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A Silent Cry For Help: Self-injury Awareness Day, 2024
Self-injury or self-harm is a complex and multifaceted behaviour where individuals may intentionally inflict pain upon themselves with methods such as cutting, burning, scratching, bruising, or hitting themselves. They may adopt these methods as a means of coping with overwhelming emotions or regaining a semblance of control in their lives. Often intertwined with conditions like depression, its roots can stem from various underlying reasons. The act of self-injury can serve as a paradoxical mechanism—a way to both express deeply buried emotions and to escape the numbing effects of depression. It's not merely about inflicting physical pain but about finding a tangible outlet for internal turmoil. For many, self-harm provides a temporary respite from emotional distress, offering a fleeting sense of relief. Far too often, individuals who engage in self-injury feel isolated and misunderstood, hesitant to seek help for fear of being labelled as "crazy" or "attention-seeking." A 2023 study found that the 12-month prevalence of Non Suicidal Self Injury (NSSI) in non-clinical populations is between 3.2% and 44.8%, and the lifetime prevalence is between 21% and 33%. In clinical populations, the 12-month prevalence is between 5% and 16.4%, and the lifetime prevalence is between 2% and 27%.
Every March 1st, individuals and organisations around the world join together in a silent revolution under the banner of Self-injury Awareness Day (SIAD). Embracing the ethos of grassroots advocacy, SIAD adds a filter of courage and compassion to mental health discourse. This annual campaign serves as a vital platform for illuminating the often-overlooked facet of self-harm. Mental health conversations can sometimes skirt uncomfortable topics and SIAD boldly encourages individuals to engage in open dialogue about the complexities of self-injury. It aims to shed light on the deeply personal struggles that individuals may face in their journey toward mental wellness. As a grassroots movement, SIAD thrives on the power of shared stories and collective empathy. It empowers individuals to break the silence, offering a safe space for candid conversations and authentic expressions of vulnerability. Through this process, misconceptions are challenged, stigma is confronted, and understanding flourishes. On 1st March and in weeks leading up to it, individuals don orange awareness ribbons, a potent symbol of advocacy, signifying a commitment to breaking down the pervasive stereotypes surrounding self-harm. By proudly displaying this emblem, participants affirm their dedication to fostering empathy and compassion for those grappling with this often-misunderstood aspect of mental health. Similarly, the simple yet profound act of writing "LOVE" on one's arms serves as a poignant expression of solidarity and affirmation.
It sends a powerful message of acceptance and understanding, reminding individuals that they are not alone in their struggles. Drawing a butterfly on the wrist, inspired by "the Butterfly Project," carries deep significance within the SIAD community. It symbolises resilience, transformation, and the hope for personal growth beyond the constraints of self-harm. Each butterfly represents a moment of strength and courage. These acts serve as visual reminders of solidarity and support. SIAD also seeks to equip medical professionals with the knowledge and empathy needed to provide effective care and support for individuals navigating this complex terrain.
To understand this harmful behaviour in detail, My City Links reached out to practising psychologist and president of WICCI Odisha Mental Health Council, Dr. Nivedita Das and Neuropsychiatrist, HOD of Psychiatric Department at Hi-Tech Medical College and Hospital, Dr. Amrit Pattojoshi. Below are the excerpts from our conversation.
Underlying psychological factors that contribute to self-injury
We asked Dr. Nivedita Das about the possible reasons one attempts self-injury. “Self-injury or self-harm, which is also known as NSSI (non-suicidal self-injury) is an act of causing or inflicting hurt or damage to the surface of the body deliberately, without suicidal intent. It is important to mention here that suicidal behaviour or socio-culturally accepted behaviour like tattooing or body piercing which is normally seen amongst adolescents are different. This behaviour is commonly observed among adolescents. The underlying causes can be many but it is a cry for help as well. It could be a rebellious act or when the adolescent wants to reject the family values or doesn’t like too much interference, they tend to project such behaviour. That doesn’t mean the adolescents are doing all that consciously or knowingly to irritate the parents and others. They just don’t know how to handle the stress that phase of life puts on them which includes hormonal changes, pubertal changes, social and emotional stress, and they often say that they just ‘felt good’ by putting cut marks on their wrist or burning their hands by playing with hot wax or fire.” She added, “It is their way of communicating their psychological or emotional discomfort or when they are struggling with low self-worth. It is a non-verbal mode of crying for help. It is sometimes their way of seeking acceptance to ‘fit in’ within a particular peer group that glorifies such self-harming behaviour. Self -harm behaviour also produces an endorphin effect and it gives them temporary relief by providing a numbing feeling. Sometimes they use it as a form of self- punishment.”
How can individuals differentiate between typical teenage experimentation and potentially harmful self-injurious behaviours?
Dr. Das replied, “The difference is the underlying stress and emotional distress. In a typical teenage experimentation, they will be thrilled to experiment. But self injurious behaviour is about inflicting pain onto oneself. Non suicidal self injury (NSSI) occurs in the context of numerous psychiatric disorders, including post-traumatic stress disorder, depression, eating disorder and substance abuse disorder. Furthermore, NSSI is associated with a variety of negative consequences and functional impairments. The adolescent’s inability to resist the impulse to injure oneself, increased sense of tension prior to the act and experience of release/relief after the act are the essential features. Also repetitiveness is a characteristic differentiation to look for.”
What role does stigma play in preventing individuals from seeking help for self-injury, and how can communities work to reduce this stigma?
According to Dr. Das, although attitudes are changing slowly, awareness about symptoms needs to be talked about openly. She said, “Instead of criticising or ignoring the cries for help which are manifested in the form of self injurious behaviour, people should address the underlying issues empathetically and offer assistance in the form of professional help. For that, there needs to be improved communication channels between the parents and children and other members in their social groups.” Agreeing with Dr. Das, Dr. Amrit Pattojoshi said, “Communities can reduce stigma surrounding self-injury by promoting education, understanding about mental health, fostering empathy and support networks, and encouraging open dialogue to reduce misconceptions and judgement.”
What are some effective coping strategies or alternative behaviours that can help individuals manage emotional distress without resorting to self-harm?
Dr. Das said, “self injury is a complex behaviour as it is caused due to emotional stress, tension, low self-esteem and lack of understanding. Though the adolescent feels like the steam of the pressure cooker is released after inflicting pain on oneself after the act, it leaves a permanent scar/mark on their bodies. Helping them cope with the feeling by talking to them openly, instead of talking about them badly is the first step. Asking them to journal their feelings, practise deep breathing and relaxation techniques when such impulses of self harm come, can help to a great extent. Helping them develop better social skills and positive stress management skills may help.” Dr. Pattojoshi also shared some effective coping strategies with us. He said, “Mindfulness and meditation, deep breathing exercises to induce calmness and relaxation, progressive muscle relaxation to reduce physical tension, and promoting relaxation through expressive art therapy such as music, art, or writing are all some alternative behaviours that can help. Physical exercises like walking or jogging can help manage stress, regulate emotions, and improve mood by releasing endorphins.” He added, “Social support from friends, family members, and mental health professionals can also provide comfort, validation, and perspective during times of emotional distress.” He also advocated some self-care practices. He said, “Maintaining good sleep, a balanced diet, good hygiene, and engaging in enjoyable hobbies can build resilience and enhance coping skills. Developing safety plans with the help of a mental health professional provides a structured approach for managing crises and preventing self-harm.”
What advice do you have for friends and family members who want to support a loved one struggling with thoughts of self-injury?
"To provide meaningful support to a loved one struggling with self-injury, it's crucial to educate yourself about self-injury, its causes, underlying psychological factors, and potential treatment options. Listen to them non-judgmentally, expressing empathy and understanding, and listen with compassion and knowledge. Avoid reacting with anger or guilt, instead, encourage them to seek professional help from a therapist, counsellor, or psychologist. Together, explore alternative coping strategies and healthier ways of managing emotional distress. Collaborate on safety plans with your loved one and their mental health provider, being patient and dedicated to your support. Remember to set boundaries when necessary to protect your own well-being,” said Dr. Pattojoshi. Meanwhile Dr. Das said, “The advice will always be to not be judgmental and have empathy for those who are going through such a difficult time.”
What advice would you give to someone who is struggling with the thought of self-injury? What can they do in an SOS situation?
Dr. Pattojoshi advised, “If you find yourself struggling with thoughts of self-injury, it's important to reach out for support, whether it's from a friend, family member, therapist, or helpline. Try using distraction techniques like going for a walk, listening to music, watching a movie, or practising relaxation exercises to help shift your focus away from harmful thoughts. Delay the behaviour by reminding yourself of the reasons to hold off. Utilise the safety plan you developed with your therapist or mental health professional, and practice self-soothing techniques such as deep breathing, taking a warm bath, or cuddling a pet for comfort and relaxation. Challenge negative thoughts and beliefs that contribute to the urge to self-injure, and remove any tempting objects from your sight. Be compassionate and kind to yourself throughout this process, seeking professional help without hesitation when needed. In an emergency situation, don't hesitate to use emergency services for immediate assistance.”
What are the potential dangers of unidentified self injury behaviour in an individual?
According to Dr. Pattojoshi, "Engaging in unidentified self-injury behaviour can lead to various potential dangers, both physical and psychological. Physically, there's a risk of serious injury such as tissue damage, scarring, infections, nerve damage, and medical complications, including those resulting from accidents or substance overdose. Psychologically, it can cause distressing emotions like shame, guilt, isolation, and low self-esteem. Interpersonal conflicts may arise, straining relationships and hindering effective communication and support. Moreover, there's an increased risk of suicide, as self-injury often indicates underlying mental health issues like depression or borderline personality disorder, which can lead to suicidal thoughts or attempts. Maladaptive coping mechanisms may develop, further exacerbating the situation, ultimately leading to a decreased quality of life due to untreated psychological distress, strained relationships, and impaired functioning."
