Self harm is defined as causing injury to one's own body without suicidal intent. Self harm can affect people of any age, gender or background. There are many manifestations of self-harming behaviour, including cutting, scratching, burning or hitting the skin, hair pulling, ingesting poisonous substances, or other harmful actions.
Self harm may indicate a cry for help, or more commonly be a dark secret in a person's life which goes unnoticed for long periods of time even by those close to the sufferer: often, people who self harm are ashamed and scared of what others will think, and will go to extreme lengths to hide their self harm rather than draw attention to it.
A person may harm themselves for a wide variety of reasons: poor body image, low self esteem, loneliness, hatred of their appearance, as a form of control or communication, a way of dealing with peer or family pressure, attempting to manage extreme negative emotions, as a latent symptom of emotional or physical abuse. All of these underlying issues require addressing in a therapeutic environment if the self harmer is to recover.
For some, self harm is a form of punishment for the body that they hate, or (particularly in cases of eating disorders) the expression of a wish to cut away flesh from the body.
Some people experience a build-up of strong unpleasant feelings – of guilt, shame, anger, sadness, self loathing or despair – that become unbearable and threaten to overwhelm them. Under these circumstances self harm can seem like the only way to deal with the emotions and introduce a sense of control over feelings that can be missing elsewhere in a person's life.
Self harm also enables sufferers to generate a sense of detachment from the world and the body. This can become a way of coping with distressing experiences, such as trauma or abuse – the self harmer convincing herself or himself that a traumatic experience didn't happen, avoiding the pain of memories but feeling emotionally numb or dead as a consequence.
There is often an absence of pain during the act of self-injury, rather like the absence of sensation that often occurs during abuse or trauma. Some people self harm to maintain that sense of being separate, and to convince themselves that they are not vulnerable. Others may already experience themselves as detached and 'unreal', and injure themselves in order to experience direct and immediate feeling, and to know that they are real and alive.
Self harm can be a means of communication for some people who are unable to put into words how they feel. People self harm as a way to show the world the pain they are in. Rather than asking for help, they believe that the only option is to self harm in order to get the help and attention they need.
Self harm can only ever provide immediate, temporary relief from emotional pain; it never deals with the issue underlying the distress. However with support and appropriate care, many who self harm do find alternative coping strategies that enable them to live their lives without needing to harm themselves again.