How To Prevent A Self-Harm Relapse

What is self-harm?

Self-harm, clinically known as non-suicidal self-injury (NSSI), is an action that an individual takes with the intention of harming themselves. Self-injury, a serious condition in and of itself, is also a strong predictor for later suicide attempts. Although individuals may keep this a secret or feel shameful or guilty about their actions, NSSI is a condition that can be treated and overcome. 

Examples of self-harm include the following: 

• Cutting oneself with a sharp object like a razor blade, knife, or sharp object  
• Pulling out hair 
• Picking at wounds 
• Burning oneself with cigarettes, matches, or candles 
• Serious injuries like breaking bones or causing bruises 
• Punching oneself or punching objects like a wall, causing hand injuries  

Of note, there are many other ways to self-harm that may not be included in the above list. These serve as examples. 

Who is at risk for self-harm? 

Because people often don’t talk about self-harm, it is likely more common than we realize. From a publication in the American Psychological Association (APA) and from the National Alliance of Mental Health (NAMI), here’s what we know. 

Those who are more likely to self-harm include: 

• Adolescents more frequently than children or adults 
• Young people who are bullied or rejected by their peers 
• Individuals who have a sexual minority status 
• Individuals with an eating disorder or body image disorder 
• People who have low feelings of self-worth  
• Individuals with depression or other mental health disorders 
• Those who have experienced trauma, neglect, or abuse 
• Individuals who use alcohol or drugs because they can lower self-inhibition 

Dr. Janis Whitlock, a developmental psychologist and public health specialist at Cornell University who contributed to the APA paper noted above, reported that in addition to the above, females are more likely to engage in self-cutting. In contrast, males are more likely to hurt themselves by bruising, taking substances, or having others hurt them.

Please keep in mind that self-harm is difficult to accurately measure due to differing definitions of self-harm and the fact that people who self-harm may not report it. 

Why do people self-harm? 

Self-harm is not the same as a suicide attempt. It is a symptom of emotional distress and something that clinicians and researchers are trying to better understand. We currently know that individuals self-harm for a number of reasons. Two commonly identified reasons include the following: 

Negative emotions without an outlet

The urge to self-harm may start as a constellation of negative feelings such as anger, frustration, pain, or depression, NAMI shares. If an individual does not have a way to release these emotions through positive coping skills or was taught as a child to hide emotions, they may turn to self-harm. Self-harm can then cause feelings of guilt, shame, and negative body issues. Individuals may feel they are “deserving of punishment” and “bad,” feeding the cycle further. 

Sensations or feelings of “release” during or after self-harm

Research studies have shown that individuals who self-harm have a temporary feeling of relief or even euphoria after the harm is completed. This is called offset relief. 

Additionally, in an article for Psychology Today, psychologist Dr. Terri Apter adds that teens who self-harm may have a different neurobiological response to pain that causes them to be calmed by pain or even feel flooded by relief while they are experiencing pain. 

People who self-harm might be trying to tap into either of these phenomena, and more research is required to fully understand what is happening to the brain during these processes. 

Does that mean self-harm is positive? 

No. Although the above description sounds like a “positive,” it is short-lived. Like any harmful action, self-harm has many psychological, social, and physical consequences. 

Psychological effects include feelings of guilt or shame, feeling helpless or worthless, or getting addicted to dangerous behavior

Physical effects may include severe bleeding requiring hospitalization, permanent scars, infection from dirty cuts or injuries, and more.  

Finally, self-harm could result in socially harmful consequences such as avoiding friends or family, distance caused by loved one’s not understanding why you are self-harming, and constantly having to lie to others about the causes of your injuries. 

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How to stop self-harming

One of the most important ways of stopping self-harm and preventing relapses is to create a safety plan. A safety plan is a clear set of steps or a plan that you have made in advance that you take when you feel the urge to self-harm. You can write down the steps ahead of time, so you know exactly what to do in a dangerous situation. 

Charlie Health clinicians explain that three key components of safety planning include 1) being aware of when self-harm is likely to happen, 2) removing negative or harmful objects, and 3) replacing these objects with a way to let out negative emotions in a safe way. 

Be aware of your triggers

Try to recognize the situations that trigger your desire to self-harm. Are there certain situations, emotions, thought patterns, people, or places that lead to thoughts of self-harm? Keep track of these situations so you can avoid them or enact your safety plan when it is not possible to avoid them. 

Remove harmful objects 

Make sure to lock up sharp objects or objects you use to self-harm. Have a friend or loved one take these objects away and place them in an area where you can not easily find them. Make sure harmful objects are taken away from all areas that you can access, especially in areas that are private, such as a bathroom or private bedroom. 

Replace harmful objects and actions with safe ones: 

If you are someone who feels urges to cut, try to replace this action with one that is similar but not harmful. As an example, if you are someone who self-harms by cutting your arms, try using markers to draw on your arms or a piece of paper instead. 

Try the TIPP skill

The TIPP skill is another way to replace unhealthy sensations with healthy ones. TIPP is an acronym that stands for temperature, intense exercise, paced breathing, and progressive muscle relaxation. It is a skill that is taught as a part of dialectical behavior therapy and other therapies. Try one or more of these techniques as a part of your safety plan. 

• Temperature: Cooler temperatures can help calm you down when you’re feeling stressed. To help yourself relax, try splashing your face with cold water, taking a cool shower, or going outside for a walk in cool weather. To create a new sensation that you can feel, try running an ice cube on your hands or face. On the flip side, warmer temperatures can help you gain energy when you’re feeling depressed. Try taking a hot bath, drinking warm tea, or making a heating pack at home using a sock and some raw rice. 
• Intense exercise: Exercise is a healthier way to relieve stress or high emotions. You don’t need expensive equipment or a gym to exercise. For 10 minutes, check out age appropriate workout videos on youtube, do jumping jacks, or go for a run or jog around the block. Only do what your body is able to do. If you have an eating disorder and are cutting back on exercise, skip this step.  
• Paced breathing: Paced breathing is a way to help calm you down when you are feeling overwhelmed with emotion. Try breathing in slowly through your nose and then breathing out slowly through your mouth. Continue doing this for 1-2 minutes. 
• Progressive muscle relaxation: Progressive muscle relaxation is a way to relax all of your muscles from your head to your toes. Sit in a chair or lay down. Focus on the top of your body, relaxing the muscles of your face, jaw, and shoulders. Then work your way down, relaxing all of your muscles until you reach your feet. You’ll be at how tense some of the muscles in your body may be without you realizing it! 

Finally, have a plan of who you can call, text, or otherwise communicate with in a situation where you want to self-harm. 

Self-harm statistics 

Many research studies have been conducted to try to better understand who completes non-suicidal self-injury and why. The following three studies all look at self-harm from unique angles and give us important information: 

Fifteen years of data on adolescents who self-harm 

A comprehensive study published in the Journal of the American Academy of Child & Adolescent Psychiatry in 2018 examined 15 years’ worth of data on adolescents from around the world to better understand self-harm. A summary of findings included:

• The total percentage of participants who had self-injured in the study was 16.9%. 
• Girls were more likely to self-harm than boys.
• The average starting age was around 13 years old. 
• Half of the individuals who reported a history of self-injury reported only 1 or 2 episodes of self-injury. 
• The most common type of self-injury was cutting, and about half of individuals said this was their method of self-injury. 
• The most frequent reason for self-injury was a relief of thoughts or feelings. 
• A little more than half of those who self-injured sought help, and for most, seeking help meant telling a friend. 
• Suicidal ideation and attempts were higher in adolescents who self-harmed. 

The effects of seeing self-harm on social media

A study published in a journal titled “New Media & Society” in 2019 described a disturbing trend on social media, especially on the social media platform Instagram: explicit and graphic depictions of self-harm that were publicly available. Researchers hypothesized that vulnerable young people seeing these depictions could start or continue to self-harm as a result. 

A similar phenomenon has been described for suicide. Exposure to media depictions of suicide can cause individuals to try to copy what they’ve seen, leading to additional suicides. This is called the “Werther effect.”

To test their hypothesis, researchers studied young people ages 18 to 29 who completed surveys answering if they had seen self-harm content on social media in part one of the study. In part two of the study completed a month later, they were asked about suicidal ideation or thoughts of self-harm. 

The results of the survey included the following: 

• Out of 729 participants ages 18-29, 43% reported being exposed to self-harm content, and of this group, only 20.1% indicated they intentionally searched for that content. This means that a good portion of individuals was accidentally exposed to self-harm content without searching for it. 
• 63% of those (either intentionally or accidentally) who were exposed to self-harm content said that the exposure emotionally disturbed them. 
• 59.6% of those (either intentionally or accidentally) who were exposed to self-harm content said that they have thought about how they would feel if they did the same thing they saw in the pictures or videos. 
• Saying yes to the above question (thinking about what it would feel like to self-harm) was associated with self-harming behavior, suicidal ideation, and suicidal plans.  
• 32.5% of individuals indicated that they performed the same self-harming actions they saw on Instagram as a result of seeing the content, meaning they copied what they saw. 

Researchers then looked at just the participants who had stumbled across self-harm content by accident without searching for it. They concluded the following: exposure to self-harm on Instagram results in harmful outcomes, even if the user accidentally came across the self-harm content. Moving forward, this information and a discussion surrounding it may be crucial for adolescents, parents, social media developers, government regulators and more. 

Self-harm during the COVID-19 pandemic 

A final paper that is relevant to our world today is a paper published in a journal titled “Psychiatry Research” in 2021. Many studies have begun to show how COVID-19 lockdowns affected the mental health of adolescents. This study specifically looked at high school students in Sweden and compared the prevalence of nonsuicidal self-injury (NSSI) at three different time points: in 2011, 2014, and finally, during the pandemic from 2020-2021. They found that there was an increase in self-harm from about 17% of reported participants in 2011 and 2014 to 27.6% of reported participants during the pandemic. Further research will be needed to see if NSSI stays at this high level and if this study can be replicated in the United States.  

How do I stop a self-harm relapse? 

For some individuals, self-injury is an action that is taken once and never again. However, for others, the desire to self-harm drives an individual to harm themselves over and over again. As mentioned above, feelings of shame, guilt, being “bad,” and needing punishment push adolescents to relapse and self-harm even if they wish to stop. 

Stopping self-harm is a process that may take time and effort. As stated above, creating a safety plan is an important first step. Here are some additional ideas:  

• Keep a journal to identify people, feelings, places, situations, or social media sites that trigger self-harm and set boundaries to reduce your risk. 
• Find another outlet for negative thoughts that you enjoy. This may be exercising, calling a friend, going for a walk, drawing, joining an after-school activity to keep yourself distracted, interacting with an animal, taking a shower, meditating, watching a TV show or more. 
• Work on improving your sense of self and self-worth. As noted above, negative feelings towards oneself are associated with the desire to self-harm. However, no one deserves to be hurt. Working with a professional, parent, or friend to remind yourself of your good qualities can help to train your brain to recognize that self-harm is dangerous, unnecessary, and unhealthy. 
• Seek professional help, to be described in more detail below. 

Support for self-harm at Charlie Health 

If you are aware of a friend who self-harms, listen to them and offer your support with the suggestions above. If your friend is a minor and under the age of 18, do not feel like you need to keep this information a “secret.”  Strongly consider telling an adult that you or your friend trusts who can make the situation better: a parent or guardian, school counselor, teacher, coach, or another adult who cares for your friend. 

At Charlie Health, our trained clinicians can help you end self-harming behavior through DBT or other virtual specialized and individualized forms of therapy. In addition to individual therapy, we also host virtual group and family therapy sessions that can help you feel better and healthier. Get started today.

Finally, if you or someone you know who self-harms are in imminent severe danger or are feeling as though you want to end your life, please call the National Suicide & Crisis hotline at 988 or text the hotline by clicking this link.