We can not simply dismiss self-harm as attention seeking

Looking in from outside, it’s hard to understand why anybody would choose to deliberately cause physical injury to their own body.

And it’s even harder for a parent who has spent years protecting their child from harm in the outside world – both physical and emotional – to understand why their child would choose to physically harm themselves.

Those working in the field are now calling for more discussion and understanding around the topic of self-harm which has markedly increased in incidence across the country since 2007.

The statistics

The latest figures from the National Suicide Research Foundation reveal that the rate of self-harm in 2016 was 10 per cent higher than in 2007. In Ireland, there were 11,485 self-harm presentations to hospital made by 8,909 individuals in 2016. However, these figures are based only on those who present to hospital, and are thought to be the tip of the iceberg.

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The peak rate for women is in the 15-19 year age group and the peak rate among men is in the 20-24 year age group, but people of all ages and backgrounds are self-harming.

Some studies suggest that as many as four out of five people under 25 who die by suicide have self-harmed, according to Paul Gilligan, chief executive of St Patrick's Mental Health Services (SPMHS), yet the act of self-harm continues to be very poorly understood.

Ahead of their third annual Self-Harm Awareness Conference on Thursday, March 15th, St Patrick's and Pieta House are urging those who deal with young people to educate themselves on the subject of self-harm and to be able to identify the signs and reasons as they present themselves.

Overwhelming distress

Dylan Moore, senior counselling psychologist at SPMHS, says it’s very hard for people to understand why somebody would want to harm themselves, but he explains that the person who is self-harming is doing the best they can to cope with overwhelming distress.

“We need to understand that these people are not just doing this for fun; they are doing it to survive and cope because they do not feel they have the skills to cope with overwhelming emotional distress in their day-to-day lives. Some people dismiss self-harm as attention seeking but in reality it’s a complicated problem and those who self-harm need to be taught new skills to manage their distress instead of doing something self-destructive.”

Short-term relief

Moore explains that self-harming behaviour can distract a person from bad thoughts and overwhelming feelings and provide short-term relief from negative emotions, but can interfere with long-term life goals. People often keep their behaviour secret and injure hidden parts of their bodies. There may also be a biological component as research has found that non-suicidal self-injury can produce changes at a neurological level that result in reduced emotional arousal and an increase in an area linked to self-awareness.

For parents who find themselves dealing with a child who is self-harming, Moore says it’s human to worry about your child and to want this behaviour to stop, but he stresses the importance of trying to understand what’s happening for your child and why they need to do this.

“It can be difficult to know what to do when someone has harmed themselves, but there are things we can do directly. Remaining calm will help the person feel safe and mean they are more likely to share what’s happening for them. Validate that they are experiencing significant distress and are trying to find ways to cope with the situation, even though these may not be helpful in the long term. Express a willingness to talk about it when they feel able to do so. There can be an urge to ask a lot of questions but the person might find this overwhelming initially.”

Coping strategies

Parents need to get support from their family GP and information on support services and potential referral options. St Patrick's University Hospital in Dublin runs a programme called Living Through Distress for adults that focuses on teaching skills to increase range of coping strategies and reduce the urge to self-harm. It also runs a programme for adolescents.

“Some alternative behaviours we teach to manage emotional dysregulation at times of high emotion include holding ice until it melts as a form of distraction. Intense exercise such as running at a fast pace or doing compound exercises like burpees can help with rumination and physiological arousal. Paced breathing, that is exhaling for longer than we inhale – for example, inhaling to a count of five and exhaling for a count of seven – can also reduce some of the arousal associated with the flight, fight or freeze response,” says Moore.

The programmes at St Patrick’s are based on dialectical behaviour therapy (DBT) which teaches four important skills for coping with overwhelming emotions.

Distress tolerance helps to build resilience and develop skills to cope with distressing emotions; mindfulness helps you to stay present and focus less on negative thoughts; emotion regulation skills help you to recognise and observe each emotion without getting overwhelmed; and interpersonal effectiveness gives you new tools to problem-solve, express your beliefs and needs, and set limits.

The 2018 Self-Harm Awareness Conference will be held at the Aviva Stadiumon Thursday, March 15th to coincide with Self-Injury Awareness Day.

This year’s conference is aimed at healthcare professionals, social care and education providers, as well as policy-makers, parents, carers, influencers and funders, and will focus on the theme of “understanding self-harm”.