How To Help Somebody Who Self-Harms

This is the second part of a two part blog series (part one available here) that discusses the very taboo topic of self harm/injury, from here on in referred to as SI. Trigger warning, may contain segments that can feel triggering or distressing to readers who are affected by this. 

To recap the first blog about SI, (if you haven’t read it, it is worth scrolling down the page to acquaint yourself with the basics about SI), it’s important to explain the facts and causes of SI.

• SI is most prevalent amongst 12-24 year-olds, but can happen as young as 5 years of age, or conversely happen to people though their entire lifetime.

• The SI prevalence in the population in any given time is about 1 in 10-20 people

• SI is higher in women, but not solely exclusive to them. It is much higher in the LGBTQA+ community where it can be as high as 4 in 10 people

• SI can be triggered by disassociation, numbness, anger, a need to express emotional pain, stress, sensory overload, and many other reasons. It can also become an addictive process due to the endorphins, or feel-good chemicals, it releases. I can attest to this as part of my own story.

• SI is rarely for attention. This is a common myth yet most SI is secretive and hidden. Even on the rare occasions that it is done for attention, consider the mental state required to SI and cause oneself physical injury for attention.

• SI is not a suicide attempt, it is a coping mechanism. However, within the population who SI the suicide rate is higher so it can be an indicator of risk.

So the big question really is, what are the alternatives to SI, and how can loved ones help a person they know or suspect is self-injuring? The truth is hard to swallow. There are no pre-determined, 100% ways to achieve either scenario. Every person who self-injures has different coping mechanisms and needs, and being attuned to them will help to help you give them the support they need. 

That said, there are some broad ways that may help that person in your life to know they are still supported and loved, as well as some techniques some people may find helpful alternatives, and are covered in my third article.

It must be a terrible shock to find out that somebody you care about self-injures. As somebody who does, I can only imagine, since I'm on the other side of the fence and, as such, have never had to experience that kind of emotional blow. If one of my children came to tell me they were self-injuring it would probably be devastating to imagine them hurting themselves. To be honest, the hardest part for me, would be to know how much they must be hurting or struggling to be desperate enough to inflict that physical pain upon themselves. However logically I would know what they were going through, the immediate feelings I would have would be visceral and emotional. 

The main thing to do is to avoid the huge emotional response. Self-injury is often kept secret, because people can be scared of being judged; it can also be hard to see the hurt and confusion on the face of a loved one, and the thought of their disappointment or anger can drive people to secrecy. However, if you did respond negatively the first time you found out, it does not mean the situation is lost. Once things have calmed, or the next time it happens, there are some things that can be done that can help facilitate a conversation. You can broach it again when the initial storm has passed, but don’t be surprised if the person is now reticent to discuss it again, and it isn’t worth pushing, as this can exacerbate the situation. 

Ask if they are OK

The next time it happens, ask that person if they are OK. Self-injury can cause a lot of physical health problems; nerve damage can occur, as can skin damage, pain, and wound infection. A lot of people will avoid seeking help despite these. The main thing to do first, is to check the person is OK and consider if they are in immediate need of urgent medical or psychiatric help. I have left wounds open, despite them needing stitches, owing to wanting to avoid letting people know; this leads to higher rates of infection, something I have also experienced, as well as worsened scarring. If your loved one comes to you and wants to talk about it, this is easier than if you happen to see the injuries, as it means that person is ready to open up.

However, if you do see signs of self-injury and are concerned you can’t broach the subject. You just don't have to immediately jump to a conversation about self-injury. Simply point out that you have noticed they have an injury or a wound and ask if they are ok, or whether they need some help or treatment for it. Please don't be surprised however, if they do not wish to discuss it; this is something that will take time. Simply knowing you care can be enough at first, and the foundation for a conversation.

Keep the reasons people self-injure in mind

As pointed out previously, your immediate response will possibly be emotional and/or negative. It's worth taking a deep breath and reminding yourself of the possible reasons this could have happened. If needs be, remove yourself from the situation, for your own sake as well as your loved one’s sake while you are processing this, assuming there is no imminent need for intervention. Nobody will find this easy to manage initially, if you care then it's natural and human to feel emotional, but a logic check can help in moving a conversation forward. 

Validate their feelings

Whilst I personally think it is OK for you to voice that the person you care about is self-injuring can make you feel sad, it's still very important to avoid anger, emotional blackmail, or making the person feel they have let you down. There will be enough guilt and shame in this person's head already for both of you and more, believe me. Acknowledgement that you understand that they have self-injured because they are struggling, cannot only be reassuring and make it easier to open up next time, but it can also open the conversation about what situation triggered the harming in the first place.

Don't make them feel bad for doing it unless you want them to clam up next time. I have been told in the past, by somebody who was a very valued friend, that I should be ashamed of myself, look in a mirror and apologise to myself, and then apologise to everybody else that I had let down. It was very triggering as I was devastated. It took our friendship a long time to recover from this, and it was never the same again as it caused me a lot of pain, shame, and fear of opening up again. I could understand their sadness and them being upset, but their anger and shaming drove me away.

No, it isn't easy. Anyone who self-injures will be acutely aware how hard this is for you as well, and be all the more thankful for your support. 

Reassure them

If someone self-injures, there is always a fear that the person they love will leave them for continuing to relapse; letting them know that you still love and care for them is reassuring. Try not to make them feel that you love them 'in spite' of their self-injury. It might seem well intentioned, but can make them feel they don't deserve that love, since to them you clearly feel they are a failure or a screw up when it does occur. Simply express your feelings without caveats. 

Don't ask them not to do it again

This is a hard one.

I discussed the reasons behind self-injury in another blog, but the long and short of it, is that it's a coping mechanism for a variety of reasons. Its maladjusted, and inexplicable if you have never had an inclination to do it, but for some people, it's the only way they can manage difficult emotions. If you ask them to stop it will only add to the stress of them trying hard not to hurt themselves anyway, creating more pressure; it will also add to the guilt and shame afterwards, and potentially cause them to cease to open up in case they fail to fulfil your request.  In some cases, it can also cause more difficulty if they don't have another coping mechanism to fall back on, and leads to them trying what is known as 'white knuckling' their way through trying to not harm themselves, which often leads to relapsing more acutely.

Educate yourself

If you are reading this blog then thank you from me, not only for taking the time to read my words, but for trying to learn about self-injury. Whilst the best way to learn is to ask someone who self-injures and is willing to talk about it to enlighten you, it never hurts to read around the subject.

There are plenty of good resources out there like LifeSigns, The Mighty or blogs like The C Word Mag, who have given people like me a platform to speak, something I am grateful for.

A simple Google search can usually find you sites specific to the person you want to help if they are of a specific demographic - young, old, male, female, or different ethnic origins, sexuality, or gender nonconforming. Every bit of education will help, and there are often online support groups that can be found for peer to peer questions.

Don’t body shame

People who self-injure can be sensitive about their scars; some might have no problem if people see them but some people make concerted efforts to hide them. It’s taken me years to be confident enough to wear vest tops in public as my scars are now fading, and even then, a simple stare can make too uncomfortable to continue doing so. Don't force them to show you their injuries or scars if they are not comfortable to do so, and don't react negatively, or force them to cover up if you do see them. 

Lastly and MOST importantly:

Make sure you have support too

This last one is so important, maybe the most important point in this entire article. You cannot pour from an empty glass, and you cannot support someone else without your own support network. It's great if you have somebody else you can download to on a personal level, but even better if you have some professional help. A GP can put you in touch with a counsellor, there are forums and groups on Facebook for relatives, friends, or carers, and plenty of information on some of the websites I've mentioned (or that you locate on your search), for places you can contact for support and advice, either by phone or in person. Your feelings are important, and it's important to express to somebody the anger or sadness you might be feeling, before you unleash it on the person who is already vulnerable through the act of self-injury.

My husband and family have learned, through many years of experience, how best to support me. They can anticipate the situations where I might be triggered, they check in to how I am coping, and if they see a wound they mention it without accusation, but will drop the subject if I am not willing to discuss it, or simply accept what has happened if I do discuss it. The phrase ‘one step at a time’ has been the mantra from my best friend for many years, and is the only way you too can get through this. Sending you much love.

~TBB