What Is Self Harm?

For many self-harm is not so much about the inflicting of physical pain as the cessation of emotional pain.

For many people the idea of deliberately harming oneself is difficult to conceptualize. Many of us may spend our time attempting to avoid harm to ourselves either in the short-term (wearing a seat-belt) or in the long-term (exercising regularly, eating a healthy diet). Many of us would flinch from the idea of wilfully inflicting acute damage to our own bodies. How then can we understand individuals for whom harming the self is not something that they avoid or find aversive but is something that they seek out?

Deliberate self-harm is a term that covers a wide range of behaviours some of which are directly related to suicide and some that are not. This is a relatively common behaviour that is little understood.

What is deliberate self-harm?
Deliberate self-harm is a term that covers a variety of behaviours, with a multitude of different functions and a wide range of intentions. Perhaps the most useful definition is from Professor Keith Hawton and colleagues at the Centre for Suicide Research in Oxford (Hawton et al, 2002):

An act with a non-fatal outcome in which an individual deliberately did one or more of the following:

• initiated a behaviour (e.g. self-cutting, jumping from a height) which they intended to cause harm to the self);
• ingested a substance in excess of the prescribed or generally recognized therapeutic dose;
• ingested a recreational or illicit drug (which they intended to cause harm to the self);
• ingested a non-ingestible substance or object (e.g. batteries, razor blades).
  

Two elements are crucial: there is acute damage to the self (this excludes, therefore, behaviours such as smoking or eating an unhealthy diet); and damage is intentional (therefore, excluding accidents or behaviours such as starving where the motive is to lose weight as in anorexia nervosa).

Some clinicians and researchers draw distinctions between forms of deliberate self-harm where there is or is not an intention to die, distinguishing attempted suicide from self-harm or self-mutilation. There is some validity to this distinction. For some people, deliberate self-harm is more about finding a way of coping with life rather than ending it.

Nevertheless, regardless of the method or motive, harming the self seems to put people at risk of more severe forms of self-harm over time. In addition, even for people who primarily think of self-harm (e.g. cutting) as a way of coping, they may at other times harm themselves in other ways where they do have the intention to die. The potential lethality of a method adopted by an individual is not always an accurate indicator of his or her intent. Very few people who harm themselves have sufficient knowledge about how the body works to judge the impact of their actions.

[Source: The Wellcome Trust]