Self-Harm

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Self-harm is a form of non-suicidal self-injury with the purposeful intent to hurt yourself. It includes cutting, burning, bruising, and breaking bones. While suicide isn't the intent of self-harm, hurting yourself can make a suicide attempt more likely.

What Are The Signs of Self-Harm?

If you suspect your child or other loved one may be self-harming, be on the lookout for any of the following warning signs:

  • Scars: Fresh (red or pink) scars on their wrists, arms, shoulders, legs, thighs, and stomach may indicate recent self-harm. Pay attention to how the scars look, too. They'll likely be in a cluster and uniform in length and direction, suggesting they were deliberate.
    • Also, pay attention to the first-aid supplies in your house. If you run out of supplies for no clear reason, someone might be using the supplies and hiding the evidence.
  • Using clothes to cover up: Someone who self-harms might constantly wear long-sleeves and pants to hide scars, even in the warmer months. They may also seem newly uncomfortable with the idea of showing skin.
  • Touch sensitivity: They may flinch or wince from pain when you touch or grab their arm, waist, legs, or anywhere else they may have self-harm wounds.
  • Sneaky or withdrawn behavior: You may notice they sneak off to a bathroom or their room to be alone, and may return seeming notably sad or distressed.
  • A collection of weapons or sharp objects: They may keep a stash of sharp objects in their room or bathroom. Examples include pencil sharpeners, box cutters, razor blades, kitchen knives, lighters, sharp jewelry, and pocket knives.

How Can I Help Someone Who Self-Harms?

If you suspect someone you love is struggling with self-harm, you can bring your concerns to them in a supportive and empathetic way. Start with an open conversation. If they choose to confide in you, you can first take what they've been using to self-harm. This keeps them safe as you discuss the next steps.

Your loved one will need to seek professional mental health treatment to begin their recovery, but you can help them stay safe and feel supported as they go through the process.

A listening ear, compassion, and empathy can help them feel heard. It may be difficult for your loved one to open up to you at first, and you may feel them attempt to shut down or pull away. You can make a continued effort to spend time with your loved one, even if they shy away at first. Try to keep the line between you and them openmdash;it can help more than you know.

What Are The Long-Term Effects of Self-Harm?

Self-harm's long-term effects range from physical to psychological. Long-term physical effects can include permanent scars, infection, nerve damage, and difficulty healing from future injuries.

Psychological effects may include depression, anxiety, difficulty forming relationships, and difficulties with self-image. You may also develop an addiction to self-harm, and run a higher risk of suicidal ideation or suicide attempts.

Repeated self-harm can lead to infection, especially if you can't take proper care of the wounds. A wound infection could travel to your heart and other areas of your body, which would require medical treatment.

What Causes Someone to Self-Harm?

For some, the entire process of self-harm serves as a soothing distraction from their emotions. It also becomes a task that makes them feel in control. Needing to clean, dress, and monitor the wound can offer a respite from situations, feelings, or people that demand attention.

Self-harm may also be a non-verbal cry for help. Your wounds may draw the attention of someone who could help you, or someone who could offer compassion.

Someone could self-harm for many reasons. Some of these include:

  • Turning emotional pain into physical pain. Rather than an invisible concept, you can see your pain and its cause.
  • Wanting to feel something, even if it's pain. Depression and other conditions can cause a state of apathy that self-harm temporarily breaks.
  • Desiring control.
  • Trying to cope with intense emotions, like anger, grief, sadness, and hopelessness. Self-harm can offer a distraction from unbearable feelings.

Do Rehabs Treat Self-Harm?

Yes, many centers focus specifically on treating mental health conditions, including depression and self-harm. Many other rehab centers treat co-occurring mental health disorders like depression alongside substance use disorders. You can attend several levels of treatment for self-harm. These include:

  • Outpatient, where you meet once or twice a week with others in treatment and your care provider.
  • Intensive outpatient, where you meet 3-5 times a week for several hours at a time for more intensive care.
  • Partial hospitalization, where you meet 5-7 times a week for a full day, or most of one.
  • Residential, where you live in a rehab center for 28+ days and engage in treatment with a community of peers and treatment providers.
  • Inpatient, where you live in a treatment center or hospital and receive 24/7 monitoring. This can be helpful for those who need constant monitoring to not self-harm.

In each level of care, you'll likely receive 1-1 therapy with a therapist and participate in group therapy. The exact type of therapies used will vary based on your symptoms, medical history, age, and more. But you can expect to engage in one or more types of evidence-based therapy throughout your treatment.

What Therapies Are Used to Treat Self-Harm?

  • Cognitive Behavioral Therapy (CBT): a form of psychotherapy that encourages you to challenge and change unhelpful thoughts, feelings, and behaviors that lead to self-harm.
  • Interpersonal Therapy (IPT): a short-term form of psychotherapy that helps you identify and address interpersonal issues that may contribute to your self-harm.
  • Dialectical Behavioral Therapy (DBT): an approach that combines elements of CBT and mindfulness to help you become more aware of your thoughts, feelings, and behaviors.
  • Psychotherapy: a form of counseling that helps you identify underlying issues that may contribute to your self-harm
  • Mindfulness-Based Cognitive Therapy For Depression (MBCT): a form of meditation that encourages you to become more aware of your thoughts, feelings, and body sensations.
  • Medication: Antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), can help treat the anxiety and/or depression related to self-harming.

Psychiatrists and therapists often use a combination of different therapies depending on the individual patient's needs and unique presentation of self-harm. Psychiatrists may also prescribe medication as an adjunct to therapy. Ultimately, the goal of treatment is to help the patient to develop healthy coping skills and strategies to manage self-harm.

What Is Dual Diagnosis: Understanding Self-Harm and Addiction

A dual diagnosis, or co-occurring disorder, is a mental health disorder that accompanies a substance use disorder.

Depression and addiction often co-occur, meaning that a person can suffer from both a mental health disorder (depression) and a substance use disorder (addiction) at the same time.

People with depression may self-medicate with drugs or alcohol to try to manage their symptoms, which can lead to addiction. Similarly, they may use self-harm to manage the symptoms of depression or another mental health condition.

In the US, over 9 million adults have a co-occurring disorder and half of those with a serious mental disorder have co-occurring substance use disorder.

Can I Use The Family and Medical Leave Act (FMLA) for Self-Harm Treatment in The U.S.?

If your self-harm is clinically defined as a serious health condition, then you can receive Family and Medical Leave Act support. The FMLA ensures that you do not lose your job when taking necessary time (up to 12 weeks) off to heal from a serious health condition. This act also guarantees that you retain the same terms of employment that you originally had for your job.

What's provided in your FMLA may vary and has requirements for eligibility. Talk with your Human Resources (HR) department at work or look online for more information on FMLAs.

Is Self-Harm a Chronic Condition?

Treatment for self-harm can address the thoughts behind it and alleviate the need to self-harm. With proper treatment, self-harm isn't usually a chronic condition.

Mental health conditions related to self-harm, like depression, can go into remission and recur throughout your life. But recurrences can be treated efficiently and quickly.

Is It Possible to Experience a Recurrence of Self-Harm?

Relapsing with self-harm is possible. You can seek professional treatment to understand and treat the root causes of self-harm to prevent future relapses. Most self-harm treatment programs include relapse prevention planning, aftercare, and connections to additional resources, like support groups.

A recurrence doesn't mean your treatment failed. It just means you need additional help to get back into healing.

How Can I Find Support?

How to Talk to Your Doctor About Self-Harm

Your doctor can help you set up your first step in treatment. At your appointment, be sure to tell them

  • How frequently you self-harm
  • What you use to self-harm
  • How long you've been self-harming
  • If your injuries need immediate medical attention, or have in the past
  • What may have caused you to start (for example, a mental health condition like depression, traumatic event, or loss of a loved one)

You can then ask questions about your next steps in treatment. Here's some examples:

  • What treatments do you recommend for self-harm?
  • What should I expect from treatment?
  • What kind of side effects can I expect from the medications you prescribe, if any?
  • Are there any lifestyle changes I should make to help manage my self-harm?
  • Are there any support groups or other resources I can use to help manage my self-harm?
  • What kind of follow-up care do you recommend?
  • How can I tell if my depression is getting worse?
  • What should I do if I feel like treatment isn't helping?
  • Are there any other mental health conditions I should be aware of?

After your discussion, your doctor may evaluate you for a mental health condition like depression, or refer you to a psychologist. They might also refer you to a therapist, especially if you've already been diagnosed with depression. In certain cases, your doctor may refer you to inpatient treatment to keep you safe.

Medications for Self-Harm

Medications can treat the mental health conditions and distress causing self-harm. Antidepressants, for example, can help relieve symptoms of depression.

SSRIs (selective serotonin reuptake inhibitors) are an effective class of medications for depression. Other forms of medications may be a better fit for you. Your doctor or psychiatrist will match you to an effective antidepressant.

Finding the right fit may take time. Your prescriber may try different doses and different medication classes before your symptoms abate. Depending on your situation, you may take medications for a few months or for a few years.

When talking to your doctor about antidepressants, keep these questions in mind:

  • How long will it take for me to feel the medication's effects?
  • Will this medication, or class of medications, interact with any supplements or other medications I'm taking?
  • What time of day should I take this medication?
  • Can I take this on an empty stomach or do I need to eat beforehand?
  • What are the most common side effects?
  • Does this medication have a Black Box/Boxed warning for an increased risk of suicide? (Your doctor will most likely bring this up right away,