Suicide, Depression and Self Harm
Self harm isn't always linked to depression but it can be a reasonable indicator of it. Whilst most people who self harm do not commit suicide, there is a significantly greater chance of someone doing so if they self harm in the long term.
This article will help you understand some of the reasons behind it so you can feel more confident of taking appropriate action if you are worried that someone who you know is self harming. If you are someone who has self-harmed, you are not alone. Take heart from the fact that it is possible develop other ways of coping and that there is help out there.
What is Self-harm?
Self-harm is intentional self-inflicted injury, carried out without the intention of committing suicide, most people are familiar with cutting as one method. You would probably have a good chance of recognising that someone was doing this if you happened to see the scars. However it is worth noting that most people will go to some lengths to keep these covered up. Given that we are all supposed to be taking care to avoid too much sun exposure to skin, the covering up behaviour can pass un-noticed unless you knew the person before they started hurting themselves. In cultures where women are expected to keep covered up it is particularly hard to detect.
Prescription abuse, or taking too much of an over the counter medication, can happen without the intention of taking your own life. Even taking a few more pills than prescribed can cause frightening effects such as stomach pain or extreme sleepiness. Scratching one's skin and pulling out hair might sound like quite minor methods of harming, but both can be surprisingly damaging,
More common in young men than women, bruising caused for example by punching walls, can be hard to pin down as intentional harm, because there are all sorts of plausible explanations that a young adventurous male can come up with for his injuries.
With all of these it is generally a change in behaviour that might initially alert you that something is wrong or the pattern of apparently plausible accidents that someone you know claims to have had when they are not ordinarily accident-prone.
Please note that in this article I will exclude anorexia and bulimia which are sometimes included under the umbrella term of self-harm.
Are People who Self-harm Suicidal?
Only 4% of people who self-harm state that suicidal feelings had led to any of their incidents of self-harm.
The reassuring news is that only a small proportion of people self-harm because of suicidal feelings. In a survey of 758 individuals who self-harm only 4% stated that feelings of wanting to take their own life had led to any of their incidents of self-harm. (NHSN 2009)
It is surprising to learn that self-harm doesn’t necessarily mean that an individual is clinically depressed or mentally ill. Some people might use it as an alternative to having a couple of drinks for courage before a night out for example. In teenagers who haven’t learnt coping methods for dealing with intense emotions self-harm can offer a quick solution allowing them to continue as normal until the next emotionally overwhelming incident occurs. This means that there is no need to get into a desperate panic on learning that someone you know has been self-harming. Approaching the subject in a measured and calm way is going to be more helpful to them than a panicked and possibly angry manner. In most cases you can gradually work towards them wanting to accept help for the underlying problem which might lead to them stopping self-harming.
Reasons for Self-harm
These are some of reasons people have offered for their self-harming behaviour. For some people several of the reasons might be relevant at different times.
- Inability to cope with intense emotions such as shame, anger, sadness, anxiety, helplessness.
Understand some of the reasons for self harm in a survivor's own words.
- Low self-worth
- Suicidal thoughts and feelings.
- Peer pressure
- To improve sporting performance – a self-harm practice known as boosting has been reported amongst some quadriplegic athletes. This can raise their blood pressure and result in improved sporting performance. (The Times August 2012)
It has always been hard to determine the proportion of people who self-harm because most people are secretive about it, but in Western countries there does seem to have been an increase in the numbers of teenagers who self-harm in the last decade. It is estimated that 10% of teenagers will try it, (Selfharm.co.uk) however fewer go on to self-harm repeatedly. According to the Royal College of Psychologists around 1/3rd of people who self-harm for the first time will do it again during the next 12 months This would indicate that in the region of 3% of teenagers will do it more than once.
Adults of all ages also self-harm, although the proportion doing so decreases with age as people receive treatment or develop alternative strategies for coping with emotions and or depression. In a study by David Pierce (International Journal of Geriatric Psychiatry Apr/June 1987) 5.4% of people admitted to hospital as a result of self harming were over over 65.
Depression and Self-harm
Some people with depression and other mental illnesses self-harm, but just as not every person who self-harms is clinically depressed, not everyone who is depressed will self-harm. However, “People with current mental health problems are 20 times more likely than others to report having harmed themselves in the past” (The Fundamental Facts, Mental Health Foundation, 2007). Therefore If you have discovered that a friend or family member has been self-harming don’t assume they are depressed, but make caring enquiries to ascertain if they are.
There is a high correlation between self-harm and mental health problems where the self-harm has been severe enough to warrant a visit to the emergency department. In these cases more than 66% would meet the criteria for depression (The Fundamental Facts, Mental Health Foundation, 2007). However even getting treated for self-inflicted injuries does not guarantee referral to mental health services. If this is the case, then you as the concerned friend or family member can be instrumental in arranging a doctor’s appointment and pushing for the individual to receive the appropriate treatment, whether that is medication, therapy or a combination of the two. Without assistance a person suffering from depression may struggle to give the doctor a clear picture of how bad things are for them and therefore miss out on treatment which could help.
Does Self-Harm Lead to Suicide?
In the long-term 3% of people who self-harm repeatedly as adults take their own lives. This compares with 1% of the population in general in the UK (The Guardian). The risk increases with age and is much greater for men. The risk is significantly greater in people who have been treated in hospital previously due to self-harm.
Clearly self-harm is a risk factor for suicide, but 97% of people who self-harm long term die from other causes, so it is a far from inevitable outcome.
If you have discovered that a friend or relative has recently started harming themselves there is a very good chance that supporting them to get help and learn alternative coping strategies will result in them being no more likely to commit suicide than average.
If the self-harm is or proves to be a long term problem then your support and friendship could still help to ensure that they are amongst the 97% who do not kill themselves.
Self Harm Help
If you self harm and are wondering where to turn for help, the resources below are a good start. It will be beneficial if you can decide upon a friend or a relative who you trust enough to support you, especially if you feel able to tell them what might help you – for example distracting you with an activity like watching a film with you or playing basketball or coming with you to the doctors. However, you may feel safer in the first place going to the doctor yourself or talking to a school or work-based counsellor. Don’t assume this is something you must deal with on your own!
There are support groups on the internet, but be wary, because just as the web has spawned some pro anorexia sites, it has also produced some pro self-harm sites which will not help anyone develop safer coping strategies.
In the short term if you feel the need to self-harm try alternatives, such as flicking your wrist with an elastic band or holding a fistful of ice cubes as long as possible or distractions such as writing down your feelings or going to the gym. If you end up harming despite this do so as safely as possible using sterilised implements, causing the minimum of damage. Keep in mind that scars can remain with you for life - the ones in the right hand picture are from injury done 15 years before. Remember that just because you can’t see the damage from an overdose it doesn’t mean there is no lasting damage.
Books about Self Harm
A well regarded work book for teens you self-harm
A valuable book for parents whose children self-harm
A self help book which could start you on the road to recovery
For Someone Else
If you discover that a friend or family member is self-harming, assuming that they are suicidal and dragging them off to hospital is likely to be more damaging in the long run. This is partly because they may not get a very positive reception from harassed staff dealing with emergencies, but also because fearing a dramatic reaction from you in the future; they may go to greater lengths to hide further incidents from you.
Explain that you are concerned about them and ask gently if they can tell you why they are doing it. If they reveal that they are depressed or are having thoughts about taking their own life, then it is appropriate to make an appointment to take them to the doctor. It is worth bearing in mind that even if they have self-harmed because they are having suicidal feelings, they have probably done so in order to help themselves survive those feelings (as odd as that might seem to you.) If you feel the situation is very urgent and they are unsafe or the injury itself needs medical attention, take them to casualty or ER.
In most other cases being there to listen, offering them unconditional positive regard and helping them cope more effectively with the problems that have led to self-harming behaviour will enable them to be more open about it and start to look for other ways of coping.
You may need help and support yourself as a concerned friend or relative.