5.1 Breaking the self-harm cycle

Self-harm is an expression of emotional distress, or of relief of unbearable tension and a sign that something is seriously wrong – it can also be an attempt to communicate internal distress and a need for help. For these reasons, and because of the physical damage people may inflict on themselves, witnessing self-harm in someone you care for or about can be distressing. It can also be puzzling, trying to understand what drives a person to hurt themselves in these ways. If, however, a young person is brave enough to seek help in relation to these behaviours, this should be considered an act that has taken courage and needs a sensitive response.

Figure 7: The self-harm cycle

Show description|Hide description

A cycle starting with emotional suffering with arrows linking to emotional overload, panic, self-harm, temporary relief and shame/grief.

Figure 7: The self-harm cycle

There are no clear-cut explanations about why people begin to self-harm. Reasons that have been put forward include a reaction to specific difficult or unpleasant experiences, and a way of dealing with something that is happening now or that happened in the past. Other common reasons suggested are:

• bullying
• difficulty at school
• sexual, physical or emotional abuse
• failure of relationships (Smith, 2013, p. 5).

Given the highly individual nature of this type of act, it is important not to make too many assumptions. The next activity will help you to consider these issues further.

Activity 7: Understanding the self-harm cycle

Timing: Allow about 15 minutes

Watch the video ‘Understanding and breaking the self-harm cycle’ presented by Child and adolescent mental health expert Pooky Knightsmith.

Download this video clip.Video player: Video 3: ‘Understanding and breaking the self-harm cycle’ presented by Child and adolescent mental health expert Pooky Knightsmith.

Show transcript|Hide transcript

Transcript: Video 3: ‘Understanding and breaking the self-harm cycle’ presented by Child and adolescent mental health expert Pooky Knightsmith.

POOKY KNIGHTSMITH

Hi, this is Pooky and Buddy. And we are here to talk a little bit more about self-harm today. So a question I get asked really commonly is, why do people continue self-harming once they’ve started? And what is it that makes it so difficult to stop?

So if you watched my first video about self-harm, you’ll have noted that I said one of the things we shouldn’t say to someone if they disclose to us that they’re self-harming is stop. It’s difficult to stop, and sometimes if we ask someone to stop and they try to do it, it can mean that those behaviors escalate. Essentially, we can’t stop until we are ready and until we’re able to replace the unhealthy coping behaviors with healthy coping behaviors.

Now, to understand this a little bit more and to think about how we might be able to help someone to stop in time, I’m going to talk to you about the self-harm cycle. It’s relatively simple. And I hope that with a little bit of video magicry, I’m trying to learn, I’ll be able to add this as some sort of split screen or maybe it will be something up here. I don’t know.

We start off with big feelings, and they might be to do with an event, they might be to do with an experience, they might just be difficult thoughts and feelings that we don’t quite know how to manage. Now, they vary massively and will change from person to person, but what these big difficult feelings have in common, this person doesn’t know how to cope with them. So they’ve got big feelings and they can’t cope.

And so because they can’t cope, they look for a way of managing. And for whatever reason, they turn to self-harm. The first instance can happen for a variety of reasons.

Sometimes it can be an accident, and actually that person just finds, actually, that made me feel a lot better. Sometimes it might be that they have learnt from friends or the media that this is a potential method of making them feel better. It might be that they’ve just run out of ideas. It might be they just stumble across it. There’s lots and lots of different reasons why people might do it for the first time.

But importantly, for those who continue, they feel that after this instance or during this instance of self-harm, just for a little while, they have some relief, things feel a little bit better. That can be for a variety of reasons. Now, it might be that the emotional turmoil that they’re in, the really difficult things that they’re managing in their head, that they are not thinking about those just for a moment because all they can think about is the pain.

So like when you stub your toe, all you can think about is your stubbed toe and that’s horrible. But if the alternative is that you are thinking about the abuse you’re experiencing otherwise, maybe the stubbed toe option feels like quite a nice change. Someone once described it to me as the ultimate form of painful mindfulness. You’re literally just thinking about that pain in that moment.

Other reasons why it might bring relief. Some people talk about themselves as being a big balloon bursting with these feelings, and that self-harm is almost like a valve allowing some of those feelings to let go. Other people find that it makes them feel better because they have feelings of self-loathing and hatred, and they feel they deserve to be punished and the self-harm brings that.

There are lots and lots of different reasons why people find self-harm to be helpful in the moment. And the important thing to note is that this is always transient. But we’ll look at the specific reasons in another video and how we would work with those specific reasons. But we need to understand them when we’re trying to help a young person stop because if we don’t understand why they’re self-harming, what they get from it, it’s very difficult for us to help them look for alternative healthy coping mechanisms.

Anyhow, so they have harmed themselves, and however briefly, they have felt some sense of relief and things have felt just a little bit better. However, there are difficult feelings that then go with that, feelings of guilt, feelings of shame, feelings of high emotion. Why have I done this to myself? What would other people think if they knew? Why can’t I manage? Everyone else seems to be able to. I’m so stupid.

And the thing with this is that these sorts of young people or sorts of people who tend to self-harm often have really low self-esteem in the first instance. They may well be struggling with things like anxiety or depression as well. And so these feelings then also feed in.

So we’ve got more big feelings to add to the original big feelings, and we’ve not dealt with whatever the problem was in the first instance. We just did something momentary to take it away. So we’re back at the beginning of our cycle, but perhaps in a slightly worse position.

So what do we do? Well, we don’t have any other ways of coping and we can’t cope, so we return to the self-harm because even though only momentarily, it did make us feel better. So we find ourselves going round and round this cycle.

Now, how we help break the cycle, the first way is to get involved really early on. So the sooner that a young person discloses that they’re self-harming-- so if you’re a young person and you’re self-harming, please try and find the words to tell someone. The sooner we try and break the cycle the better because what happens, remember these feelings of guilt and shame, they begin to go away after a while. The more and more and more you go around this cycle, the more normal it feels and the more that you can justify that behavior in your mind.

The soonest you start talking to someone about it, then you start to realize, actually, these behaviors aren’t OK. And if we can try and use the guilt, the shame, the difficult feelings that come after the self-harm as a leverage to try and break the cycle, then that’s really, really helpful. The other thing that we can do is to have a look in our cycle at the unhealthy coping.

So we’re using self harm of many different types. What healthy coping strategies could we replace there? We’d be thinking really carefully about that.

And that will depend on what relief that’s bringing. So we need to also think, why? What’s the motivation for the self-harm? What’s the relief this it’s bringing?

But hopefully, just understanding the cycle a little bit will help you see why people get stuck in this cycle and which bits of it we need to really attack if we’re going to try and break it. But the key thing, number one thing is to try and break it as early as possible. But if you are watching this and either you know someone who’s been self-harming for a long time, or you are someone who’s been self-harming for a long time, it’s never ever too late to try and start breaking that cycle.

And the other thing is, if you do manage to stop for a while and then you have a slip or a blip, it doesn’t mean you have to go straight back down that cycle and spiral of self-harm. We can break back out again. But it’s much easier if you do it with people around you who you trust.

Good luck. And please leave a comment if you found this helpful. And don’t forget to subscribe. Subscribe, yeah, that’s it. Please subscribe. Thank you.

End transcript: Video 3: ‘Understanding and breaking the self-harm cycle’ presented by Child and adolescent mental health expert Pooky Knightsmith.

Download

Video 3: ‘Understanding and breaking the self-harm cycle’ presented by Child and adolescent mental health expert Pooky Knightsmith.

Interactive feature not available in single page view (see it in standard view).

If you know someone who is self-harming, make a note of one or two things you might be able to do to begin breaking the cycle.

To use this interactive functionality a free OU account is required. Sign in or register.

Interactive feature not available in single page view (see it in standard view).

Discussion

Understanding how a young person can get stuck in the self-harm cycle is a good starting point. Act as early as possible, remembering that talking about the problem is a good thing. Also, exploring ‘healthy’ coping strategies as alternatives to self-harm may be helpful. You may have picked up early in the video that telling someone to stop can be unproductive in the absence of effective coping strategies to replace the self-harm. It is also important to reassure a young person that they can step out of this cycle of self-harm and even though they may revert to these behaviours during difficult times, with help and support they can find healthy coping strategies.

If you are interested in more detail about how to help, see the further reading section [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

Sadly, young people who self-harm are more likely than average to contemplate suicide. The next section will deal briefly with this difficult topic.