There’s an extensive list of myths and misconceptions about self-harm and I’m sure you’ve heard at least a few of them. The problem with these myths are that they perpetuate the stigma of self-harm and force those who self-harm into a painful silence. I know because I have experienced it. I have been told that my self-harm is manipulative; that I’m crazy, unstable, and suicidal. I was kept out of school once as a 9th grader because I was cutting and the school psychologist said I was basically too unstable to be in school. I slowly came to believe that there was something innately wrong with me and that I could never be helped.
This flawed belief was a direct result of misconceptions about self-harm that those around me believed. Even mental health professionals were plagued with misinformation. Not only is this alarming but it’s just sad. You can find therapists with specialties ranging from codependency to severe mental illness. But where are all the therapists trained to help those who self-harm?
I have a suspicion that those of us who self-harm become either lost in a mix of clients diagnosed with borderline personality disorder OR we just hide our self-harm from even those who are supposed to help us. Self-harm is misunderstood so I figured I would look to research to find out specifically what self-harm is.
According to the DSM-V (the most recently published version) they define nonsuicidal self-injury (NSSI) with 6 proposed criteria (I will do my best to paraphrase):
A. Intentional self-inflicted damage to the surface of the body, within the past year on 5 or more days. The expectation that the injury will lead to only minor or moderate physical harm. Absence of suicidal intent is stated or inferred.
B. The self-injurious behavior yields one or more of the following expectations:
- Relief from negative feeling
- To resolve an interpersonal difficulty
- To induce a positive feeling state
C. The intentional self-injury is associated with at least one of the following:
- Interpersonal difficulties or negative feelings or thoughts occurring prior to the self-injury
- Prior to the behavior, a period of preoccupation with the behavior is difficult to control
- Thinking about self-injury that occurs frequently, even when it is not acted upon
D. The self-injurious behavior is not socially sanctioned (like body piercings)
E. The behavior or the consequences of it cause clinically significant distress or interfere with interpersonal, academic, or other important areas of functioning
F. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication or withdrawal
… so that’s all pretty great and clinical.
However, I really like the definition created by some experts in the field. In their extremely informative book Freedom from Self-Harm, Kim L. Gratz & Alexander L. Chapman compassionately define self-harm as, “something people do purposely to harm themselves physically in the moment, without intending to kill themselves.” Note that the damage is physical, the damage is immediate, the harm is intentional, and the intention is not to die by suicide. Some of the most common forms of self-harm include cutting, burning, biting oneself, hitting oneself, scratching or picking at skin to cause scrapes or cuts.
Self-harm is also much more common that we might think. Some studies have indicated that about 4% of adults have self-harmed at least once in their lifetimes (Briere and Gil 1998; Klonsky, Oltmanns, and Turkheimer 2003). Self-harm is also extremely common in high school and college settings across Canada, Europe, and the United States. It’s difficult to know just how many young people are self-harming because of the stigma attached to talking about the behavior. Although, I think it’s important for people who self-harm to know that you are not alone even if it might feel that way.
Self-harm is also not a behavior that discriminates. Gratz & Chapman suggest that people of all genders, races, ethnicities, sexualities, and social classes engage in self-harm. The behavior is most common among adolescents and young adults although any person at any age can engage in self-harm. Knowing the facts about self-harm will help reduce the myths and stigma about the behavior.
In my next post I will go more into what self-harm isn’t since it’s equally important to understand both what the behavior is AND what it isn’t.