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Know how to recognise self-harm, understand the causes and know the possible treatments.

What is self-harm ?

What is self-harm?

Self-harm is a complex behaviour, which has many meanings. It is found in particular in adolescents, but also in adults with borderline personalities. The term self-harm has no commonly accepted unique definition.
Self-injurious behaviour can have a religious or cultural dimension. They may tend to testify a belonging to a group (body markings, tattoos, piercings, implants, etc.).
Without these social or aesthetic criterias or motivations, self-harm takes on a pathological character.

What are the causes of self-harm?  

People with self-injurious behaviour most often attack their skin, and more generally their body envelope. As the first psychic envelope, the skin is above all a barrier protecting from external aggressions.
The body is also a place of dialogue, of privileged and intimate communication, especially when words are lacking. When a person self-injures, he or she challenges and mobilizes those around him or her and his or her interlocutors. Finally, the skin has a major sensory role: it is a place of pleasure if the subject has been able to build him or herself by investing his or her body positively.
Dr Thierry Bigot describes some of the meanings given to self-harm:
Affect regulation model: when the self-injurious gesture shows poorly controlled mental suffering such as despair, anger, guilt, anxiety or the feeling of emptiness. The individual converts this suffering into actively provoked pain. The person moves the pain from mind to body (“now I know why it hurts”).
Self-punishment model: when the person feels guilty as a result of psycho-trauma and turns aggression against themselves. Here, in particular, we find the feeling of not having been worthy of an expected parental love that did not happen in childhood, or the guilt that can arise after suffering from sexual abuse.
Limits model: when the person comes to test their limits in a pathological search for sensations. More often than not, she thus marks her will to make a cut with the other. In this model, self-harm is linked to a failure in identity structuring. Self-harm then occurs most often following an abandonment or a felt intrusion, repeating painful childhood experiences.
Environmental and communicational model: when the self-aggressive gesture is a means of communicating to others a psychological distress felt, a message or a request for attention …
Sexual model: the access to adult sexuality can be lived in a very agonizing way by the teenagers, with drive overflows which they can seek to channel by acts of self-mutilation.

Self-harm - typology and figures

There are several distinct types of self-harm, the consequences (injuries) and locations of which differ, by their nature and severity.

  • Major self-mutilation: it is most often a single, impulsive act (e.g. amputation, enucleation, castration). They generally occur in the context of a psychotic crisis or while taking drugs. The lethal or/and suicidal risk for the person in this type of self-harm is significant.

  • Stereotypical self-harm: such as repetitive blows or bites, is most often encountered in people with mental retardation, autistic disorder, severe psychotic disorder with retardation and/or pervasive developmental disorders.

  • Superficial or moderate self-harm: These are self-inflicted injuries, intentional, conscious, not life-threatening or functional. They can be episodic, compulsive or repeated. These are the most frequent self-harm.

Regarding the types of lesions, the most frequently used means are superficial scarifications (80% of cases), blows with bruises (24% of cases), burns (20% of cases), head shots against walls (15%), bites (7%). Abrasions and introduction of foreign bodies are more rare.
In 80% of cases, the areas of the body affected are the forearms, and more particularly the left forearm. The head or face are more rarely affected and their self-mutilation is often associated with severe mental disorders. The involvement of the sexual organs, it can testify to an unresolved sexual problem or a delusional disorder.
Places of self-inflicted injuries such as the stomach, back, or orifices are less common and are often associated with psychotic disorders.

Cases of self-harm in adolescence

During his doctorate in sociology, Baptiste Brossard conducted a survey on 63 adolescents and young adults met through Internet forums devoted to the practice of self-harm and accompanied in mental health care facilities.
The objective was to analyze the practice of self-inflicted injuries by linking three elements:

  • the personal history of the patients

  • the concrete modalities of their injuries

  • the emotional system that gives them meaning

The result of these discussions made it possible to highlight a goal common to many adolescents: self-harm is a practice aimed at deliberately changing their emotional state, and this change occurs to restore a norm that has been challenged.
Thus, depending on the case, one feels “dirty” following an event related to rape, and then partially regains symbolic cleanliness. The other feels anger, in a context of generalized violence, fails to communicate and calms down by the injury in order to tend towards verbal communication with his or her family. Others seek to recover “normal” bodily sensations disturbed by anxiety attacks.

Self-harm - who is affected?

The incidence and prevalence of self-injurious behaviours have been constantly increasing in Western countries since the 1960s. Studies show that 1 to 4% of the general population and 12 to 35% of middle school students have already engaged in behaviour.

Self-injurious behaviour is found among a third of people consulting or hospitalised in psychiatry. In addition, 25 to 45% of people with an eating disorder of the bulimic type and 80% of people diagnosed with a borderline personality, or so-called “borderline” have self-injurious behaviour, most often episodic.

In 59% of cases, symptoms start around the age of 12-13 years and affect girls twice as often as boys.

According to Dr Thierry Bigot, risk factors are to be sought in childhood (sexual abuse, physical and psychological mistreatment, emotional deficiencies and lack of security felt by the child, etc.) and in adulthood (history of violence, addictive substance abuse, psychiatric comorbidities, etc.).

How to help a person suffering from self-harm?

For people with self-injurious behavior, the first contact with care can be done in a context of emergency in the most serious cases. It can also be done more simply, with a general practitioner. Hospitalization, sometimes at the request of a third party, may be necessary.

The therapeutic approach is then twofold: pharmacological and psychological

Pharmacologically, treatment depends on the associated comorbidity. Antidepressants may be used if the person has depression and/or a marked impulsive dimension. Antipsychotics can be used in cases of proven psychosis or personality disorders which jeopardize the relationship with reality. Finally, mood stabilizers are prescribed in the case of bipolar disorder or a personality limitation.

On the psychological level, the care must allow the person to better understand his or her behaviour and to find other issues than taking action. The methods are varied: analytical therapy, cognitive-behavioural, family, centred on writing or drawing …

Body therapeutic approaches can also help people to re-establish a harmonious relationship with their own body.