Explainer Series: Self-Harm

SAFMH News Room

Welcome back to our explainer blog series where we unpack specific mental health conditions and share stories of those with lived experience. In this edition we are focusing on self-harm.

Any behaviour that causes harm to oneself as a way to deal with difficult emotions can be seen as self-harm (UNICEF, 2024).

In 2023, 60% of South African youth felt that they needed mental health support. This was according to the latest UNICEF South Africa U-Report poll, which was released in October 2023. Youth in the country are facing immense uncertainty and pressures, and often feel misunderstood and unheard. These feelings can lead many to self-harm.

Self-harm is a behaviour that is most common amongst youth and young people, and it continues to be something that is misunderstood. According to the UK-based Mental Health Foundation, whilst self-harm is something that can affect anyone, “it’s believed that around 10% of young people self-harm, but it could be as high as 20%’’ (Mental Health Foundation, 2023).

Self-harm (or self-injury) is any behaviour that causes harm to oneself as a way to deal with difficult emotions (UNICEF, 2022). The American Psychiatric Association (2022) describes it as ‘’a harmful way of coping with emotional distress and people often try to hide the behaviour and feel shame or guilt” (American Psychiatric Association, 2022).

Young people have described self-harm as a way to “get out the hurt, anger and pain” caused by pressures in their lives (UNICEF, 2022). Nineteen year-old Dintle Mothei, who kindly offered to share their story with SAFMH, describes self-harm as the “infliction of pain in order to escape whatever I was feeling.’’

People who self-harm usually start doing it as a way of dealing with a lot of different and difficult emotions that they do not know how to process. This was true for Dintle, who started self-harming at the age of 14:

Growing up, I always struggled to express myself. I didn’t know how to speak about my emotions. I’ve always bottled them and no one ever knew what I was going through. I felt that if I told anyone what I was going through, they would see me as a burden or weak.”

While not classified as a separate mental health condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), self-harm is included as a condition for “further study”. We all experience stress and negative feelings in our lives, and there are some people who can find these feelings overwhelming. Young people may find it more difficult to express their emotions, and when bottling them up feels too much, they can turn to self-harm as a way of letting out the feelings and thoughts they can’t convey (UNICEF2022).

Causes for self-harm differ from person to person; however, some reasons reported by young people who have self-harmed include:

  • Loneliness, feelings of guilt or being unloved
  • Low self-esteem or issues with body image
  • Exam stress, feelings of extreme pressure or fear of failure
  • Witnessing or experiencing abuse at school, home, or in a relationship
  • Criticism from family, friends or teachers
  • Bullying

Dintle says:

I felt I had too many emotions inside of me and I didn’t know what to do about it, so that is when I started self-harming.’’

No one way to self-harm

There are different ways people self-harm. People sometimes use the same way all the time, other people hurt themselves in different ways at different times (Mind UK, 2020)  Some forms of self-harm are physical and can be seen. However, there are also other forms of self-harm that people don’t notice (Mind UK, 2020) For Dintle this meant:

I feel like a lot of people think it’s just cutting, but it can be through pulling of hair and excessive exercising…not always cutting.’’

Most people who self-harm do not speak about it, and so it is important to watch out for warning signs. UNICEF has offered the following list that you can take note of:

  • Cuts, burns, bruises or scars on people’s bodies, especially on their arms, stomach or thighs
  • Wearing clothes that hide these physical signs like long sleeve shirts
  • Making excuses about injuries
  • Carrying sharp objects with them like knives and scissors
  • Talking about feelings of pain, discomfort, weakness, sickness or dizziness
  • Feelings of shame, disgust, confusion or fear
  • Feeling a lack of control, isolation or loneliness
  • Signs of low self-esteem, such as blaming themselves for any problems or saying they are not good enough

Myths and stigma

There are many myths and misconceptions around self-harm, including:

  • People who self-harm are suicidal
  • Self-harm is attention seeking
  • People who self-harm enjoy doing it

It is important to know that in many cases, people who self-harm hide it for a very long time and don’t speak to anyone about it. Self-harm is sometimes seen as a suicide attempt; however for a lot of people, self-harm is a way to cope with misunderstood feelings and not an attempt at suicide (Mental Health Foundation, 2023). Despite the fact that self-harm and suicide often involve the same types of behaviours, the key difference is usually the motivation behind the behaviour. Although self-harm is different than suicide, many young people who self-harm may be depressed or become suicidal over time (Mental Health Foundation, 2023). Each person’s story is different and should be treated as such.

There is also another stigma attached to self-harm, namely the belief that the person is responsible for their condition and how they respond to their feelings. Dintle believes this stigma stems from a lack of education and awareness about self-harm.

Self-stigma is also an issue affecting people who self-harm, and can be a barrier to their recovery. The negative attitudes that those who self-harm hold against themselves can often add to the already-overwhelming feelings they are facing. A study from Ireland [REF] showed just how much “stigma has the power to silence, shame, and push those who struggle with self-harm into secrecy”. The study reported that 90% of those who self-harm believe others have a low opinion of them.

It is important to recognise that in many cases, people who self-harm hide it for a very long time and don’t speak to anyone about it.

It’s not talked about a lot and there is miseducation about it. I want to break down that stigma and educate people more about it [self-harm]”.

Moving forward

Source: Mental Health Foundation, 2023

The above diagram illustrates the cyclical nature of self-harm. When people start self-harming, they might find temporary relief and stop. However, when these overwhelming feelings arise again, they are likely to self-harm again. The Mental Health Foundation [date] argue that this is why it is crucial that persons who self-harm speak to a mental health professional? and learn coping strategies to start breaking this cycle of harm.  For Dintle, like many others, the journey of recovery was a ‘roller-coaster’ with many ups and downs:

There were moments when I thought I had recovered, only for me to then get triggered and relapse again. It was a lot, but I felt like once I reached out and finally opened up about it, I started getting better. People showed me ways that I can cope with my emotions in my own way.”

Dintle is passionate about raising more awareness about self-harm, especially in her community. She has started an awareness campaign on Instagram called The Scarlett Campaign, with the aim of educating people on self-harm and how to create a safe community for those who have self-harmed or are self-harming currently.

Dintle said that she wants to: break the stigma around self-harm, and for those people who have scars through cutting to not be ashamed to show their scars. As much as society sees self-harm scars as a weakness, I see it as a sign of resilience. It is a sign that you are still here and your scars are a beacon of strength”.

Dintle is keen to have as many people as possible get involved in the campaign and would love more people with lived experience of self-harm to join and share their stories.

It’s important for people to know that they are not alone and that it is possible to heal.”

Finding support

During my journey with self-harm, I really didn’t have someone who I could talk to and who could relate to me.”

Self-harm can be seen as a coping mechanism, as well as a cry for help. It’s important for people, especially young people, to know that they are not alone and that there is support out there. With the help of therapy and mental health facilities, Dintle was able to find the support she needed and open up about what she was going through.

There are support services available to people who are seeking help. You can start by opening up to someone you trust or speaking with your GP. Research shows that talk therapies, like cognitive behavioural therapy (CBT), can be effective in reducing self-harm as it focuses on building coping strategies and problem-solving skills. For more on self-harm and how you can manage it, read through this helpful booklet from the Mental Health Foundation here.

Dintle is positive about her future and wants to continue sharing her story to help other young people who may be dealing with self-harm or struggling with their mental health. She encourages young people to reach out and be open about what they’re going through.

Being open is a good thing. Showing vulnerability is a good thing. It is brave of you to open up and speak to someone about what you’re going through. Being able to have the strength to tell someone what you’re going through is something to admire.”

If you suspect that you or someone you know may be self-harming, always seek the help of a mental health professional. If you are interested in connecting with the organisation in your province, feel free to reach out to us via our enquiries Help Desk. For those who are looking for more guidance, you can head to our website and check out our Information Library.

If you or your loved one is feeling hopeless and/or having suicidal thoughts, please call the SADAG Suicide Crisis Line on 0800 567 567 or SMS 31393. You can also contact Dr Reddy’s Mental Health Helpline on 0800 21 22 23 and Adcock Ingram Depression & Anxiety Helpline on 0800 70 80 90. These numbers are free and counselling is available in all 11 official languages.

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