups-sydney.org.au/suicidal_thoughts

1DELIBERATE SELF-HARM

WHY DO PEOPLE SELF-HARM?

Reasons for self-harming vary. Many young people report that their self-harming is a way of coping with severe stress or overwhelming feelings. For some, self-harming is a way of creating a sense of control when other things in life feel out of control. Others report that they self-harm in order to reconnect with their body, or just to feel something at times when they are experiencing themselves as numb or empty.

For some, self-harm can be a way of communicating to others that they need help. The majority of people however, go to great lengths to hide their cuts, scars or burns.

While self-harming can bring an immediate sense of relief it is important to realise that such relief is only temporary because the triggering feelings of hurt or distress have not been addressed. Self-harm can also cause permanent damage by leaving scars or injuring nerves.

WHO SELF-HARMS?

Self-harm is most common among adolescents and young adults. While the majority of people who self-harm are female, 30-40% of those who self-injure are male. Many people who self-harm do not have other serious psychological problems – indeed a recent study found that almost half of the US college students who were self-harming did not have current mental health disorders.

However, it is also true that many people who self-harm in a habitual or repetitive way report being diagnosed with depression, bipolar disorder, bulimia or anorexia, post-traumatic stress or other anxiety disorders, or personality disorders. Some may also have experienced abuse.

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IS SELF-HARMING A SUICIDAL ACT?

Research suggests important differences between people who are attempting suicide and those who self-injure as a way of trying to cope with overwhelming feelings. Most studies indicate that self-harm is generally not a suicidal gesture. Instead, self-harming is often a strategy for trying to manage overwhelming distress (perhaps not unlike binge drinking or drug-taking).

Self-harm is, however, a clear indicator of distress and if that underlying distress is not resolved, some young people who self-harm can become suicidal.

SEEKING HELP

As deliberate self-harm is often used as a way of coping with negative events and feelings it is easier to stop when you have other healthier ways of expressing and coping with feelings. Professional help from the counselling service or from other services accessed via your GP can help you find alternative ways of managing

your emotions. For many young people seeking help takes courage especially as self-harm is often secretive and sometimes connected to feelings of shame and guilt. Some suggestions for coping without self-harm are also discussed below.

IDENTIFY THE SITUATIONS AND FEELINGS THAT TRIGGER SELF-HARM

Becoming aware of the situations and emotions that trigger the urge to self harm can help you to work out better ways of managing those situations and feelings. You might ask yourself the following questions:

– What am I doing when the urge to harm arises? Are there any common themes/situations? Where am I when it arises? Does it occur after interactions with the same people, after the same type of events?

– How am I feeling just before I want to injure myself?

Sometimes people choose to keep a dairy so that they can better understand the triggers to their self-harm.

People who self-injure sometimes report that it is hard for them to identify what they are feeling. Learning how to identify and label emotions involves starting to notice the three components of emotion – bodily sensations, thoughts and actions/urges. For example, if you pay attention to your experience you might notice:

ANGER FEAR SADNESS

Bodily sensation Shortness of breath, tight of muscles

Trembling, sweatingHeaviness in chest, exhaustion

Thoughts “It’s not fair”“It’s too awful/threatening”

“It’s hopeless”

Actions/urges Argue Run, avoid “Give up, cry”

DELAY AND DISTRACTION STRATEGIES

Just delaying the urge to self-harm for several minutes often helps the wave of distressing feelings subside and become more manageable. Different strategies work better for different feelings – for example if you are angry running might help, if sad you might talk to a friend or listen to soothing music. A number of these alternatives are listed on the next page:

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FEELING ANGRYFEELING FRIGHTENED OR OVERWHELMED

FEELING SAD OR DEPRESSED

FEELING EMPTY OR UNREAL

Dance Break down tasks that need to be done into small steps.

Listen to soothing music

Interact with other people

Clean house Take one step at a time

Light soothing incense

Focus on how it feels to breathe - notice the movements of your abdomen with each breath

Run Start with the least scary

Visit or phone a friend

Stomp your feet on the ground

Jump Talk with a friend Play with your pet Chew ginger or bite a hot pepper

Ride your bike/swim Use mindfulness and grounding strategies (see below)

Curl up in your doona with a good book

Use grounding strategies (see below)

Yell or sing at the top of your voice (into your pillow if you share a house!)

Have a cry

Work in your garden Draw, paint or write in a journal

Have a hot bubble bath or shower

Talk with a friend

Do something kind for another person

Watch a feel good movie

GROUNDING AND MINDFULNESS STRATEGIES

We can get stuck in painful emotional states because we judge them to be permanent and an inherent part of who we are. It is helpful to see emotions as rising and falling with each moment of experience like a wave ebbing and flowing. Use your breath as an anchor to keep your focus grounded rather than getting carried away by your emotional state. Here is an exercise that may help you to learn how to step back from turmoil.

Take ten breaths – Throughout the day, pause for a moment and take ten slow, deep breaths. Focus on breathing out as slowly as possible, until the lungs are completely empty, and breathing in using your diaphragm.

– Notice the sensations of your lungs emptying and your ribcage falling as you breathe out. Notice the rising and falling of your abdomen.

– Notice what thoughts are passing through your mind. Notice what feelings are present. Notice what physical sensations are in your body and what action urges you are experiencing.

– Observe your thoughts, feelings, physical sensations and action urges without judging them as good or bad, and without trying to change them, avoid them or hold onto them. Simply observe them.

– Notice what it’s like to observe thoughts, feelings, physical sensations, and action urges with an attitude of acceptance rather than reacting to them with your usual habits and patterns. (from Learn To Manage Uncomfortable Feelings)

For information and exercises on mindfulness explore the ThinkMindfully website.

FURTHER GROUNDING STRATEGIES

Grounding exercises help you focus your attention on the present moment. They are helpful whenever you are having an experience that is overwhelming, or that is absorbing all of your attention. Grounding exercises help you to “snap back into reality” relatively quickly.

Try the following: – 5-4-3-2-1: This technique makes you aware of things in your environment and helps you calm down and realise that you are safe. Say 5 things you can SEE around you, then say five things you can HEAR around you, then say 5 things you can FEEL touching the outside of you body. Then repeat this process with 4 things, then 3 things and so on. It doesn’t matter if you repeat the same thing or get out of order. It seems to help most when you say it out loud (even quietly).

– Look around you: Catalogue the things you see. Notice even the small details (e.g., the light switch is cream and a little crooked). Trace the details in the room with your eyes like you would if you were tracing using a pencil without lifting it from the page.

– Listen: Listen to the sounds you hear around you. Notice the obvious sounds and then the layers of sound (e.g., the sounds behind the sounds). Notice them rise and fall, their pitch and tone

http://www.ups-sydney.org.au/uncomfortable_feelingshttp://www.ups-sydney.org.au/uncomfortable_feelingshttp://elearning.talariainc.com/default.aspx?tut=539&pagekey=59245&s1=1174701

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OTHER ALTERNATIVES TO DELIBERATE SELF-HARM

Below are some other strategies that people have found useful in emergencies – they are safer strategies than engaging in self-harm but are not longer-term solutions, as they don’t really address the thoughts and feelings triggering self-harm. If you find yourself using these strategies often – it may be time to seek some professional help.

– hold an ice cube or rub it over your wrists or parts of your body where you self-injure

– snap a rubber band worn loosely around your wrist/arm

– have a cold shower

– eat a chilli or something really hot

– put a liniment like Vapour Rub or Deep Heat under your nose (it stings and makes you cry)

– punch a pillow or punching bag

– wax your legs

– draw or write all over your body in red ink (rather than cutting).

– scribble down your negative thoughts on paper in red pen and then tear up the paper

(Source: http://au.reachout.com/find/articles/deliberate-self-harm)

http://au.reachout.com/find/articles/deliberate-self-harmhttp://au.reachout.com/find/articles/deliberate-self-harm

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Produced by the University Publishing Service, the University of Sydney, June 2011. The University reserves the right to make alterations to any information contained within this publication without notice. UPS51446© 2011 Counselling and Psychological Services (CAPS), The University of Sydney

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ContentsDeliberate self-harm Why do people self-harm? Who self-harms? Is self-harming a suicidal act? Seeking help Identify the situations and feelings that trigger self-harm Delay and distraction strategies Grounding and mindfulness strategies Further grounding strategies Other alternatives to deliberate self-harm