SELF-HARM – St. Albert and Leduc Therapy
There are different ways that people cope with their problems, situations, and feelings. Some people cope by injuring themselves. Deliberate Self-Harm (DSH), or self-injury, is not a mental illness. It is when someone hurts him or herself on purpose but has no intention of ending his or her life. The main motivation is that the person is experiencing emotional distress and wants to stop feeling this way but has been unsuccessful at relieving their hurt and distress using other coping strategies. People who engage in DSH do not want to end their life or harm themselves – they just want to feel more in control, distract from life, or release emotional pain. Afterwards, the person may feel better in the short term. However, inevitably the painful feelings (sadness, self-loathing, emptiness, guilt, and rage) surface again and the person may feel an urge to hurt themselves again. Relief that comes from self-harm does not last very long. It is like placing a Band-Aid on a wound that likely needs stitches. It may temporarily stop the bleeding, but it does not resolve the underlying injury. Often times, people who self-injure may try to keep this a secret, perhaps because they feel ashamed or guilty or feel that no one can understand. Often times, the secrecy leads to feeling isolated and overwhelmed.
When people engage in DSH, they are tapping into a mechanism that all people have and that allows them to obtain relief in a natural and powerful way.11 When the harmful stimulus that causes the pain is removed or reduced, the person immediately experiences a feeling of relief, which is a pleasant experience. In other words, once the physical pain has ended, it causes a person to subjectively experience a sensation of feeling better. More specifically, when we get hurt, our body releases endorphins (“the happy chemicals”) and people typically feel a “natural high” or a feeling of euphoria, which can be addictive and habit forming.
A significant difference between suicide and self-harm is intent. Self-harm is the intent to harm the body (scratching, biting, hitting, punching, burning, etc.), whereas, suicide is the intent to deliberately take one’s life. However, DSH may escalate into suicidal behaviours  and it may also be experienced alongside other mental issues such as Depression, Anxiety, and Bipolar Disorder.
- Most self-harming begins between the ages of 12 and 15 years old.
- Five percent of the general adult population and Fifteen percent of youths have harmed themselves. 
- In 2013, 6% of Canadian college and university students reported intentional self-harm in the last 12 months.
- In 2013, it was also estimated that 20% of Canadian college and university students had engaged in self-harm at some point in the past. 
- According to Canadian Institute for Health Information, there were nearly 2,500 youth aged 10 to 17 years old that were hospitalized due to intentional self-harm in 2013 and 2014.
- In 2011, among youths aged 15 to 19 years old, there were 140 deaths due to intentional self-harm for boys and 58 for girls. While among 10 to 14 year olds, there were 12 deaths for boys and 17 for girls. 
- Girls aged 14 to 17 are hospitalized for self-harm four times more often than boys. 
- Over the past 5 years, the rate of intentional self-harm-related hospitalizations increased by more than 110% among girls (78 to 164 per 100,000) and 35% among boys (23 to 32 per 100,000). 
- Most common methods of self-harm: 
- Cutting 75%
- Self-hitting 30%
- Burning 28%
- Females adopt cutting most often, while males are more likely to burn or hit themselves. 
- Fifty-six percent of people who reported to have engaged in self-harm also reported to have sought help or support for this behaviour. 
- Health-seeking behaviours of people who reported to have engaged in self-harm: 
- 56% talked to a friend
- 54% talked to a Psychiatrist or Psychologist
- 48% talked to a family member
- 32% talked to other mental health professional
- 30% talked to a Family Doctor
- 18% talked to other non-specified sources
- 18% talked to help-lines
Behaviours associated with Deliberate Self-Harm:
- Wears clothes inappropriate for the weather, usually to hide his/her scars
- Head banging, cutting, burning, scratching, hitting, or biting him or herself
- Has problems with his or he relationships 
- May appear withdrawn or more quiet/reserved than usual or may have stopped participating in regular activities 
- There may be a significant change in academic performance 
- Exhibits rapid mood changes 
Feelings associated with Deliberate Self-Harm:
- Low self-esteem
- Dissociation (has been in high emotional distress and their mind has temporarily disconnected them from feeling their emotion)
Thoughts associated with Deliberate Self-Harm:
- “I feel numb and the only time I can feel ‘something’ is when I cut myself.”
- “I hate myself. It is my fault I am this way and I deserve to be punished.”
- “I cannot control my thoughts or my behaviour. The only way I can stop myself is when I burn myself with a cigarette.”
- “I do not really want to kill myself. I just want to escape from everything awful.”
Deliberate Self-Harm and the Body:
People who self-harm usually show the following physical symptoms:
- Unexplained frequent injuries, such as cuts and burns 
- Unexplained scars 
- Bleeding, bruising, or pain 
- Tension in the body
- Broken bones
- Small, linear cuts
Deliberate Self-Harm and the Brain:
The brain areas that are involved in DSH are the Anterior Cingulate Cortex and the Anterior Insula; these areas have been found to have an important role in the experience of pain.
Just before people engage in DSH, they often experience dissociation. Dissociation is a human’s natural ability to block the experience of pain. In addition, while people engage in DSH, there is a release of endorphins in the body and brain. Endorphins are “feel happy” neurotransmitters that are released when people are physically hurt or in pain and that; these endorphins reduce the amount of pain that people experience. Dissociation and the release of endorphins both contribute to a lessening or removal of both physical and emotional pain sensations. But because emotional pain is more difficult to reduce or relieve than physical pain, people engage in physical self-harm in order to relieve their emotional pain. This is able to happen because there is a large degree of “neural overlap” between physical pain and emotional pain whereby a large percentage of neural circuits for registering emotional pain are intermingled or near the neural circuits used for registering physical pain. This means that the physical relief that individuals get from engaging in DSH is interpreted by the brain as emotional relief as well.
Does Psychology work?
- Cognitive Behavioural Therapy (CBT): CBT is a type of psychological therapy that is aimed at addressing issues such as anxiety and depression.1 Research shows that CBT significantly reduces self-harm, suicidal cognitions and symptoms of depression and anxiety while significantly improves self-esteem and problem-solving ability. This type of therapy helps clients understand the relationship between their thoughts, feelings, and actions while teaching you new ways to cope with your problems and stress.5
- Mindfulness Therapy (MT): MT requires the client to intentionally direct his or her focus away from his or her negative and worrisome thoughts and instead observe and accept the present moment. Research has found that mindfulness increases subjective well-being, reduces emotional reactivity, and improves behavior regulation which can be helpful for those who self-harm.
- Emotionally Focused Family Therapy (EFFT): EFFT is based on attachment theory and is focused on emotion in the context of the family. The goal of the therapy is to increase the accessibility and responsiveness of the parents to their children. By doing this, the child’s access to a secure environment is also increased and behaviour alternatives can be expanded. By changing the parent-child relationship, the problematic behavior is also changed. Since self-harm is usually associated with emotion, creating a responsive environment can help meet the emotional needs of the person.
Tips to Manage Deliberate Self-Harm!
It is important to seek professional help when you have DSH but there are also a few steps that you can take so that you can manage your urge to self-harm. Here are some of the ways you can do this:
- It is important to know or be mindful of what kind of situations lead you to have the urge to self-harm so that you can watch out for it in the future.
- Find new coping techniques and direct the urge to self-harm at something else or find ways to distract yourself from self-harming.
- Find ways to express your emotions more effectively.
There are different reasons why people engage in Deliberate Self-Harm but most of the time it is because they are having trouble coping with their difficult emotions, thoughts, and situations. DSH may be experienced alongside other mental health issues that are related to emotion regulation such as depression, anxiety, and bipolar disorder. It is important that you seek professional help for DSH to prevent further harm to yourself. There are different treatments offered at Hopewell Psychological such as Cognitive Behavioural Therapy and Emotionally Focused Therapy, which has been found to be very helpful for individuals who engage in DSH.
*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.
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 Slee, Nadja, Garnefski, Nadia, van der Leeden, Rien, Arensman, Ella, & Spinhoven, Philip. “Cognitive-behavioural intervention for self-harm: randomized controlled trial.” The British Journal of Psychiatry 192.3 (2008): 202-211. DOI: 10.1192/bjp.bp.107.037564.
 Keng, Shian-Ling, Smoski, Moria J., & Robins, Clive J. “Effects of mindfulness on psychological health: A review of empirical studies.” Clinical Psychology Review (2011): DOI:10.1016/j.cpr.2011.04.006.
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