Do you have a friend who cuts their body with a sharp object till they bleed? How about someone who holds a hot lighter or burning cigarette against their hand or forearm? This behaviour is commonly referred to as self-injury/self-harm/self-mutilation. While it’s not considered a mental disorder, the majority of adolescents who self-injure meet the criteria for a current mental disorder.1
Self-injuring behaviour typically starts in early adolescence and is more common than people tend to think. Part of the reason for that could be because people injure themselves in areas easily hidden from view of others such as the arms, legs, ankles or chest. So, it seems likely that someone we know struggles with self-injury and along with that a mental disorder. Remember, as we discussed in our first post (here) our purpose in shedding a light on mental health and discussing disorders is to create awareness, remove shame, give hope and encourage you to love others by being a good friend.
The most common form of self-injury is cutting and it’s the one you’re most likely to associate with when you think of self-injury. Other forms include: self-hitting, pinching, ripping or pulling hair and sticking needles or pins into skin.
You might find yourself wondering why your friend or peers at school would do such things to themselves. Don’t worry, you’re not alone in that thought! The reasons people give when asked why they self-injure include:
- Easing tension and anxiety
- Escaping feelings of depression and emptiness
- Relieving anger and aggression
- Regaining control over one’s body
- Obtaining a feeling of euphoria
As previously stated, self injury is more common in youth who have a mental disorder, particularly substance use, depression, anxiety and borderline personality disorder.
There’s other factors though that could contribute to young people engaging in this behaviour and they include:
- Socioeconomic disadvantage: low socioeconomic status, low level education, low income
- Sexuality: risk is increased in same sex attracted youth, specifically around the time they realize they are not heterosexual.
- Adverse family and childhood experiences: separated or divorced parents, conflict in the home, emotional/physical/sexual abuse, mother being abused
- Psychological characteristics: acting without thinking (impulsiveness), poor problem-solving and decision-making skills
- Adverse life events: particularly when it involves conflict with others or the breakdown of a relationship.
- Self-injury in peers: may be influenced by actions of peers.
- Alcohol: use may acutely increase risk. Self-injury often happens when a person is intoxicated.
There are things that make it less likely a young person will self-injure. These things include:
- Social Support: good communication and healthy involvement of family
- Religious beliefs: high moral values helps prevent the behaviour
- Optimistic outlook: being optimistic combats hopelessness
HOW CAN I HELP MY FRIEND?
You’ve probably wondered what the best way is that you can support your friend who self-injures. Well, Mental Health First Aid Canada has an acronym they use to guide the appropriate responses with our friends suffering any mental health disorder and the good news is that it would apply to our friend who self-injures as well.
The acronym is
Assess the risk of suicide and/or harm
Give reassurance and information
Encourage the young person to get appropriate professional help
Encourage other supports
ACTION 1 – Assess the risk of suicide and/or harm
Suicide and suicidal thoughts should always be considered a possibility when a person has a mental health problem or is in a crisis and so it should be on your radar with your friend whom self-injures. In fact, young people who self-injure are at higher risk for suicide or bodily harm. While most Here’s the steps to follow for determining your friends risk of suicide or harm.
- Engage your friend in a serious conversation about how they’re feeling.
- Ask them about suicide (have they considered?).
If no, move to Listen non-judgmentally. If yes, then…
- Explore and assess the risk.
why do they want to die? live?
- Ask if they have a plan
have they prepared how & when?
have they obtained any items they will need to kill themselves?
- Ask about prior suicidal behaviour
previous attempts lead to increased risk
- Ask about their supports
do they feel alone? who can they feel they can turn to?
- Ask if they have a plan
- Engage your friend in a plan for safety
help them create a plan to keep them safe and give them hope.
help them agree to NOT killing themselves for a manageable period of time (the weekend/week)
connect them with other resources they trust & respect such as
- crisis/distress line
- School counselor, social worker, psychologist, doctor, mental health worker
- Pastor, mentor
Connect them with someone beyond yourself and if necessary at that moment, ensure your friend is not left alone.
If they have a plan, means(items/supplies needed to do it) and intent, call 9-1-1 immediately.
ACTION 2 – Listen non-judgmentally
Given the secrecy of S.I. behaviours, it’ll be important for your friend to know that by talking to you they aren’t just trying to get attention from others.
- respond calmly (not angrily) and don’t judge them
- don’t dismiss their behaviour as manipulative or attention-seeking
- don’t minimize their feelings or situations that have led them to self-injure
- recognize that self-injury is a coping mechanism so stopping isn’t a focus for this conversation.
Avoid unhelpful advice like ‘snap out of it’ or ‘it’ll be ok’.
ACTION 3 – Give reassurance and information
Help your friend to sense there is hope and know that:
- they may have an underlying mental health issue and if so, there are effective treatments
- with the right supports/treatment/help they will feel better
ACTION 4 – Encourage your friend to get appropriate professional help
As we said in a previous post, our concern, support, prayers, care and love for our friends is huge and helps tons. However, there may come a time where we need to refer our friend to a professional for help. These professionals include family doctors/physicians, psychiatrists, counselors, mental health therapists and clinical psychologists and telephone helplines.
Help your friend see a family doctor, psychiatrist, counsellor or clinical psychologist. Your friend may actually even need you to support them in attending these appointments as they may forget or be unmotivated to go. Their doctor can help treat their wounds and refer them to a specialist. Specialists will conduct a mental/psychological assessment that will indicate if there is an underlying mental health issue as well as use treatment like Cognitive Behaviour Therapy(CBT) in order to help the person with managing their behaviours. Some CBT’s are self-help strategies they can learn (particularly if there is an underlying diagnosis of anxiety or depression) and it’s also possible that medication could be prescribed.
ACTION 5 – Encourage other supports
This includes friends, family, mentors, pastors, exercise and websites to name a few. Let your friend know that you’re there for them. It’s important for your friend to know they are surrounded by caring, non-judgmental people who will listen to them and provide support when they’re stressed out and would typically cope by self-injuring.
- What’s been your attitude regarding self-injury? Why do you think you’ve had that attitude?
- How has this article affected your perspective about self-injury?
- How common is self-injury amongst your peers/friends? What’s the most common form of self-injury you are aware of amongst your peers?
- How can you help break the stigma about mental health issues and encourage open conversation in your church community/youth group/school?
Share your thoughts and comments below.
Love Never Fails!
If it’s helpful, we’re here to support you if you self-injure. You can catch us via live chat using that pop-up in the bottom right corner of your device/computer. Otherwise, fire us off an email.
Meditate on The Word
The Word of God can also be a great source of hope and life for people struggling. Here’s some verses that are good to read over and ponder if you struggle with self-injury. If it’s your friend who struggles, share these verses with them.
It would also be REALLY helpful to save a copy of this .pdf on yours or your friend’s smartphone to regularly review.
Kids Help Phone 800-668-6868 – 24/7 free, anonymous, confidential counseling for youth 5-20 yrs old.
Kids Health – accurate, up-to-date info on youth health
Mind Your Mind – interactive games and mobile apps.
Mind Check – looks at symptoms with quizzes, then gives links, stories & info
Centre for Suicide Prevention - info re: suicide and self-injury
To Write Love On Her Arms (TWLOHA) – not-for-profit providing hope for people struggling with self-injury, addictions and mental health issues.
Mental Health First Aid – get training
1. Mental Health First Aid Training and Research Program. (2007). First aid guidelines for deliberate self-injury. Melbourne: ORYGEN Research Centre.Tweet