What is self -harm
With the term self -harm, we refer to all those behaviors deliberately oriented towards provoking physical pain.
These behaviors do not have to do necessarily with suicide attempts or desire to commit suicide. Instead they include, for example, cutting the skin with different types of sharp objects, the inflicting burns and branding with cigarettes or hot objects.
In fact, self -harm is defined as a “deliberate and self -influence damage to one’s body without suicidal intent and for non -socially accepted purposes” (International Society for the Study of Self Injury, 2018).
Criteria for the diagnosis of self -harm
The DSM-5-TR (2022) includes “non-suicidal self-injury” (Nssi: Not Suicidal Self Injury) as a distinct diagnostic category. Defines it as a series of intentionally selfish acts towards your body conducted for at least 5 days in the last year.
To be such, the self -elevation must be preceded by one or more of the following expectations:
- obtain relief from a negative cognitive feeling/state;
- resolve a relational situation;
- induce a positive feeling.
In addition, the self -elegant behavior must be associated with at least one of the following symptoms:
- interpersonal difficulties or sensations/thoughts/negative feelings preceding the self -elegant gesture;
- uncontrollable concern for the gesture;
- frequent self -elevation thoughts.
Finally, to be such, it must cause significant discomfort.
What self -harm hides: the causes
Self -harm as an admitted coping strategy
The implementation of self -harm It allows you to focus your attention on physical pain.
The reasons underlying the implementation of theself -harm They are generally related to the need to get out of a state perceived of a deep void to reconnect to reality and the management of unpleasant emotional states perceived as otherwise not handling.
The self -injurious behavior Thus shifts attention from emotional to physical pain, experienced as more tolerable.
Physical pain at first attach the tension, generating relief, and moves away from emotional experiences that do not want to experiment.
Over time, however, this risks generating new unpleasant emotional experiences, such as guilt and shame for having implemented behavior.
The effectiveness of theself -harmin relation to both the functions described, increases the possibility of putting it back again, and therefore promotes the establishment of vicious circles that maintain the problem over time.
Self -harm as punishment
Self -harm can also represent a form of self-division: the sense of guilt and self -criticism can elaborate self -elevable conduct in vulnerable subjects.
Self -harm as a search for attention
Finally, self -injurious behavior can represent a dysfunctional method through which look for attentionrequest help or communicate their discomfort to others.
An extreme gesture used in order to scream to the world one’s existence/presence and the suffering that you are unable to communicate in words.
Because self -harm is made: risk factors
There are various individual risk factors including:
- Presence of mental disorders (borderline personality disorder, anxiety, depression, eating disorders and conduct disorders)
- Temperamental traits (loss of control, impulsiveness and emotional disregulation)
- Negative feelings towards one’s body (dissatisfaction, shame, control)
- Abuse of substances
- Internal and outsourcing behaviors
- Problems in the school field
- Lack of self -esteem and self -efficacy
Then there are social risk factors:
- Stressful events
- Abuse experiences (sexual, physical and/or emotional)
- Family problems (negligence and conflicts)
- Negative relationships with peers (bullying, isolation and lack of support)
- Messages presented by Social/Video Games/TV (addiction, normalization, generalization and encouragement to self -elegant behavior)
Self -harm and suicide
Despite the documents self -harm They have a different nature than the suicide attempts, there is a strong predictive bond between the first and the latter.
The self -regrets are more frequent and provide behaviors with less serious consequences than those used in the real suicide attempts. Furthermore, the people who implement them are not moved by the desire to end their existence.
The research highlights that self -elevations are risk factors for suicide as it is more correlated to stories of suicide attempted. Furthermore, there are numerous studies that demonstrate how the self -elevation They are a predictive factor of major suicide of repeated and previous suicide attempted.
Self -injurious behavior They represent a risk factor for suicide. This is since with the passage of time they can desensitize people from physical pain thus increasing their ability to implement it.
Prevalence of self -injurious behavior
THE’self -harm It is a very widespread phenomenon among teenagers (15-20%). This behavior sometimes also persist in the early adulthood, but at now there have been no data on the research on the factors that can influence the persistence of the self -injurious behavior over time.
The self -injurious behavior is higher in the psychiatric population (mood disorders and/or anxiety disorders, substances abuse, eating disorders, dissociative disorders, post traumatic stress disorders, schizophrenia and personality disorders). It is often associated with the borderline personality disorder but in this case the picture is more serious, the behavior is repeated and the self -elevation methods are varied.
How self -harm begins and how it is maintained over time
The investigation conducted by Kiekens G. et al. (2017), and published on Journal of Nervous & Mental Diseasehighlights the possible factors associated with the persistence of self -injurious behavior over time.
The authors, using the data that emerged from a longitudinal study that lasted three years, have in fact compared the levels of some variables on a sample of 101 young adults. Of these 51 they continued to implement the self -elevation after adolescence. 50, on the other hand, interrupted these behaviors.
In addition to the characteristics of self -harm behaviorsin terms of the function performed and gravity, the study evaluates the levels of many factors. Interpersonal factors (perceived social support, perceived family support) and intrapersonal (sexual orientation, ability to regulate emotional regulation, emotional distress, academic stress, self -esteem, satisfaction for one’s life).
Gravity of self -injurious behavior
The results note that a greater gravity of the self -injurious behavior implemented in adolescence, in terms of greater frequency and use of different methods, it was associated with greater persistence of behavior in the early adulthood.
It was also found that the number of methods used correlated with suicide attempts much more than the frequency of the implementation of the behavior.
Function of self -harm
In relations to the functions performed by self -harm behaviorboth the presence of positive consequences deriving from the helixing of Arousal (excitement, neurovegetative activation) and the difficulty perceived in controlling behavior are relevant.
In fact, the reasons based on positive reinforcement mechanisms, such as obtaining a discharge of energy and the perception of not being able to resist the impulse of implementing the behavior, were associated with the permanence of behavior over time.
Interpersonal and intrapersonal factors
In relation to the other factors examined, the persistence of self -harm behavior Over time it was found to be associated with greater levels of academic and emotional distress. But also at minor levels of peer support, satisfaction for one’s life, and perception of competence on one’s emotional regulation skills.
On the other hand, factors such as homosexuality and family support perceived, unlike how much literature indicates as relevant factors for the implementation of behavior in adolescence, were not found.
Emotional distress and perceived emotional regulation
Finally, the study also evaluated the role of emotional distress and perceived emotional regulation skills. All elements that could mediate the effect of other factors considered to maintain the problem over time.
The perceived emotional regulation skills were an important factor for the interruption of theself -harm. Low levels of ability to perceived emotional regulation (understood as the presence of negative beliefs about their skills to be able to regulate emotions) mediated the effect of the “perceived social support” factors and “satisfaction for one’s life”.
Furthermore, emotional dystress had a predictive value, for the maintenance of behavior over time, lower than the skills perceived of emotional regulation.
The authors themselves therefore indicate that the perception of being competent in regulating one’s emotions in the face of adversity is a more important factor than the objective levels of distress perceived.
How can self -harm: how do you get out of it
The most widespread and effective treatment to intervene on self-elevation on cognitive-behavioral psychotherapy.
The cognitive-behavioral approach provides for the use of techniques (cognitive renovation and repercussions prevention) useful for helping teenagers and young adults to face any self-relevant situations.
As emerged from the aforementioned investigation, for example, in addition to the general evaluation of emotional regulation skills, it is important to detect the perception that children have of their ability to regulate their emotions. It therefore becomes important to change dysfunctional beliefs about it, when present.
Cognitive-behavioral tools such as functional analysis could be precious in order to identify the antecedents and the situational, cognitive and emotional consequences of theSelf -propelled act.
Serve to detect i risk factors To protract the problem over time (strong elicit of positive Arousal and implementing behavior because it has now become conditioned, therefore with poor perception of control).
This allows you to identify the most appropriate therapeutic strategies. This in order, for example, to modify the environmental contingencies that act as a trigger for the implementation of the self -harm behavior and/or to learn new, more functional ways, to increase the positive sensations perceived.
Finally, the research shows the effectiveness of behavioral dialectical therapy (DBT) in the treatment of self -harm in subjects with borderline personality disorder, this pays attention to the component of acceptance/tolerance of suffering in order to reduce emotional discomfort.
In -depth resources
To download for free
- First chapter of the volume “overcoming the borderline personality disorder. Practical guide for family, partners and clinicals ”published by Centro Studi Erickson
Texts for deepening suggested
- Porr, V. (2020). Overcome the borderline personality disorder. Practical guide for family, partners and clinicals. Trento: Erickson Study Center
Bibliography
Kiekens, G., Hasking, P., Gruffaerts, R., Claes, L., Baetens, I., Boyes, M., Mortier, P., Delyttenaere, K., Whitlock, J. (2017). What predicts ongoing nonsuicidal self-injury?: A Comparison Bethaeen Persistent and Ceased Self-Injury in Emerging Adults. Journal of Nervous & Mental Disease.
