What Lies Behind Self-harm?

What lies behind self-harm?

Many use the blade of a sharpener or razor, a pair of scissors or even fingernails to make horizontal cuts on their arms, abdomen or even thighs. Self-inflicted injuries are for many an escape from emotional pain, a way to fill the void, but they are above all a reflection of a psychological malaise that has not been managed correctly.

The first question that comes to us when we see these signs, some recent, others less so, as evidence of the fact that the self-harming practice has lasted for a long time, is: “Why?”. Why does a person intentionally harm himself? Sometimes they are cuts, other times they are burns or even scratching constantly to cause a wound.

The answer to this question is complex, first of all because it is not only adolescents who suffer from this disorder, but also adults, much more than you think. Nor can we underestimate a growing and alarming phenomenon: the impact of self-harm on social networks and the consequent contagion among adolescents.

It must also be said that if the fourth version of the Diagnostic and Statistical Manual of Mental Disorders  (DSM-IV) considers self-harming practice as a symptom and not as a disorder, in the fifth version (DSM-V) it is considered as a condition independent with its symptomatology. It must be borne in mind that self-injury can also present along with other disorders, such as mood disorders, anxiety, food, etc.

The American Psychiatric Association speaks of “non-suicidal self-harm” defining it as a strategy in which pain serves as a catharsis to relieve negative emotions, loneliness, emptiness, isolation, to divert attention from other problems, to reduce feelings of anger, release tension or control accelerated thinking.

Self-harm: the wrong way to escape from emotional pain

Many experts have questioned the clinical definition of this disorder, wondering if it really is non-suicidal behavior. For example, it is known that 50-70% of people who inflict injuries have attempted or will attempt to commit suicide at a particular time in their life. It may be that the purpose of these cuts, burns or lacerations is not to take one’s own life, but that they conceal a negative thought and psychological malaise that could have alarming consequences.

However, each case is unique, each person has unique and special characteristics. We can understand that self-inflicted wounds are the tip of the iceberg, they are only part of a buried but increasingly present social phenomenon that should sensitize us more. Authorities and social organizations should be more careful and interested in verifying what really lies behind this behavior.

When I cut myself, the anger and pain go away, so I relax .  This is the phrase most repeated by teenagers between the ages of 12 and 18 who practice  cutting or injure themselves. This form of self-sabotage and self-destruction is the result of poor management of stress or life’s challenges. It is the same behavior of a person who has an addiction and tries to satisfy it in order to “forget”.

Even if these are superficial cuts and most of the young people who inflict them do not have borderline personality disorders, it is also true that they have emotional, relational, scholastic problems, have low self-esteem and a clear rejection of their body.

On the other hand, even if many professionals think that this is a way to “attract attention” or to show off their inner malaise, it is a very serious problem that, as we have anticipated, also affects the adult population.

How to manage self-injurious behavior

Marco is 56 years old. He does a very stressful job and there is one thing about him that draws a lot of attention: in the summer he always wears long-sleeved shirts, he makes sure that the cuffs are never unbuttoned. If you were to lift the sleeves of your shirt, you would notice horizontal wounds, old scars and more recent ones.

Marco’s is an example, but it represents a good part of the adult population. In fact, according to researchers from the Universities of Oxford, Manchester and Leeds, for every 100,000 inhabitants there are 65 adults who inflict injuries (the elderly in retirement homes must also be considered). It is an alarming fact, not to mention that in these cases the risk of suicide is very high. If we asked ourselves now what is behind these behaviors, the answer would be simple: persistent negative emotions, a high degree of self-criticism and a great difficulty regarding the expression and management of one’s emotions.

To manage this self-defeating behavior, you first need to understand what is behind it. There may be other disorders (eating disorders, depression, obsessive-compulsive disorder, anxiety disorder, etc.). Only professionals will be able to determine which reality lies behind self-harm.

Although hospitalization is recommended in many cases, this option should be the last option, especially in the presence of suicidal behaviors or thoughts. Cognitive-behavioral therapy, for example, is very effective in these cases and helps reduce self-inflicted injuries, suicidal thoughts, and symptoms of depression and anxiety.

In case of self-harm, a good approach is also represented by family therapies, group dynamics, the practice of full consciousness, dialectical behavioral therapy, because they can help to tolerate anxiety, frustration, regulate emotions and improve relationships with others.

We therefore seek more useful, sensitive and reasonable alternatives to the pain of life. 

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