Self injury, self harm and PTSD

This article explores this highly sensitive topic and contains triggers. So, we recommend proceeding with caution if you feel this is an issue you are currently struggling with.

What does self harming mean?

Self-injury, also known as self-harm, self-mutilation, or self-abuse occurs when someone intentionally and repeatedly harms themselves in a way that is impulsive and not intended to be lethal.

Self-harm can take many different forms and can include any behaviour that is not in our best interests, that we use to try and deal with an emotional pain.  The most common type of self-harm is cutting, but there are many other types of self-harm including

• Burning
• over eating or under eating
• picking skin or sores
• exercising excessively
• scratching or rubbing your skin excessively
• banging your head
• punching yourself or walls
• having unsafe sex
• inserting objects into your body
• misusing alcohol or drugs
• drinking hazardous liquids
• pulling out hair
• or creating risks that lead to bone fractures

It is often done in secret and focuses on places you can hide with clothing. However, there are times when people deliberately injure themselves, and show this to other people, providing apparently rational causes linked to accidents.

Self-harm is sometimes referred to as non-suicidal self-injury (or NSSI). It involves damaging yourself without an intention to end your life. Though it can include activities that do create serious risks, such as deep cuts in your wrists or thighs or consuming excessive amounts of alcohol or drugs.  Though initially, suicide is not a motivation, people who self-harm are around 49 times more likely to take their own life, and there’s a chance that they may hurt themselves more than they intended to; which increases their risk of accidental suicide.

Why do people self-harm?

‘In general people self-harm as a way of coping. People often talk about harming themselves to relieve, control or express distressing feelings, thoughts or memories. Some people harm themselves because they feel alone, while others do so to punish themselves due to feelings of guilt or shame. However, the relief they experience after self-harming is only short term and at some point the difficult feelings usually return. With the return of these feelings often comes an urge to self-harm again. This cycle of self-harm is often difficult to break.’

‘Some people have described self-harm as a way to:

• express something that is hard to put into words
• turn invisible thoughts or feelings into something visible
• change emotional pain into physical pain
• reduce overwhelming emotional feelings or thoughts
• have a sense of being in control
• escape traumatic memories
• have something in life that they can rely on
• punish themselves for their feelings and experiences
• stop feeling numb, disconnected or dissociated
• create a reason to physically care for themselves
• express suicidal feelings and thoughts without taking their own life.’

How common is it?

NSSI levels in the general population are believed to be around 17% for adolescents, 13% for young adults, and 5.5% for adults.

The connection between PTSD and self harm

Though statistics vary, it is clear that having post-traumatic stress disorder does increase the likelihood of self-harming behaviours, including substance misuse and the type of injuries listed above.

Whether you secretly harm yourself or explain away visible injuries you created, it is a vivid indication of deep emotional distress. This is why it is seen as an early indicator of undiagnosed PTSD.

This is especially true of complex PTSD (C-PTSD), when trauma and your emotional response to it are often deeply suppressed.

People who self harm often refer to it as a coping mechanism, a way of releasing or soothing heightened emotions, and feelings of frustration, self-loathing or insecurity – all feelings which can feature in people with PTSD.

It is easy to see why it would be a common symptom of PTSD. A feature of PTSD is being in a constant state of alarm, hypervigilant to danger, and anxious. To find temporary relief from this exhausting situation, you may deliberately injure yourself.

It is also sometimes described as creating physical pain, to distract from emotional and mental pain. In response to biological pain, you release endorphins, a hormone that can temporarily lift a person’s mood.

PTSD is often associated with feelings of guilt too, which can also lead to a compulsion to hurt yourself. Victims of sexual abuse can turn their anger and shame on themselves, or self-harm to ‘feel something’ rather than numbness.

Treatment for trauma related self injury

Whatever the reasons behind these behaviours, it is important to address them in PTSD therapies like CBT and Eye Movement Desensitisation Reprocessing (EMDR).

Also, finding ways to self-manage your injurious behaviours can be a huge help, for example:

• Discussing your triggers and anxiety with a close friend/family.
• Finding new outlets to release emotional distress, tension and feelings of inadequacy.
• Using coping mechanisms such as mindfulness, mediation and breathing techniques.
• Finding robust ways to distract yourself.
• Rewarding yourself when you choose a different way to soothe yourself.

The sort of distractions, coping mechanisms and alternative behaviours people sometimes use are:

• Screaming into pillows
• Playing with and stroking pets
• Going for a run, walk, bike ride or gym visit
• Energetic dancing to music
• Massaging your hands, face and limbs
• Weighted blankets or human hugs
• Learning a new, engrossing skill
• Engrossing yourself in a favourite past time
• Meeting up with friends and enjoying treats
• Relaxing baths or showers.

The aim is to find something that feels good to you, and that defuses your emotional distress in a healthy way.

Dealing with misconceptions

One of the hardest things for people with PTSD to deal with is discussing their behaviours and emotional state with other people.

This is especially true if you use self-harm as a coping mechanism. It is often wrongly assumed to be attention-seeking behaviour or is dismissed, as the physical damage is ‘not serious’. The level of harm is immaterial and the person self-injuring themselves is carrying out a deeply personal act, not seeking reactions from others.

If you suspect someone is self-harming, then it is vital to encourage them in a non-judgemental way to seek professional help in finding the cause, which may include a diagnosis of PTSD.

The NHS signposts people to help with self-harming, though tackling underlying conditions like post-traumatic stress disorder is a vital first step.

How do I know if I’m self-harming?

Not all self-harm looks like self-harm. Diagnosing the ‘less obvious forms of self-harm can be difficult – and just because you do some of the things mentioned above, doesn’t necessarily mean you’re self-harming. However, if your actions are any of the following, it may be self-harm:

• it’s an obsessive habit
• you do it on a regular basis to distract you from how you’re feeling
• it’s tied up with emotional trauma
• you feel emotionally ‘numb’ and the behaviours help you ‘feel something’
• you regularly use unhealthy behaviours to break free from your thoughts
• you feel like doing it is easier than tackling your issues
• you find it hard to stop
• you feel like you don’t deserve to be happy

How can I get help?

‘Having supportive people around you is always important. Surround yourself with people that you trust, who will listen to you without judgement and who you enjoy being with. It’s good to work on some things that you can do for yourself, but you don’t to have to face this challenge alone. It’s important to let others know how you feel when things don’t go to plan. Don’t build up worries, anger or disappointments – talk about them.

A counsellor, psychologist or GP can help you to work out what is triggering your self-harm and begin to work with you on managing your difficult thoughts and feelings – and ultimately look to treat your PTSD or C-PTSD if that’s the root cause of your self-harm.

For more information on self harm please visit organisations such as Rethink, Mind or if you’re under 25, Papyrus or The Mix.

These services offer confidential advice from trained volunteers. You can talk about anything that’s troubling you, no matter how difficult:

• Call 116 123 to talk to Samaritans, or email: jo@samaritans.org for a reply within 24 hours
• Text “SHOUT” to 85258 to contact the Shout Crisis Text Line, or text “YM” if you’re under 19

If you’re under 19, you can also call 0800 1111 to talk to Childline. The number will not appear on your phone bill.

If you prefer a webchat, these services are available at certain times:

• Self Injury Support webchat (for women and girls) is open Tuesday, Wednesday and Thursday from 7pm to 9.30pm
• CALM webchat (for men) is open from 5pm to midnight every day