The Function of Self-Harm
By understanding self-harm, we can help vulnerable teens.
by Dr Erin Bowe
Self-harm is usually defined as the deliberate act of damaging one’s body tissue without suicidal intent. Many bewildered parents, teachers and health professionals are unaware that self-harm tends to have very powerful psychophysiological rewards. Self-harm is known to reduce heart and breathing rates, flooding the body with feel-good endorphins.
The typical pattern of self-harm begins with the experience of negative emotions. The adolescent then quickly reaches a level of distress that they feel unable to tolerate, their breathing becomes shallow and their heart rate goes up. When someone regularly engages in self-harm, they typically won’t feel any pain, or if they do, the pain will be minimal. This is because the body floods with natural pain-reducing opiates. The response is somewhat similar to ‘runner’s high’. For many people, mild damage to the body triggers this chain of ‘feel good’ hormones, so then feelings of relaxation and wellbeing take over. Self-harm then becomes associated with a quick fix for feeling better, and for many young people, it’s very addictive.
Firstly, it’s important to address the commonly held view that adolescents simply engage in self-harm for attention. My answer to this is that no matter what type of presentation, self-harm is a maladaptive way of communicating distress. There’s no real evidence to suggest that an adolescent who is secretive about the behaviour is more serious or more distressed than one who makes a bold announcement or shows their scars. The other common assumption is that adolescents must know that the behaviour is unhelpful and that they need to stop. Many adolescents are actually quite ambivalent about their self-harm and have a view that it is playing a helpful role in their lives. They may tell adults what they want to hear, but secretly fear that without self-harm, they will have no way to cope or to regulate their emotions.
Parents and caregivers often experience feelings of anxiety, shame and failure in response to child’s self-harm. These feelings sometimes come across to the teen as anger, or personalising the non-acceptance of the behaviour to mean that the parent doesn’t love and accept them as a person. Punishing, bargaining, making no-harm contracts or isolating teens from friends and social activities tends not to work.Instead, the focus needs to be on managing their distress and improving coping skills.Adolescents are often intrigued when I ask them what their parents do to cope with stress. It’s worth thinking about your own adaptive skills (exercise, meditation, social support, crafts etc.) and how you learned to cope with stress. It’s possible that there’s a teaching moment there, and an opportunity to redirect them from unhelpful coping suggestions they may receive from peers.
The short-term goal is to equip the adolescent with other adaptive coping skills, building their confidence in using these until they are ready to cease self-harming. To end the behaviour, the adolescent needs to make a challenging commitment. They need to be the ones to decide to replace their maladaptive, but highly effective strategy with something more adaptive that will not provide instant gratification. The most powerful decisions are the ones we choose for ourselves, and adolescents generally need to feel confident that a change in behaviour was their idea.
It is difficult to stop someone from using a maladaptive coping strategy until he or she has fully mastered an alternative. This is often why adolescents and parents clash.They simply have different goals and expectations. When a parent brings their adolescent for treatment, they will say ‘I want you to get them to stop cutting’, whereas the adolescent usually says they just want to ‘feel better’. The teen is are often scared or angry at the prospect of someone trying to take his or her coping strategy away, and feels guilty because he or she can’t meet others’ expectations.
Dr Erin Bowe is a Clinical Psychologist from Melbourne who completed her PhD in self-harm. She works with adolescents and families, and consults with schools about best practice for self-harm management.