Self-Harm: Signs, Symptoms and Causes

What is Self-Harm?

Self-harming, also known as self-injury, is a relatively common behaviour where someone may hurt themselves to feel temporary relief from their pain. It is often concealed from friends and family members, so it can be difficult to spot. 

Self-harming may start in childhood and increase in frequency and severity in adolescence, as the pressures of growing up, coupled with bodily and hormonal changes in puberty, take their toll.

Drastic changes in a person’s situation, such as end of a relationship, an increase in work related stress, or any other significant personal trauma can contribute to the intense emotions which lead to the urge to self-harm.

Why do People Self-Harm?

Self-harming can provide temporary relief from feelings such as anxiety, depression, stress or self-loathing.

The pain that is inflicted can release endorphins and a rush of adrenaline, which often become pleasurable to the sufferer and causes them to temporarily forget other negative feelings that they may be experiencing. However, this is often short-lived, and the internal anguish often remains afterwards.

Self-harm is frequently associated with adolescents, and in fact, recent figures show that it is impinging on younger people more than ever before. The stresses of puberty, school life and the influence of social media can be challenging for some adolescents and can often result in anxiety and depression. When depression and anxiety mount, some turn to self-harming, and many parents say they just do not know how to help their child in the best way. It's important to understand that self-harming is not an attention seeking behaviour and is actually a coping mechanism. 

Signs of Self-Harm

Dr Paul McLaren, General Adult Psychiatrist and Medical Director at Priory Hospital Hayes Grove, explains that self-harm is a common sign of psychological dysfunction. It has seeped into popular culture and spans the generations from childhood to old age. 80% of self-harm episodes involve stabbing or cutting the skin with a sharp object. Self-cutting and overdosing are the most common forms, but other self-injurious behaviour includes:

• Punching hard objects
• Picking at skin
• Hair pulling
• Swallowing foreign bodies 
• Intentional poisoning with medication
• Burning parts of the body 

More complex behaviours such as piercing or tattooing, while socially sanctioned, can have similar psychological drivers in some individuals. Munchausen’s syndrome and factitious disorder also share some of the psychopathology of self-harm.

As self-injury is often associated with minors, there are some additional signs that parents can look out for if they think their child is hurting themselves. These 6 signs of self-harm for parents may come in useful for any parent, guardian, or even friend who is concerned about someone. 

Psychological Symptoms of Self-Harming

While the physical impact of self-harming can be more apparent, the psychological difficulties experienced if you self-harm can be extreme.

Feelings of anxiety, frustration and depression regarding your current situation, or as a result of personal trauma, ultimately become so overwhelming that damaging your body provides temporary relief. Psychological symptoms of self-harming include:

• Anxiety
• Depression
• Frustration
• Confusion
• Insomnia
• Social isolation

What Causes Self-Harm?

Due to self-harm affecting people of all ages, it is believed that the overwhelming emotional issues that can affect you at any stage of life are a major factor behind self-harming, as a means of coping and releasing built-up tension or frustration.

Self-harm is a symptom of mental distress and in a high proportion of those presenting for help, it is evidence of underlying psychiatric disorders or emotional distress. A wide range of psychological processes can lead to self-harm. For example, in adolescence, emotional distress is common and self-harm can emerge as a maladaptive coping strategy.

Common underlying diagnoses are:

• Anxiety
• Depression
• Obsessive compulsive disorder (OCD)
• Maladaptive personality traits, such as borderline personality disorder (BPD)

Those who self-harm may also struggle with emotional difficulties that have external influencing factors. Other causes of self-harm could be: 

• Social and relationship problems - social issues can affect anybody at any age. Bullying in school or the workplace, having relationship problems with partners, friends and family, as well as coping with gender or cultural expectations, can all cause a build-up of anxiety, stress or depression which can ultimately lead to an urge to self-harm
• Trauma or abuse - physical or sexual abuse, suffered either as a child or adult, can lead to confusing feelings of self-blame and low self-esteem, while severe trauma such as the death of immediate family members and close friends, or having a miscarriage can trigger symptoms of depression

Treating Self-Harm

In respect of treatment, the physical complications of your self-harming behaviours will be managed and treated first. This will be done promptly and efficiently in order to set a positive tone and enable good communication for the duration of your treatment. Further self-harm treatment will depend on whether you have any underlying psychiatric conditions. For example, if you are depressed or anxious, these conditions will also form part of your treatment plan.

Your treatment for self-harm may involve outpatient visits for sessions with a psychologist or a psychotherapist. In more severe cases of self-harm, you may benefit from inpatient treatment or intensive community support, to help you get back on track. This would encompass a combination of group and private therapy sessions with a psychologist, and can also involve family sessions, talking therapies, or medication.