Understanding Self-Harm and its functions
Self-harm or non-suicidal self-injury (NSSI) is when someone intentionally injures their own body (e.g., cutting, hit themselves). Self-harm can be a difficult coping mechanism to understand as it can seem counter-intuitive and does not always indicate someone has suicidal intent. But understanding self-harm helps you understand your loved one’s perspective and how to help them in moving forward as well.
Here are some common functions for self-harm:
Emotion regulation
- Individuals who self-harm usually feel overwhelming emotions (e.g., shame, anger) so self-harm is used as a way to reduce or manage these emotions (Klonsky, 2007)
- This may seem most difficult for loved ones to understand but at times when the emotional pain is so overwhelming, physical pain can temporarily take away the emotional pain or give them some relief. Due to this relief, this reinforces the likelihood of them engaging in self-harm again because it can appear to be an “effective” coping strategy to manage emotions (Chapman et al., 2006).
Grounding
- In some cases, individuals feel numb or detached so they are unable to access their emotions. This can be very uncomfortable and self-harm is used as a way to ground themselves to try and “feel something” and that they are real and present.
Self-punishment
- Self-harm is a common coping mechanism for individuals who have experienced traumatic and/or adverse childhood experiences. For some, they may have internalised shame and negative core beliefs about themselves and believe they need to be punished in some capacity.
Communication
- Self-harm is commonly viewed as an “attention-seeking” behaviour. For some individuals, they will use it for this function but when they do, they are usually trying to communicate their high levels of distress or seeking a specific response from an individual (Nock & Prinstein, 2004).
- However even if the behaviour is used for this function, it is important to not dismiss it because self-harm usually has underlying functions as outlined above and can escalate.
Helping a loved one who self-harms
Approaching a loved one about self-harm requires compassion, patience, and a non-judgmental attitude. Your role is not to be their therapist or doctor, but a source of consistent, non-critical support that encourages professional help.
1. Listen and Validate
- Express your concern gently and specifically about the behavior you’ve noticed, while avoiding blame and judgment.
- Acknowledge that their emotional pain is real and overwhelming, even if you don’t understand the behavior. Statements such as, “I can see you’re going through a lot right now, and I want to help,” are more effective than, “Why would you do that to yourself?”
- Do not demand they stop, threaten them, or make them feel guilty. This often increases shame and isolation.
- Ask what they might need from you (e.g., listening ear, help finding a professional)
2. Encourage Professional Help
- Gently encourage and assist them (where appropriate) in seeking professional mental health support (e.g., a psychiatrist, psychologist)
- Offer to help research qualified professionals, attend initial consultations (if appropriate and requested)
3. Learn Safe Ways to Cope Together
- Work with them (or encourage them to work with a professional) to identify distress tolerance and alternative coping strategies to use when the urge to self-harm is strong. This can include existing coping strategies (e.g., reading, listening to music, watching funny videos) that already work for the individual.
- Identify trusted family and/or friends they can talk to when they need it
4. Maintain Boundaries and Your Own Wellness
- Supporting a loved one who self-harms can be difficult. It is essential for you to seek your own support if you are having difficulties coping as well.
- Understand your limits as your role is to be supportive and present rather than solving their problems.
⚠️ Immediate Safety Warning:
If a loved one is in immediate danger, or if you believe their self-harm is escalating into suicidal intent, contact the National Mindline at 1771 (applicable to Singapore only)
To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.
References
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394. https://doi.org/10.1016/j.brat.2005.03.005
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. https://psycnet.apa.org/doi/10.1037/0022-006X.72.5.885