In Harm's Way

24th May 2013

As we approach exam season, often one of the most stressful times in a young person’s life, Becky Slack profiles a damaging behaviour that may result from stress

“I started by banging my head or fist against a wall, but after a while I would use a hammer that I would hide under my bed. I broke my wrist with it once. I would also cut and burn myself, usually in places that couldn’t be seen.”

Zoë (not her real name) was six when she started self-harming, the result of abuse by her step-uncle. Today she is 43 and still finds herself making trips to A&E as a result of the damage she inflicts on her own body. She’s trying to resolve the issues – “I’ve had counselling and seen psychologists” – but is not finding it easy to come to terms with a past that has been challenging, to say the least. Until she can, self-harming will continue to feature in her life.

Zoë’s case is severe, but not unique. Self-harming – the term used when someone intentionally injures or harms themselves – is carried out by many thousands of individuals across the UK. Most of these are young people: in 2011/12, for example, ChildLine reported more than 16,000 counselling sessions in which self-harming was discussed. Meanwhile, national statistics indicate that around one in ten young people will have deliberately hurt themselves at some point – a rate believed to be one of the highest in Europe. It is a behaviour so prevalent that there is even a proliferation of ‘pro-self-harming’ websites that actively encourage people to self-harm and which even provide tips for the most effective ways for people to go about doing so.

“It is incredibly difficult to pinpoint accurate statistics,” says Rachel Welch, project director at Self-Harm, a charity that works nationally to provide support and guidance on this issue. “People who self-harm are incredibly secretive and will go to great lengths to ensure they are not found out.” This means that many young people struggling with this issue have not, and may never, come to the attention of health and social services.

However, while the secrecy and scale make this a difficult problem to tackle, it is not insurmountable, says Welch. To help those people who self-harm, first it’s important to understand what it is they are doing.

Self-harming typically involves cutting, burning and scratching but it can also include overeating, drinking too much alcohol, taking drugs, smoking, and promiscuity. Some people may simply scratch themselves, while others will cut themselves so deeply that they require hospitalisation.

“Boys will often punch a wall very hard,” says Welch. “Often they are just seen as violent and aggressive but actually what you find is that the act of punching a wall has made them feel better.”

Rarely is self-harming a step towards suicide. Instead, it is used as a means of managing negative feelings that cannot be dealt with in a rational or logical way, usually at times of anger, distress, fear, emotional worry, depression or low self-esteem. It can also be used as a form of self-punishment for something that an individual has done or thinks they have done.

“There is a small minority of people who self-harm who have a bigger mental health concern, but for the vast majority it stems from emotional distress or an unmet emotional need,” says Welch. “It could be anything from being bullied to feeling the pressure of exams. Not everyone who self-harms is going to have been abused or experienced trauma. A lot of young people will do it, no one will ever find out and they will come out of the other side unscathed.”

It is challenging to understand why someone would resort to hurting themselves in such a way. Those who do it say that, contrary to making them feel worse, it actually makes them feel better. It’s as if their heads are so full of thoughts, questions, problems and stress that they feel like they could burst. Self-harming relieves the pressure. It makes everything stop and slows it all down.

“Cutting makes me feel better”, Zoë tells me. “It’s like when you pour a pint and there isn’t any room left in the glass to fit all the liquid in so you pour a bit down the sink to make more room. It is a release.”

Stress-relieving though it may be, self-harming is just as its name suggests – harmful. As such, it’s important that such behaviour is properly addressed when discovered. However, identifying someone who is self-harming can be difficult, particularly given the secrecy.

Welch recommends looking out for changes in behaviour, but admits this in itself can be a challenge. Teenagers are not renowned for their consistency of mood, after all. That said, though, there are certain clues.

“If you have a young person who’s been stressed for a long time but is suddenly more confident you might want to try and find out what it is they are doing differently that means they are now able to cope,” she suggests, adding that there are other indicators too, such as someone hoarding sharp things or stocking up on first aid equipment, or hiding their arms and legs.

Friends are often the first to find out, but equally are unlikely to disclose this information to parents. Neither can teachers be relied upon. As Welch points out, many schools are naïve about the problem or have no set guidelines on how to act.

“Teachers are stumped with what to do. They often have no policy in place and so don’t know where to start. Is it a safeguarding issue? Is it child protection? Should they tell the parents? They tend not to know the answers,” she says.

Part of the reason for this, she believes, is that there is no specific outcome to self-harming that can be measured or assessed. And it can be difficult to create a policy on how to handle something if you don’t fully understand it or even know exactly how many people are being affected. Welch draws an interesting comparison between self-harming and teenage pregnancy, highlighting how it is known that, of the hundreds of schoolgirls who fall pregnant each year, many won’t go into higher education and most will end up on social welfare. “We know what the consequences are, but with self-harming we don’t have the same measures. We can’t say that kids who self-harm are not going to take GCSEs. We can’t say that it’s not the higher achievers who self-harm as there are plenty of examples of doctors, solicitors and other people who have achieved successful careers who struggle with self-harm,” she says.

Step outside the school gates, however, and there are plenty of people who can help, be they counsellors, psychiatrists or psychologists. And in many cases the individual need not even be referred to a professional. A child’s parents are often ideally placed to provide the emotional support needed.

Discovering your child is deliberately hurting themselves can be devastating for parents. The obvious reaction might be to panic or to shout and direct blame, but this can actually have the opposite effect and can result in the person who is self-harming feeling even more emotionally vulnerable.

Patricia, a counsellor at ChildLine, says that the best way to deal with this issue is not to focus on the self-harming at all. Instead, she explains, it is much more beneficial to talk about how the person is feeling.

“They may not know the reason why they are self-harming,” she says. “They may not have the emotional outlet to deal with problems. It is important to get to the root of what they’re feeling and why they might be cutting.”

In her experience the underlying reason is that most people believe it gives them control. Thus, it is important to find out what is out of control in their lives and try to rectify this. Importantly, she says, control mustn’t be taken away from them. Parents who find out that their child is cutting themselves will naturally want to remove every sharp object from the house. However, this serves to remove the very control that the individual is looking for. It won’t stop them from cutting and could lead to them doing so in a much less safe environment.

“It is very important to take things very slowly. The key is that you give them chance to talk and that you listen to them. For many young people who come to ChildLine with this issue it is the first time they have been actually listened to,” she says. It is not always possible to change the trigger situation (exams still need to be taken, for example, and it can be difficult to eliminate bullying), but she emphasises how vital it is that youngsters can be given the time to express how they feel.

“It’s really important to take the time to develop their emotional development, but it’s a slow, slow process. You can’t expect people to change after just one conversation.”

Zoë knows just how long it can take for wounds to heal. While she has embraced major changes in her life and is making good headway, she knows she still has a long way to go. She wishes that someone had seen what she was doing and stepped in to help her sooner.

“If there is anyone reading this and they know that someone is self-harming then don’t ignore it. Don’t try and bury it. If you think there is something going on then, please, raise the issue.”

Where To Find Help

There are many organisations that can help provide support and advice to people who are self-harming or who suspect others of self-harming:

Your local GP, health centre or NHS Choices website: www.nhs.uk

The National Self-Harm Network: www.nshn.co.uk

Mental health charities, such as Rethink, Mind and Sane:
www.rethink.org
www.mind.org.uk/mental_health_a-z/8006_understanding_self-harm
www.sane.org.uk/home

Websites aimed at helping young people who self-harm:
selfharm.co.uk/home
www.thesite.org/healthandwellbeing/mentalhealth/selfharm
www.youthnet.org
www.childline.org.uk

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