self harm: unfathomable?

why do people self harm? it is a question that many people ask and that the majority of us have no idea about. i am asked by friends and family of those who self harm and many clinicians also ask because there are not many training manuals around on how to approach it.

For me the interesting thing about self harm is that it is a behavior (like many) that has many different causes. Even though self harm looks the same from person to person their motivations are varied. Saying that though, there are some common themes. people self harm when they are in great distress, there is no doubt, but the function of the self harm can change.

one of the most common reasons people self harm is that they want their outsides to look like their insides. they want the world to see how distressed they are. by inflicting injury on themselves their internal pain becomes obvious to the world. this is often the function when stress is unendurable. When families are in conflict, when abuse is occurring, when the person feels absolutely powerless to do anything else to illustrate the level of distress they are feeling.

Another reason that people self harm is that while they are hurting their bodies they are distracting themselves from their emotional pain. Kind of like drinking alcohol, drugs or pokies. For some exquisite minutes they are not thinking about rejection, fear, guilt or self loathing. They are consumed mentally by something else.

Then there are the people who just want to feel anything. These people, perhaps because of a life of distress, have turned off their feelings. They might have learnt to mentally disappear as a child to avoid the bad things going on in their lives but then find it hard to feel. Self harm reminds them that they can feel, even if it is just pain.

I also occasionally come across the individual who self harms because it is punishment. This seems to be about self loathing for some apparently unforgivable sin, perhaps carried out in childhood. They last client I had who self harmed to self punish had shared her own sexual abuse with her little brother and she just couldn't forgive herself for that.

Because they all feel similar and look similar there is a tendency to wonder how to treat self harming. I think the first step is to look hard for the of the function the self harm. Without knowing what purpose it serves it is very hard to change it.

Then the slow process really begins....