Self Harm Treatment: Treatment for Self injury or Self Harm

Self harm (SH) is defined as a direct and intentional injury to the body, with or without suicidal intention.

According to DSM-IV-TR, Self harm is listed as a symptom of Borderline Personality Disorder. However people who self harm may include those suffering from depression, anxiety disorders, post-traumatic stress disorder, substance abuse, eating disorders, schizophrenia, and other personality disorders. Sometimes, well functioning people who have no clinical diagnosis may also self harm.

There are two kinds of Self harm: Covert, non-deliberate self harm and Deliberate self harm or direct injury.

Covert, Non-deliberate Self harm: This includes:

• Disordered eating - Anorexia, Bulimia, Compulsive over eating
• Omission of self care
• Poor Hygiene
• Self neglect
• Lack of boundaries
• Submission
• Perfectionism
• Appetitive behaviours
• Destroying valued possessions
• Over working/ under-working
• Over exercising/under-exercising
• Engaging in risky behaviours - extreme risk-taking, reckless driving, extreme sports, Russian roulette, violence
• Promiscuity
• Gambling
• Self poisoning without suicidal intent - overdosing
• Self medication and substance misuse - excessive use of alcohol, drugs, prescribed medication, smoking, food, love, shopping etc.

Self injury is a "compulsion or impulse to inflict physical wounds on one's own body, motivated by a need to to cope with unbearable psychological distress or regain a sense of emotional balance. The act is usually carried out without suicidal or decorative intent" (Sutton et al, 2007).

Following are some of the most common forms of Self harm:

• Cutting, slashing and carving (words, symbols, designs and dates)
• Skin burning and scalding
• Erasing or rubbing off layers of skin
• Pulling off skin or nails

What substance or behaviours calm or soothe you?

Is it alcohol, recreational or prescribed drugs, cigarettes, chocolate, sex, food, work, shopping, exercise?

How often do you use them?

• Excessive scratching, enough to cause bleeding
• Compulsive picking (CSP). Also, called neurotic excoriation and dermatillomania
• Self stabbing with sharp objects (pins, needles, compass, scalpels, nails etc)
• Inserting objects into oneself
• Inserting needles under skin or veins
• Self punching, hitting, slapping, biting or bruising oneself
• Head banging
• Interfering with wound healing
• Hair-pulling (scalp, eyelashes, eyebrows)
• Ingesting toxic substances or swallowing foreign objects
• Bone breaking

One way to start is by managing Self harm. This involves taking fewer risks such as sterilising implements, avoiding drinking and drugs, taking better care of injuries, reducing severity and frequency of self injury and replacing cutting for pain with rubber bands etc.

Moreover, self-harm can be managed by exploring alternative ways of regulating moods, identifying triggers to self injury, making links between self injury and cause, as well as affect regulation i.e. gaining emotional literacy and distress tolerance.

Daily grounding techniques, keeping monitoring charts and replacing blood with red marker pen can be helpful too.

The following are some grounding techniques that can help manage Self harm:

Identifying all emotions

Soothing and self calming yourself

Engaging in dialogue with the inner critical voice i.e replace it with compassion and self-forgiveness

Encouraging positive messages

Distracting yourself by doing something fun!

Staying in present reality

Carrying safe things like pebbles, crystal or an image

Touching a loved one or something or someone associated with comfort such as photo, clothing, shoes, hair etc.

Making contact with nature

Going for a walk to feel the elements

Listening to soothing music or playing loud music

Alleviating numbing with squeezing ice cubes or holding chilled aluminium cans

Connecting with someone via phone, email, face to face and focusing on their voice

Writing and journaling

Keeping brain and hands occupied and focused such as making lists such as list 10 favourite things, favourite books, films, songs etc.

Counting nice things

Taking a shower, bath or brushing teeth

Chewing strongly flavoured food stuff such as chilli, ginger root, raw onion, lemon etc.

Doing mindless chores, changing clothes, drinking water or applying hand and body lotion

There is still much debate and uncertainty about which form of treatment is most effective for Self harm. Further clinical studies and research is needed before the best possible treatment is agreed upon.

However, it is very important to trace the actual cause and reason behind Self harm in order to properly treat the problem. Often it is seen that individuals who self harm suffer from depression or other psychological disorders. Anti-depressents have been found to be effective in treating such cases.

Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour therapy (DBT) are also used with success for the treatment of Self harm. Individuals who habitually self harm are sometimes hospitalised, depending on their ability and willingness to seek help.