SANE, the leading mental health charity, today publishes the findings of its study of almost a thousand people with direct experience of self harm, and the results challenge many common misunderstandings about who does it and why.
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People who self harm include men and women, the young and old, and the behaviour may not be related to suicide in the way in which many people think. Also, far from being a method of seeking attention, self harm is generally hidden, often out of fear over the impact on family and friends, or because of a lack of understanding. Among the misconceptions the report challenges are:
1. Self harm is restricted to teenaged girls.
Some participants reported that they first started to harm themselves when they were as young as four, others had not started self harming until they were in their late fifties, and participants up to the age of 59 reported still harming themselves. Also, of the 532 who were still harming when they answered the survey, almost half (47%) had been harming for more than five years and a quarter (27%) for 11 years or more.
The idea that such behaviour is restricted to young girls is also challenged by this survey, with more than 100 men who had harmed themselves taking part. And as the authors note, it is unclear whether self harm really is that much more common amongst girls than boys, who may conceal their harming more.
2. Self harm is really attention seeking.
It is often thought that self harm is essentially manipulative, that people are seeking attention by being seen to hurt themselves. However, SANE’s findings challenge this misperception, with 84% of respondents seeking to hide their harming from their family and 66% hiding it from their friends. Also, the most commonly given reason participants gave for their choice of body part that they harmed, was how easy it was to conceal the damage, or explain it away as an accident.
Only one person in eight said their first act of self harm was motivated by a desire for others to take notice and care, and this figure dropped to one in 12 for subsequent acts of self harm.
But perhaps most tellingly, only 10-15% of respondents who hid their harm expected family or friends to recognise that they were hurting themselves as a response to their emotional distress. A common idea amongst participants was that those closest to them would not understand.
3. Self harm such as cutting wrists or overdosing is really a failed suicide attempt.
Self harmers experience more suicidal thoughts and feelings than the general population, and self harm is a risk factor for suicide, with between 25 and 50% of adolescent suicides having either self harmed or attempted suicide previously. However, as the authors noted, for most of the time self harmers do not want to die and they actually hurt themselves to alleviate the persistent thoughts of suicide and death that they experience.
Commenting on the report, Marjorie Wallace, chief executive, said: “Over the last few years SANE has been aware of an epidemic of self harm, and this report shows an increasing diversity of people using extreme ways to release their mental turmoil. It is a potentially addictive and desperate way of dealing with the stresses of life – as one girl told us: ‘I need to cut myself as I need to breathe’.
“What is alarming is the numbers of those taken to A&E departments who are sent home without any follow-up help. We need doctors and teachers to be more alert to the potential risks, and many more therapists available, to prevent the vicious cycle of relief by painful self-harm.”
Ian Hulatt, Mental Health Advisor at the Royal College of Nursing, said: “The RCN welcomes the publication of this report. Self harm remains a challenging and often unspoken subject. We welcome materials that help us as nurses to better understand and care for individuals who use this method of coping with their distress.”
Other Key Findings
· The most commonly reported methods were: cutting and scratching (93%); burning the skin (28%); overdosing (20%); and bruising the body (17%)
· The body parts most frequently harmed were: arms (83%); thighs or legs (50%); stomach (19%); and wrists (14%)
· Of those who were self harming at the time they responded to the survey, 20% were hurting themselves daily and 30% were harming themselves weekly
· 44% of participants reported a change in their motives for harming over time 60% of respondents who were harming at the time they took part in the survey reported having been diagnosed with a mental illness.
Why do people self harm?
The results of the survey revealed that the most common reason why people self harm is to regulate their emotions. 62% of participants harmed themselves when they felt overwhelmed by anger, sadness, anxiety or self-loathing. But 34% harmed themselves when they felt too little, and rather than feel numb and empty they hurt themselves to feel something.
More than a third of participants said they began to self harm because they felt self loathing and wanted to punish themselves, while this figure rose to nearly half for more recent acts. One in four either reported feeling guilt, shame or embarrassment after self harming, with one in eight feeling hateful, angry or disgusted with themselves.
Breaking the cycle
The authors recognised that self harming behaviour can be maintained through a cycle of harm and self-recrimination, fuelled by stigma and the prejudices of others. They suggest that a permissive treatment approach, in which self harmers are encouraged to feel alright about their behaviour, may help to break the cycle. As one respondent said:
“After I’d been in hospital, I went to the college nurse and told her I had been self harming. She told me there was nothing wrong with doing it and that I should continue if I wanted to, and booked me in with a counsellor. By telling me that I could do it, it took the guilt out of the cycle and I slowly began to stop. I finally realised that what I was doing wasn’t ‘bad’ or ‘wrong’, it was just my way of coping.”
Part of this approach should be the recognition that self-harm is a high-cost coping strategy, which provides temporary relief rather than lasting improvement in mental health. These facts about self-harm can, and should, be divorced from moral judgements such as ‘bad’ or ‘wrong’.
The ‘Secret Self’
Many participants explained that they felt their emotional life to be different and wrong, when compared with what others appeared to feel. This idea of an inner world that is unacceptable and that should be hidden was present in many guises throughout the participants’ responses. When asked what role self harm played in their lives it was often mentioned that it helped to keep their true feelings under wraps, to prevent their anger or distress “spilling out”. Participants worried about being found out as someone who hates themselves, or is angry, anxious or depressed. A ‘secret self’ had become separated from their ‘social self’, the self that they feel they’re expected to be.
As one respondent said: “When others find me attractive or pretty or socially appealing I harm a lot more, because I know that they are wrong and I am right; I have a dark, rotten core”.
Source: Sane
· The study, Understanding Self Harm, by Outi Horne (SANE, London), Emese Csipke (Imperial College, London), and Sarah Paul (SANE, London), involved a web-based questionnaire answered by 946 participants
· Of these participants, 61% had harmed within six months of completing the questionnaire, 28% had self harmed more than six months previously, and 12% had never harmed themselves
· The number of children admitted to hospital due to self harm has risen by a third in five years, according to the National Health Service. Between 2002/3 and 2006/7 the figures rose from 11,891 to 15,955. During both periods, more than three times the number of girls were admitted as boys, but boys outnumbered girls among the under-10 age group
· The UK has the highest rate of self harm in Europe, according to the Camelot Foundation.
