DELIBERATE SELF-HARM (DSH)

Deliberate self-harm (DSH) is the intentional direct harm to body tissues; not committed with suicidal intention. Self-harm behaviors most often begin to appear in adolescence.

What Is Deliberate Self-harm?

Deliberate self-harm (DSH) is the intentional direct harm to body tissues (such as cutting, burning, scratching, self-hitting, self-biting, and head banging). Although self-harm is not committed with suicidal intention (as distinct from suicidal behaviors), it results in serious, potentially life-threatening injuries. Self-harm is often associated with borderline personality disorder; common in adolescents and people with intellectual and developmental disabilities.

Many studies show that self-harm behaviors most often begin to appear in adolescents: 85% of children first commit self-harm behaviors in middle school; 61% of students have started this behavior before the age of 16. In Vietnam, statistics from 2009 and 2013 show that the rate of adolescents and young adults engaging in self-harm is 2.7% and 7.5%, respectively.

Self-harm behaviors that begin in adolescence tend to be more intense, last longer, and involve more forms of physical harm than cases of self-harm in adulthood. What's worrying is that teenagers seek help less frequently than adults when they fall into this situation. Therefore, detecting signs and symptoms of self-harm promptly is extremely important.

Signs And Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5 TR), self-harm is considered a separate mental health problem under the term “Nonsuicidal Self-Injury Disorder”. A person is diagnosed with this disorder when they exhibit the following signs and symptoms:

1. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain, with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent).

2. The individual engages in self-injurious behavior with one or more of the following expectations:

• To obtain relief from a negative feeling or cognitive state

• To resolve an interpersonal difficulty

• To induce a positive feeling state

3. The intentional self-injury is associated with at least one of the following: 

• Interpersonal difficulties, or negative feelings or thoughts (such as depression, anxiety, tension, anger, generalized distress, or self-criticism), occur in the period immediately before the self-injurious act.

• Before engaging in the act, a period of preoccupation with the intended behavior is difficult to control.

• Thinking about self-injury that occurs frequently, even when it is not acted upon.

4. The behavior is not socially sanctioned (such as body piercing, tattooing, or part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting.

5. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.

6. The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (such as psychotic disorder, autism spectrum disorder, intellectual developmental disorder/intellectual disability, and so on).

WARNING: The symptoms listed are for reference only. If you suspect that you have nonsuicidal self-injury disorder, see a psychologist for an accurate diagnosis.

Why Do People Hurt Themselves?

Everyone has different reasons for stress and anxiety. Some people can deal with these problems by talking to friends and family, while others find these difficulties overwhelming. When a person does not express their feelings or talk about the things that make them distressed, angry, or upset, the pressure can build up and gradually become unbearable. Some people with accumulated pressure use their bodies as a way to express thoughts and feelings that they cannot verbalize. When the pressures become too much to bear, they may engage in self-harming behaviors. These behaviors may appear with increasing frequency when they feel angry, miserable, anxious, or depressed.

Anyone can engage in self-harm, but it is most common in adolescents. They described self-harm as a way to “escape the hurt, anger, and pain” caused by the pressures in their life. They do this because they don't know what else to do and don't feel like they have any other options. Self-harm behaviors in adolescents are not only a way for them to cope with external pressures, but also to release stress, communicate pain, or distract themselves from memories of traumatic experiences. Some children feel guilty, so they engage in this behavior to punish themselves.

Some factors that can be considered causes of self-harm in adolescents include:

• A sudden life change like a death, divorce, or moving school

• Exam stress, feelings of extreme pressure, or fear of failure

• Seeing or experiencing abuse at school, at home, or in a relationship

• Seeing or experiencing a severely distressing or traumatic event

• Loneliness, feelings of guilt, or being unloved

• Low self-esteem or issues with body image

• Criticism from family, friends, or teachers

• Violence among peers

Some Myths About Self-Harm

“Self-harm is attention-seeking”

This is one of the most common stereotypes about self-harm. In fact, many people who self-harm don't tell anyone about what they are going through for a long time; and it can be very difficult for them to have the courage to seek help.

“Self-harm is a goth thing”

Many people consider self-harm behaviors to be part of youth subcultures (like goth or emo). Although some studies show a link between the two, there is little or no convincing evidence to support the view that self-harm is part of any particular young person's subculture.

“Only girls self-harm”

People often think that girls are more likely to self-harm than boys, however, there is no concrete evidence to support this idea. Both men and women may engage in different self-harming behaviors, or have different reasons for hurting themselves - and these are both serious issues.

“People who self-harm must enjoy it”

Some people believe that people who engage in self-harm take pleasure in the pain or risk associated with the behavior. There is no evidence that people who self-harm perceive pain differently from other people. Self-harming behaviors often make people extremely miserable. For some people, depression has left them numb, and they want to feel anything to remind them that they are still alive, even if it is painful. Others have described the pain of hurting themselves as punishment.

“People who self-harm are suicidal”

Self-harm is sometimes considered by many people to be a suicide attempt. However, this is not completely true for everyone. Some people may feel suicidal and try to commit physical harm to kill themselves; while some people see self-harm as a way to cope with current difficult emotions and circumstances – they describe self-harming behaviors as a way of staying alive and surviving these difficulties.

Coping With Self-harm

Distraction Techniques

When you feel the urge to self-harm, diversion strategies can be a helpful way to control your emotions and overcome the desire to hurt yourself. Some distraction activities include:

• Write down thoughts and feelings that make you miserable; crumple the page, tear it out, and throw it away as a way to let go of that thought

• Take some modeling clay, stretch or squeeze it to relieve tension

• Scream or hit the pillow/cushion to vent your anger

• Take a minute to practice deep breathing or meditate

• Go for a walk to get yourself away from triggers. Being in open places gives you the time and space to decrease the urge to harm yourself

• Make a lot of noise with a musical instrument or simply bang on pots and pans

• Scribble on a large piece of paper with a crayon or red pen

• Call a relative or friend and conversation with them (not necessarily about self-harm)

• Do something creative, like pairing colors to express your mood or colors that remind you of things you love

• Listen to music or watch a movie you like

The Help of People Around You

If you are experiencing psychological difficulties, are contemplating, or have committed acts of self-harm, don't be afraid to ask for help whenever and however you need it. Expressing your feelings is not a sign of weakness. It shows that you are taking responsibility for your health and doing what you need to do to protect it. Expressing feelings is not always easy, if you have difficulty describing, use as many words as possible to illustrate your feelings.

Talking can be a way to resolve the problem that is bothering you. Feeling heard can help you feel more supported. It's important to tell someone you trust and feel comfortable with, as they will be able to help and support you.

If you find talking about it too difficult, you can write a letter or email. You can even ask a friend to talk to a trusted adult on your behalf. Let them know that you need help. You don't have to provide details about how you have harmed yourself, and you don't have to talk about things you feel uncomfortable talking about. Try to focus on the thoughts and feelings behind it, rather than the self-harming behaviors.

Seek Professional Help

There are many support services and treatments available for people who are experiencing psychological difficulties and self-harming behaviors. Psychotherapies such as Cognitive Behavioral Therapy (CBT) focus on building coping strategies and problem-solving skills and are very effective in reducing self-harm. Other forms of counseling, such as Psychodynamic therapy, will help people with self-harm identify the issues that cause them distress and self-harm. When working with people with psychological and psychiatric expertise, people with self-harming behaviors will better understand the problems they are facing and receive intervention with the most appropriate treatment methods.

How To Help Someone Who Is Self-Harming?

In case you are worried that someone is self-harming, you mustn't wait and be passive. Waiting and hoping they will come to you for help can miss out on the right time to give them the best support and treatment.

Be aware that they may not feel ready or able to talk about their self-harm. It takes a lot of trust and courage to be open about self-harm. So let them lead the discussion at their own pace and don't pressure them to tell you details they're not ready to share.

In particular, you must always react in a non-judgmental, caring, and respectful way. This may be difficult when you see somebody in distress and you may find it troublesome to understand why they are harming themselves. However, you should try to see the person's perspective and the reasons they harmed themselves, rather than focusing on the behaviors.

If you feel you are having symptoms of nonsuicidal self-injury disorder, go to a medical facility for a timely examination and diagnosis, or contact the Vietnam - France Psychology Institute via Hotline: 0979.158.463 for specific advice. Early intervention is key to improving health and quality of life.

Tham khảo:

[1] Deliberate self-harm (DSH). https://dictionary.apa.org/deliberate-self-harm

[2] Hành vi tự gây tổn thương ở trẻ vị thành niên: thực trạng, các mô hình lý giải, các chiến lược phòng ngừa & can thiệp trong trường học. https://repository.vnu.edu.vn/bitstream/VNU_123/13181/1/53.pdf

[3] Diagnostic and statistical manual of mental disorders (DSM-5 TR). https://www.mredscircleoftrust.com/storage/app/media/DSM%205%20TR.pdf

[4] What is self-harm?. https://www.unicef.org/parenting/mental-health/what-is-self-harm

[5] The truth about self-harm. https://www.mentalhealth.org.uk/explore-mental-health/publications/truth-about-self-harm

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