Deliberate self-harm is linked to problems in emotion regulation
Pain-relieving endogenous opioids are naturally released in the body in response to intense pain. Self-harm behaviours will cause release of these opioids just as any other sort of injury would, and the opioids have been shown to decrease the intensity of negative emotions and moods, and increase positive affect. Thus self-harm is highly reinforced by its desirable effect on emotion and mood. Interesting research suggests that individuals who engage in self-harm have lower levels of endogenous opioids in their cerebro spinal fluid, suggesting the possibility that chronic low levels of opioids constitutes a vulnerability to engage in self-harm behaviour.
Deliberate self-harm usually occurs in response to intense emotions that are experienced as overwhelming. In addition to the biochemical factors discussed above, self-harm can allow the person to focus on the physical pain as a way of avoiding or distracting from the overwhelming emotional pain. The intense physical pain also can serve to validate for the person that their pain is real. Self-harm is also sometimes used as a form of self-punishment. In this situation the self-harm is calming because it validates the individual’s world view and self-belief that he or she is bad and should be punished.
Individuals who struggle with emotion regulation certainly experience very intense emotions that they may want to down-regulate, but they also experience intermittent feelings of emotion numbness or emptiness. These feelings of emotional numbness are often highly distressing, and self-harm may be used in an attempt to end the numbness by providing some kind of feeling.
Members of the general community may believe that self-harm is an indirect attempt to influence others or to communicate distress to others, but in fact most people who engage in self-harm are very secretive about it, and feel considerable shame and guilt about their self-harm behaviour.
Treatment for self-harm is important
The fact that self-harm may not be a “cry for help” in the way that people often believe, does not mean that those who self-harm do not need help. Far from it. While self-harm may provide temporary relief from distress, the longer term consequences may be negative and undesired, and may include feelings of shame and guilt, impaired interpersonal relationships, low self-esteem and low mood. Perhaps most importantly, when a person is using deliberate self-harm to deal with difficult and intense feelings, they are not learning other, more healthy, ways to cope. In addition, recent Australian research indicates that only about 50% of people who self-harm ever get treatment for this, and self-harm is associated with many other psychiatric and psychological problems including anxiety disorders, mood disorders and Borderline Personality Disorder.
DBT for self-harm
Dialectical Behaviour Therapy, or DBT for short, is a thoroughly researched behavioural treatment for problems of emotion regulation, and targets behaviours such as self-harm and other impulsive and potentially destructive behaviours. DBT involves participants learning specific DBT Emotion Regulation Skills which help people understand and control intense emotions and reduce the incidence of negative emotions, and specific DBT Distress Tolerance Skills which provide alternative ways to cope in crisis moments. Both these sets of skills are highly relevant for problems of deliberate self-harm.
If you or someone you know struggles with self-harm urges I encourage to contact me at Bridget Hogg Psychology Brisbane so that we can discuss whether DBT would be an appropriate treatment. Please also review my other articles on DBT, particularly What is Dialectical Behaviour Therapy?, About DBT Emotion Regulation Skills, and What are DBT Distress Tolerance Skills?
Deliberate self-harm and DBT
What is deliberate self-harm?
Deliberate self-harm refers to a range of self-injurious behaviours. Common methods of self-harm are cutting, burning, pinching, scratching or punching oneself, banging or hitting body parts and overdosing on medication. Prevalence studies report mixed results but recent Australian studies indicate a life-time prevalence of self-harm for the 20-24 year old age group of 18% for males and 24% for females.
Some self-harm is reflective of suicidal thoughts such that the individual uses self-harm as a way to avoid making a suicide attempt, self-harm being seen as “the lesser of two evils” so to speak. However, in the majority of cases the deliberate self-harm is often referred to as Non-Suicidal Self Injury or NSSI for short. NSSI is not related to suicidal thoughts and is not associated with an intent to die. Why then do people engage in this distressing and potentially dangerous behaviour?