Did you know that March is Self-harm Awareness Month and Self-Injury Awareness Day is March 1st 2016.
Unfortunately there is still a stigma attached to talking openly about self-harm. Some common myths around self-harm include that it is something that teenage girls do, or it is attention seeking, or it means someone wants to end their life. The truth of the matter is quite different. The Young Minds charity found that: 1 in 12 young people self-harm. • Last year 38,000 young people were admitted to hospital because of their injuries. • Inpatient admissions due to young people self-harming has increased by 68 per cent in the last 10 years.
As a Counselling, Health and Wellbeing Service we have frequent contact with students who are self-harming. We acknowledge that this is a coping strategy for many students and something that can be really difficult to change. We hope that this blog is an opportunity for any student to find out a little more about what self-harm is, why people self-harm and some ways of coping with urges to self-harm, as well as how to get support.
What is Self-harm?
Self-injury is a term used to describe a broad range of behaviours that someone would use to purposefully hurt themselves. An important point to clarify is that self-harming behaviour is not suicidal behaviour. Many people that self-harm do not have any intention of trying to end their life. It is true that some people who self-harm will also experience suicidal thoughts and may be more at risk of seriously hurting themselves, however, this is not true of everyone who self-harms.
Some ways that people choose to hurt themselves include:
- Breaking Bones
- Self-poisoning (misuse of alcohol, drugs, prescription medication or by ingesting harmful substances/objects)
- Dermatillomania (Compulsive Skin Picking)
- Restriction of Calories/fluids
- Engaging in ‘risky’ or self-neglectful behaviour
- Interference with wound healing
- Trichotillomania (Compulsive Hair Pulling) can also sometimes be considered as a form of self-harm, although it is also related to anxiety and stress.
Essentially, any behaviour that causes someone harm, even if this harm is slight, can be considered self-harm. Often the more helpful thing to focus on is how much this harm is impacting on the person and whether or not they would benefit from getting some support with it. Sometimes just having the thought of wanting to hurt yourself can be extremely distressing and is a valid reason for getting support.
Why do people Self-harm?
People self-harm for a number of reasons. Our personal experiences and emotional state can play a big role in this, as well as our knowledge of different ways to cope. When we have experienced, loss, abuse, a trauma, poor mental health or poor physical health we can be more vulnerable to using self-harm as a way of coping.
Self-harm tends to serve a specific function for people too, some of which are highlighted below:
- To self-punish
- In response to feeling emotionally numb and wanting to feel something
- To see a physical representation of emotional pain
- As a way of feeling in control
- To escape from negative/unpleasant emotions
- To feel emotional relief
- To communicate to others how difficult things are.
Self-harm is something that not everyone understands so it is helpful to highlight some of the things that keep people stuck. Anyone can make choices about how they cope with a difficult situation…
…Some people avoid….some people talk to friends… some people distract… some people exercise… some people drink…
…And some people self-harm.
We have already covered some of the reasons why people choose to self-harm but it is important to know that just because it has been acknowledged doesn’t mean it is easy to stop doing. Often there are certain outcomes to the self-harm that end up reinforcing it as a coping strategy such as immediate emotional relief or a feeling of control. Also, many people will experience strong urges to self-harm. Most of us can relate to experiencing strong urges to do something and it can take a lot of our will power, motivation and focus to stop ourselves.
Motivation to change self-harm can sometimes be helped by doing a simple pros and cons exercise. Firstly, think about the advantages that you think you get from self-harming, for example a release of emotion. Then switch this round to what the disadvantages are. Once you have done this try writing about the advantages and disadvantages of not self-harming. You might find there is overlap on your lists, or that one list is bigger than the other. Sometimes this helps with clarifying why you are stuck, or whether you are feeling motivated to change. If you are struggling with your list then take a look at some of the reasons for stopping self-harm below:
- Stop the physical pain
- Reduce the scarring
- To give themselves the opportunity to find other coping strategies
- To decrease the chances of infection
- To be able to wear different clothes that are less concealing
- To stop other people worrying
- To stop avoiding/escaping things
- To take back some control and build confidence in their ability to cope.
Finding Other Ways of Coping
- First steps for addressing self-harm can be to acknowledge the problem, talk to someone you trust, identify your triggers for self-harm and look at the function the self-harm serves. Sometimes doing a ‘Chain Analysis’
- If you want to understand your self-harm better it can be helpful to keep a diary
- Try urge surfing, which shows you how urges come and go by themselves, even when they seem impossible to manage.
- Delay the act
- Create a list of self-soothing activities, distractions and pleasant/mood boosting activities. When you are struggling, choose one thing from this list and focus on it for at least 20 minutes.
- If you want to enhance your self-soothing skills and then join our Wellbeing Champions in making a Wellbeing Shoebox
- This will be held on 15th March 2016, 11am-2pm, Y Plas
- Write down some coping statements and remind yourself of what has helped you before. (Coping statements could include ‘This feeling has passed before’ or ‘I can tolerate this feeling’, ‘I know other ways of managing this urge’, ‘This is just a feeling, it will start to fade soon’.)
- Look at ways of managing difficult emotions
- Connect with Others
- Find ways of managing feelings of anger
- Practice Self-compassion. All compassion exercises are on page 30 onwards
- Find other ways of communicating emotional pain
- Dialectical Behavioural Therapy (DBT) Skills provide some specific strategies for managing emotions and feelings of distress. It also looks at communicating your needs to others and being more assertive. If you would like a starting guide there is a useful DBT Skills group therapy document. Page 11 onwards will be the best place to start. For other DBT self-harm avoidance techniques including Ice Diving, exercising and relaxing click here.
- Distraction with other strong sensations. For example, eating citrus fruit, ginger or something spicy or you could use temperature to help regulate your emotion by taking a hot or cold shower. These are also examples used in DBT and are part of the ‘ACCEPTS’ skills for tolerating distress
- Create a Self-harm Coping Plan.
Want to Help Others?
Changing self-harming behaviour can be a slow process so try not to hold high expectations of someone. For example, “now that we have talked about it they should be able to stop”. “If they agree to stop self-harming then they should be able to do that”. Feeling motivated to change is crucial as our motivation to do something can change from minute to minute, so try to keep this in mind.
Some key pointers for supporting someone who is self-harming are:
- Try to really listen to them about how they feel
- Do not show negative judgement
- Take a look at some of the useful links provided here to help you understand more about why people self-harm
- Set your boundaries in terms of how much you can help. It is good to offer a peer ear and provide non-judgmental support, however, the person still might need to seek professional support and this should be encouraged. Or perhaps point them in the direction of self-help resources. The Life Signs Website is a good starting point.
- Don’t overly focus on their self-harming, as there are often other reasons why someone is struggling
- Don’t try too hard to ‘fix’ the problem. Jumping in to problem solving mode can shift the focus from listening to the person and what they are struggling with
- Give the person space and time.
When to get Medical Attention
For a full explanation of assessing whether you require medical attention please use the published leaflet from the Royal College of Psychiatrists called ‘Self-harm: Limiting the damage’. You can also read up on basic first aid here, produced by the National Self-harm Network.
Some basic starters are that if you self-harm it is important to have a first aid kit, including plasters, bandages, adhesive closure strips and antiseptic wipes or spray. If you have not had a tetanus vaccination in the last 10 years then get a booster as this can be a serious infection.
With cuts – seek medical attention if:
- The blood is pumping out – continue to apply pressure and call 999.
- The bleeding does not stop after 10 minutes of applying pressure.
- The cut is very large or very deep, or may require stitches.
- There is a chance that nerves or tendons have been affected.
- You go into shock
- The injury is on a joint – this can cause long-term movement difficulties.
- Something is embedded in the wound.
- The cut involves the mouth, face, hand or genitals.
- The cut does not heal properly.
- The cut shows signs of infection (it is red, sore, or painful, hard or has puss oozing out).
With burns – seek medical attention if:
- The burn is larger than a 50 pence piece, painful, charred (white), or seems to be getting worse.
- The burn is on the face, hands, genitals or across joints – burns to these areas can cause long-term movement problems.
- The burn is chemical.
With poisoning and overdoses – seek medical attention if:
- You have overdosed on substances or medication, or ingested toxic (poisonous) substances. Contact NHS Direct if you are unsure if what you have taken is an overdose. You might feel physically well, but the effects of an overdose can be delayed and fatal.
Be aware that extensive blood loss can lead to shock.
For more information on this check out the Life Signs Website.
Contacting Counselling Health & Wellbeing
If you are currently self-harming, have self-harmed in the past or you know someone who is self-harming and need some support then please do not hesitate to get in touch with us. We have friendly and approachable staff who are able to listen to you non-judgmentally, in a safe and confidential space.
Please know that the Counselling, Health and Wellbeing Service can offer support to anybody experiencing any sort of difficulty, however big or small. We offer booked appointments via our online referral questionnaire, plus a daily Wellbeing Walk-In Service (3pm-3.45pm: Monday–Friday and Wednesday mornings: 9.30am-10.15am at the Student Support Centre at 50 Park Place; and Wednesday afternoons 3pm-3.45pm at Cardigan House, Heath Park Campus).
In relation to this, we would strongly advise you to make a GP appointment to discuss your self-harm if this is something that is affecting you at the moment. If you do not already have GP please contact Park Place Surgery. Also, we would advise you to seek support from the appropriate professionals (GP or A&E) should you think that you have caused an injury that requires medical attention. If you are concerned that you’ve taken an overdose or harmed yourself too severely, call 999 or go straight to your nearest A&E department.
- Cardiff Adult Self-injury Project
- Cardiff and Vale Action for Mental Health Directory
- Self-injury support
- Self-harm UK
- Life Signs
- Life Signs Self-injury Awareness Video
- CASS Women’s Self-injury Helpline, 0808 8008088, Monday to Friday 7pm-10pm
- Talk to your GP about Cica-Care, a silicon gel dressing which can, in some cases, reduce raised and red scars less than 20 years old. It is available on prescription.
- Changing Faces offers a skin camouflage service. You can self-refer.
- The British Association of Skin Camouflage offers camouflage consultations. Your GP may be able to refer you to them.
- Mind Self-harm Workbook.
- Northumberland Tyne and Wear Self-help Book.
Other Professional Support Service
If you need professional support, you can contact the following services:
- Your GP. If you do not already have GP please contact Park Place Surgery.
- NHS Direct on 0845 46 47 (England and Wales) or 08454 232323 (Scotland).
- Samaritans (the confidential emotional support service, available 24/7) on 116 123.
- CALL on 0800 132 737.
- Nightline (student-run listening service, 8pm-8am, term-time only) on 029 2087 0555.
- CALM (for young men) on 0800 58 58 58.
- HOPELineUK (support for young people up to the age of 35) on 0800 684 141.
- Get Connected on 08088 084 994.
- University Security on 029 2087 4444.
Amy, Wellbeing Practitioner, Counselling, Health & Wellbeing Team
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