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Understanding Self-Harm: A Q&A with NewBridge Services

Friday, March 15, 2024

Viki Ferlauto, NewBridge Services' executive director of counseling services, discusses what to know about self-harm during Self-Harm Awareness Month.Self-Harm, also known as non-suicidal self-injury (NSSI), is an unhealthy coping behavior used especially by some tweens, teens and young adults to alleviate emotional distress. The habit is self-reinforcing both positively and negatively: it causes temporary relief from negative feelings but also feeds feelings of shame. While someone who self-harms doesn’t intend to end their life, injuries can be serious and, in some case, life-threatening.

For Self-Harm Awareness Month, Viki Ferlauto, executive director of Counseling Services at NewBridge Services, answered questions about why people self-harm, what myths persist in society, and how loved ones can help. For more information, click here to read an article on self-harm that NewBridge previously published.

Q. Why do people self-harm?

A. It’s often a sign that the person has unresolved trauma and often, but not always, it reflects a history of abuse. When a person has been abused physically or sexually, the unspoken message is that your body can be harmed. The self-harmer is internalizing the perpetrator of that abuse; it becomes a way of dealing with that often unspoken abuse. There is self-loathing in people who harm themselves, whether inside their awareness or not. As Lisa Ferentz, an expert in self-harm treatment, said: “When you hate yourself, you hurt yourself.” 

Q. What are warning signs that someone may be self-harming?

A. Wearing weather-inappropriate clothing, such as long sleeves when it’s hot, to hide injuries. A person who self-harms may withdraw from daily life because of the shame and guilt they feel afterward. They may have cuts, bruises, bite marks or burns on their skin. They may express feeling worthless.

Q. What are common misconceptions about self-harm?

A. Some common misconceptions are that it is an attention-getting effort by needy teenagers, or that it is meant to be a suicide attempt. Another is that the person can just stop if they just want to, that it’s only a matter of willpower.

Q. What is the difference between self-harming and a suicide attempt?

A. People who self-harm are not trying to end their life, they are seeking relief from emotional distress. The injuries they inflict on themselves are not life-threatening in most cases but it’s like practicing taking risks on one’s body. There is a higher rate of suicide in those who self-harm.

Q.  Please discuss the stigma around self-harm.

A. It is seen as an abnormal behavior by society, as pathology, but for the person it’s a survival strategy. Looking at it as pathological and not as a coded message of, `I don’t know how else to cope,’ does that person an injustice. The person who self-harms thinks they deserve it. They sometimes will not seek treatment because of that stigma. As a society, we don’t want to perpetuate the stigma, blame the self-harmer or tell them to just stop it. Most of us wince at the slightest paper cut. The person who slices into their arm or legs with a razor has a different experience. There’s an analgesic effect, where it feels good. It is similar to an addiction. Feeling good temporarily perpetuates the behavior. 

Q.  What constitutes effective treatment? 

A. Therapists have to apply trauma-informed therapy. We have to look at the person’s strengths in order to change the cycle. We have to understand their trauma triggers, what sets up the impulse to self-harm. One pitfall in therapy is to contract with the person to not self-harm. Simply put, it doesn’t work and puts in play a potential power struggle between the therapist and client. That alone can be a trigger to self-harm. 

Q. How can individuals learn to manage self-harm triggers?

A. Based on current research, the best way is to interrupt the cycle, delaying and diminishing the impulse to self-harm, and refocus on behaviors that are healthy and safe. Urges don’t last. When an impulse strikes, the self-harmer needs to have a playbook of other activities, such as journaling, drawing, doing guided imagery, calling a friend, walking for 15 minutes. Therapists need to help people understand the behavior and help them translate pain into words. We have to work on addressing self-loathing.

Q. Self-Harm can be difficult for loved ones. What suggestions can you offer? 

A. You feel helpless and frustrated as caregivers but the message of self-harming is, `I’ve been hurt.’ If we begin to see self-harming as an expression of pain, rather than attention seeking or trying to create trouble for others, that changes the way we deal with it. A more empathetic response begins to emerge. The person who is self-harming realizes that the behavior is frowned upon, not normal, or even frightening to others, but they haven’t learned healthier ways of dealing with abuse or neglect in the past. We need to create a more supportive, shame-free environment among families and in treatment centers. 

Q. If I’m concerned someone is self-harming, what can I do?

A. Ask about it. Bring it out of the shadows. Say, `I notice that you’re not yourself, would you like to talk?’ Offer support in a non-confrontational manner. It all begins with the conversation. As with suicide, asking about it doesn’t put the idea in someone’s head. Ask, ‘What can I do to help?’

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