What Is Suicide?

Suicide :

What is suicide?

Suicide is the process of purposely ending one's own life. The way societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, such as in protest to persecution (for example, hunger strike), as part of battle or resistance (for example, suicide pilots of World War II; suicide bombers) or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members).

Nearly a million people worldwide commit suicide each year, with anywhere from 10 to 20 million suicide attempts annually. About 30,000 people reportedly kill themselves each year in the United States. The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single car accident, overdose or shooting, are not recognized as being a suicide. Suicide is the eighth leading cause of death in males and the 16th leading cause of death in females. It is the third leading cause of death for people 10 to 24 years of age. Trends in rates of suicides for teens 15 to 19 years of age indicate that from 1950 to 1990, the frequency of suicides increased by 300% and from 1990 to 2003, that rate decreased by 35%.

1 As opposed to suicidal behaviors, self-mutilation is defined as deliberately hurting oneself without meaning to cause one's own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Other self-injurious behaviors include self- burning, head banging, pinching, and scratching.

Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful, for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2003, Oregon was the only state with laws that authorized physician- assisted suicide. Physician-assisted suicide seems to be less offensive to people compared to euthanasia that is done by a nonphysician, although the acceptability of both means to end life tends to increase as people age and with the number of times the person who desires their own death repeatedly asks for such assistance.

What are the effects of suicide?

The effects of suicidal behavior or completed suicide on friends and family members are often devastating. Individuals who lose a loved one from suicide (suicide survivors) are more at risk for becoming preoccupied with the reason for the suicide while wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one, and stigmatized by others. Survivors may experience a great range of conflicting emotions about the deceased, feeling everything from intense sadness about the loss, helpless to prevent it, longing for the

2 person they lost, anger at the deceased for taking their own life to relief if the suicide took place after years of physical or mental illness in their loved one. This is quite understandable given that the person they are grieving is at the same time the victim and the perpetrator of the fatal act.

Individuals left behind by the suicide of a loved one tend to experience complicated grief in reaction to that loss. Symptoms of grief that may be experienced by suicide survivors include intense emotion and longings for the deceased, severely intrusive thoughts about the lost loved one, extreme feelings of isolation and emptiness, avoiding doing things that bring back memories of the departed, new or worsened sleeping problems, and having no interest in activities that the sufferer used to enjoy.

What are some possible causes of suicide?

Life circumstances that may immediately precede someone committing suicide include the time period of at least a week after discharge from a psychiatric hospital or a sudden change in how the person appears to feel (for example, much worse or much better). An example of a possible trigger (precipitant) for suicide is a real or imagined loss, like the breakup of a romantic relationship, moving, loss (especially if by suicide) of a friend, loss of freedom, or loss of other privileges.

Firearms are by far the most common means by which people take their life, accounting for nearly 60% of suicide deaths per year. Older people are more likely to kill themselves using a firearm compared to younger people. Some individuals commit suicide by threatening police officers, sometimes even with an unloaded gun or a fake weapon. That is commonly referred to as "suicide by cop." Although firearms are the most

3 common way people complete suicide, trying to overdose on medication is the most common way people attempt to kill themselves.

Risk and Protective Factors

There is no single cause of suicidal behaviour and each individual's situation is unique. However, research has revealed a number of risk factors and protective factors. Risk factors increase the probability of suicidal behaviour, while protective factors tend to offset that risk.

Risk Factors

There is no single cause of suicidal behaviour and each individual's situation is unique. However, research has revealed a number of risk factors and protective factors. Risk factors increase the probability of suicidal behaviour, while protective factors tend to offset that risk.

Many people who have some of these risk factors in their lives will not have thoughts of suicide. Research also tells us that although thoughts of suicide are not uncommon, most people do not act on these. Risk factors provide a broad indication only, so assessment by a health professional with experience in this area will be needed, to determine the actual risk of suicide in any individual.

Much of the research on risk factors has focussed on youth suicide and elderly suicide and there are some noticeable differences. In general, suicide among the elderly is often associated with a mental health problem co-occurring with physical health problems. Psychotic and substance use disorders are more likely to be found in suicides of young people.

4 Risk factors can be grouped into: individual and personality risk factors, mental illness, family-related risk factors, social risk factors and environmental risk factors.

Individual Factors

 Male gender - suicide rates are higher in males than females, across all age groups. They are highest in the 20s and 30s, then rise again in elderly people;

 Psychological and emotional problems - for example, low self- esteem, being very introverted, social inadequacy, being impulsive, recklessness, hopelessness, anxiety, anger, aggression and violent behaviour;

 Sexual Orientation - some studies suggest that young gay or lesbian people may have an increased risk of suicidal behaviour, possibly through being more likely to experience prejudice, homelessness, depression and substance use;

 Physical health problems - for example, recent onset of serious illness, chronic or painful illness, functional limitations due to illness, injury or age;

 Stressful life events - for example, recent loss of a significant person, relationship breakdown, disciplinary or legal crisis, interpersonal conflict.

Mental Illness

 Major depression - major depression carries a significant risk for suicidal behaviour and may be associated with low levels of certain neurotransmitters in the brain;

5  Other depressive illnesses - other depressive illnesses may also be associated with suicidal behaviour - for example, bipolar disorder has been shown to be a significant risk factor for completed suicide;

 Substance use disorder - alcohol and other drugs exacerbate other mental illnesses and may decrease inhibitions and increase impulsive and risky behaviour;

 Antisocial behaviour - there is some association between suicidal behaviour and antisocial behaviour, such as conduct disorder, oppositional defiant disorder and antisocial personality disorder;

 History of psychiatric care - a previous history of mental illness which required psychiatric care increases the risk of suicidal behaviour;

 Previous suicidal behaviour - a previous history of suicidal behaviour increases the risk of suicide or suicide attempt.

Family-related Risk Factors

 Family breakdown - divorce or separation may leave family members feeling isolated and vulnerable and increase the risk of depression and suicidal behaviour;

 Family conflict or poor communication - for example, marital discord, family conflict, domestic violence, extremely high or low parental expectations and control, parental mental illness such as depression or substance abuse;

 Child abuse - the risk of suicidal behaviour may be increased when there is a history of child abuse, such as neglect, sexual abuse,

6 physical abuse, emotional abuse, witnessing abuse or domestic violence;

 Family history of suicidal behaviour - the risk of suicidal behaviour is higher in families of those who engage in suicidal behaviour and increases with closer genetic connections.

Social Risk Factors

 Socio-economic disadvantage - social disadvantage and economic disadvantage may increase the risks of mental health problems and suicidal behaviour;

 Indigenous communities - suicide rates are higher in Indigenous communities and particularly high among young Indigenous men;

 Migrant populations - overall suicide rates for immigrants are similar to those among other Australians but there is variation among immigrant groups; females and people over the age of 65 are at higher risk;

 School disengagement - mental health problems and the risk of suicidal behaviour may be higher among young people who are disengaged from school, which may be seen in non-participation, early school-leaving, truancy and suspension;

 Unemployment - unemployment appears to increase the risk of suicidal behaviour, possibly through lack of social contact, loss of sense of identity, reduced activity and sense of purpose and lower income;

 Isolation - for example, social isolation, being isolated by unemployment or homelessness, living in a remote place;

 Rural Communities - some studies suggest that suicide risk may be higher in rural communities, perhaps due to isolation and social

7 problems; in Australia the elevated risk seems to be most applicable to young men.

Environmental Risk Factors

 Access - ready access to methods of ending one's own life may increase suicide rates, for example in countries with high gun ownership;

 Exposure in peers or the media - people may be at higher risk if a friend, acquaintance or family member has shown suicidal behaviour - exposure in the media may increase risk if the story is sensational or provides detailed description of the method of self- harm.

Protective Factors

A number of factors have been identified which seem to reduce the probability of suicidal behaviour. In general, health and security and a sense of connection to others seem to be important in the prevention of suicide. The following protective factors have been suggested:

 Connectedness - a sense of connection with family, school or the community;

 Significant other - the presence of a caring adult to provide support for a young person, or the presence of a caring partner or family member for an adult;

 Responsibility for children - for adults, having the responsibility for children or for family communication is protective;

 Personal resilience - some personal attributes enhance resilience, such as problem solving skills and positive coping styles;

8  Spirituality and beliefs - protective factors may include a strong spiritual or religious faith, a sense of higher meaning or purpose in life, or a belief that suicide is wrong;

 Economic security - economic security is protective, particularly in older people;

 Good health - good physical and mental health is a protective factor;

 Effective treatment - the early identification and effective treatment of mental health problems such as depression is important in protection from suicide;

 Restricted access - lack of access to a means of suicide can help to reduce suicide risk, such as restricting the presence or accessibility of guns or certain medications.

: Warning Signs for Suicide

While it is difficult to predict who will be at risk of suicide, there are some signs which may indicate that a person is thinking about ending their own life. Some of the possible warning signs for suicidal behaviour include:

 A person has threatened to end their own life, either verbally or in some other way such as a letter or poem;

 A person has made statements which suggest that they are thinking about suicide, e.g. Life isn't worth living, or Nobody would care if I wasn't around any more;

 A person with problems has made a covert statement that might suggest they have come to a final decision, e.g. It's okay now, soon everything will be fine;

9  Sudden changes in behaviour and 'tying up loose ends', such as giving away prized possessions, writing farewell notes or making out a will;

 Increased risk-taking behaviours such as heavy drinking or drug use, driving while intoxicated, dangerous behaviour such as hanging from moving trains or vehicles;

 Signs of persistent and severe emotional problems, such as withdrawal, hopelessness, helplessness, guilt, poor self-worth, inability to function at home or school or work.

What are the signs and symptoms for suicide?

Warning signs that an individual is imminently planning to kill themselves may include the person making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope or medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell any mental-health professional they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.

Individuals who take their lives tend to suffer from severe anxiety, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing firearms, medications, knives, and other instruments people often use to kill themselves can allow the individual time to think

10 more clearly and perhaps choose a more rational way of coping with their pain.

How are suicidal thoughts and behaviors assessed?

The assessment for suicidal thoughts and behaviors performed by mental- health professionals often involves an evaluation of the presence, severity, and duration of suicidal thoughts in the individuals they treat as part of a comprehensive evaluation of the person's mental health. Therefore, in addition to asking questions about family mental-health history and about the symptoms of a variety of emotional problems (for example, anxiety, depression, mood swings, bizarre thoughts, substance abuse, eating disorders, and any history of being traumatized), practitioners frequently ask the people they evaluate about any past or present suicidal thoughts, intent, and plans. If the individual has ever attempted suicide, the circumstances surrounding the attempt, as well as the level of dangerousness of the method and the outcome of the attempt, may be explored. Any other history of violent behavior might be evaluated. The person's current circumstances, like recent stressors (for example, end of a relationship, family problems), sources of support, and accessibility of weapons are often probed. What treatment the person may be receiving and how he or she has responded to treatment recently and in the past, are other issues mental-health professionals tend to explore during an evaluation.

Sometimes professionals assess suicide risk by using an assessment scale. One such scale is called the SAD PERSONS Scale, which identifies risk factors for suicide as follows:

← Sex (male)

11 ← Age younger than 19 or older than 45 years of age

← Depression (severe enough to be considered clinically significant)

← Previous suicide attempt or received mental-health services of any kind

← Excessive alcohol or drug use

← Rational thinking lost

← Separated, divorced, or widowed (or other ending of significant relationship)

← Organized suicide plan or serious attempt

← No or little social support

← Sickness or chronic medical illness

How are suicidal thoughts and behaviors treated?

Those who treat people who attempt suicide tend to adapt immediate treatment to the person's individual needs. Those who have a responsive and intact family, good friendships, generally good social supports, and who are hopeful and have a desire to resolve conflicts may need only a brief crisis-oriented intervention. However, those who have made previous attempts, have shown a high degree of intent to kill themselves, seem to be suffering from either severe depression or other mental illness, are abusing alcohol or other drugs, have trouble controlling their impulses, or have families who are unwilling to commit to counseling are at higher risk and may need psychiatric hospitalization and long-term mental-health services.

Suicide prevention measures that are put in place following a psychiatric hospitalization usually involve mental-health professionals trying to implement a comprehensive outpatient treatment plan prior to the individual being discharged. This is all the more important since many

12 people fail to comply with outpatient therapy after leaving the hospital. It is often recommended that all firearms be removed from the home, because the individual may still find access to guns stored in their home, even if locked. It is further often recommended that potentially lethal medication be locked up as a result of the attempt.

Vigorous treatment of the underlying psychiatric disorder is important in decreasing short-term and long-term risk. Contracting with the person against suicide has not been shown to be especially effective in preventing suicidal behavior, but the technique may still be helpful in assessing risk since refusal to agree to refrain from harming oneself or to fail to agree to tell a specified person may indicate an intent to harm oneself.

Talk therapy that focuses on helping the person understand how their thoughts and behaviors affect each other (cognitive behavioral therapy) has been found to be an effective treatment for many people who struggle with thoughts of harming themselves. School intervention programs in which teens are given support and educated about the risk factors, symptoms, and ways to manage suicidal thoughts in themselves and how to engage adults when they or a peer expresses suicidal thinking have been found to decrease the number of times teens report attempting suicide.

Although concerns have been raised about the possibility that antidepressant medications increase the frequency of suicide attempts, mental-health professionals try to put those concerns in the context of the need to treat the severe emotional problems that are usually associated with attempting suicide and the fact that the number of suicides that are completed by mentally ill individuals seems to decrease with treatment.

13 The effectiveness of medication treatment for depression in teens is supported by the research, particularly when medication is combined with psychotherapy. In fact, concern has been expressed that the reduction of antidepressant prescribing since the Food and Drug Administration required warning labels be placed on these medications may be related to the 18.2% increase in U.S. youth suicides from 2003 to 2004 after a decade of steady decrease. Mood-stabilizing medications like lithium (Lithobid), as well as medications that address bizarre thinking and/or severe anxiety, like clozapine (Clozaril), have also been found to decrease the likelihood of individuals killing themselves.

How can people cope with the suicide of a loved one?

Grief that is associated with the suicide of a loved one presents intense and unique challenges. In addition to the already significant pain endured by anyone that loses a loved one, suicide survivors may feel guilty about having not been able to prevent their loved one from killing themselves and the myriad of conflicting emotions already discussed. Friends and family may be more likely to experience regret about whatever conflicts or other problems they had in their relationship with the deceased, and they may even feel guilty about living while their loved one is not. Therefore, individuals who lose a loved one from suicide are more at risk for becoming preoccupied with the reason for the suicide while wanting to deny or hide the cause of death, wondering if they could have prevented it, feeling blamed for the problems that preceded the suicide, feeling rejected by their loved one and stigmatized by others.

Some self-help techniques for coping with the suicide of a loved one include avoiding isolation by staying involved with others, sharing the experience by joining a support group or keeping a journal, thinking of

14 ways to handle it when other life experiences trigger painful memories about the loss, understanding that getting better involves feeling better some days and worse on other days, resisting pressure to get over the loss, and the suicide survivor's doing what is right for them in their efforts to recover. Generally, coping tips for grieving a death through suicide are nearly as different and numerous as there are bereaved individuals. The bereaved individual's caring for him- or herself through continuing nutritious and regular eating habits and getting extra rest can help strengthen their ability to endure this very difficult event.

Quite valuable tips for journaling as an effective way of managing bereavement rather than just stirring up painful feelings are provided by the Center for Journal Therapy. While encouraging those who choose to write a journal to apply no strict rules to the process, some of the ideas encouraged include limiting the time journaling to 15 minutes per day or less to decrease the likelihood of worsening grief, writing how one imagines his or her life will be a year from the date of the suicide, and clearly identifying feelings to allow for easier tracking of the individual's grief process.

To help children and adolescents cope emotionally with the suicide of a friend or family member, it is important to ensure they receive consistent caretaking and frequent interaction with supportive adults. All children and teens can benefit from being reassured they did not cause their loved one to kill themselves, going a long way toward lessening the developmentally appropriate tendency children and adolescents have for blaming themselves and any angry feelings they may have harbored against their lost loved one for the suicide. For school-aged and older children, appropriate participation in school, social, and extracurricular activities is necessary to a successful resolution of grief. For adolescents,

15 maintaining positive relationships with peers becomes important in helping teens figure out how to deal with a loved one's taking their own life. Depending on the adolescent, they even may find interactions with peers and family more helpful than formal sources of support like their school counselor.

: Helping a Person who may be Suicidal

Anyone - not only those in the helping professions - may come into contact with a person who is having suicidal thoughts. Many people who try to end their own lives give verbal or non-verbal clues about their intent. Any suggestion of suicidal thoughts should always be taken seriously - do not dismiss this behaviour as 'attention seeking' or assume that the person is not serious about their threat. Do not agree to keep their threat a secret - this is a situation where confidentiality must be broken if need be, in order to save a life.

People are often concerned about talking about the issue with someone who may be at risk, fearing that discussion may encourage a vulnerable person to act on thoughts of suicide. In fact, a troubled person may be relieved that somebody has finally recognised that life has become difficult for them. Ask directly but compassionately, by saying something like…Are things so bad for you that you've been thinking about hurting yourself?

If a person is having suicidal thoughts, encourage them to seek help from a health professional, such as their GP, a counsellor, a psychologist or psychiatrist. A person who is depressed may need some help to identify an appropriate service and make an appointment. People can also contact telephone counselling services such as Lifeline on 13 11 14 for advice.

16 It is generally agreed that people are most at risk if they have a specific plan, it involves a highly lethal method, and they have access to whatever they will need to carry it out. If the risk is high or immediate, consider making arrangements to ensure that someone stays with the person and contact a local mental health crisis team or hospital emergency department.

If you are waiting with someone until professional help is available, ensure that they do not have access to weapons, car keys or anything else they might use to hurt themselves. If they want to talk about their feelings while you're waiting, listen to them with compassion and empathy but try not to become too involved in their problems. Avoid any comments which might be considered judgemental or dismissive.

Self harm :

Cutting and Self-Injury :

The number of young people who participate in acts of self-mutilation is growing. Although self-harm is rarely a suicidal act, it must be taken seriously because accidental deaths do occur. It’s difficult to see the light at the end of the tunnel but breaking the cycle of self-abuse is possible if you reach out to someone you trust. Finding new ways of coping with your feelings can help to tone down the intense urges you feel which results in you hurting yourself. Recovery is a continuous process and learning how to stop this addictive behavior is within your reach if you work at it.

17 Who engages in self-injury?

The numbers are staggering…about two million people in the U.S. are self-injurers and approximately 1% of the population has inflicted physical injury upon themselves at some time in their life as a way to cope with an overwhelming situation or feeling. Those numbers are most likely an underestimation because the majority of acts of self-injury go unreported. In other parts of the world the numbers are considerably higher. Self-injury does not discriminate against race, culture, or socio- economic strata, but there is conflicting data regarding demographics. Some reference sites indicate that the majority of people who engage in this type of addictive behavior are predominately female teenagers and young adults, while other sites indicate that both genders, ranging in age from 14 to 60 self-injure. However, there is consistent agreement that self-harm has more to do with having poor coping mechanisms than anything else.

Types of self-injury

Definition of self-injury

Self-injury, self-inflicted violence, self-injurious behavior or self- mutilation is defined as a deliberate, intentional injury to one’s own body that causes tissue damage or leaves marks for more than a few minutes which is done to cope with an overwhelming or distressing situation.

The most common self-injurious behaviors are:

 Cutting - involves making cuts or scratches on your body with any sharp object, including knives, needles, razor blades or even fingernails. The arms, legs and front of the torso are most

18 commonly cut because they are easily reached and easily hidden under clothing

 Branding – burning self with a hot object, Friction burn – rubbing a pencil eraser on your skin

 Picking at skin or re-opening wounds (dermatillomania) - is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused which relieves stress or is gratifying

 Hair-pulling (trichotillomania) – is an impulse control disorder which at times seems to resemble a habit, an addiction, or an obsessive-compulsive disorder. The person has an irresistible urge to pull out hair from any part of their body. Hair pulling from the scalp often leaves patchy bald spots on their head which they hide by wearing hats, scarves and wigs. Abnormal levels of serotonin or dopamine may play a role in this disorder. The combined treatment of using an anti-depressant such as Anafranil and cognitive behavioral therapy (CBT) has been effective in treating this disorder. CBT teaches you to become more aware of when you’re pulling, helps you identify your pulling habits, and teaches you about what emotions and triggers are involved in hair pulling. When you gain awareness of pulling, you can learn to substitute healthier behaviors instead.

 Hitting (with hammer or other object), Bone breaking, Punching, Head-banging (more often seen with autism or severe mental retardation)

 Multiple piercing or tattooing - may also be a type of self-injury, especially if pain or stress relief is a factor

 Drinking harmful chemicals

19 Reasons for self-injury :

Why do they do it?

Even though it is possible that a self-inflicted injury may result in death, self-injury is usually not suicidal behavior. The person who self-injures may not recognize the connection, but this act usually occurs after an overwhelming or distressing experience and is a result of not having learned how to identify or express difficult feelings in a healthy way. Sometimes the person who deliberately harms themselves thinks that if they feel the pain on the outside instead of feeling it on the inside, the injuries will be seen, which then perhaps gives them a fighting chance to heal. They may also believe that the wounds, which are now physical evidence, proves their emotional pain is real. Although the physical pain they experience may be the catalyst that releases the emotional pain, the relief they feel is temporary. These coping mechanisms in essence are faulty because the pain eventually returns without any permanent healing taking place.

It is difficult to understand the motivations behind self-injurious behavior, but a clearer picture develops when you hear the common explanations self-injurers give for doing it:

 “It expresses emotional pain or feelings that I’m unable to put into words. It puts a punctuation mark on what I’m feeling on the inside!”

 “It’s a way to have control over my body because I can’t control anything else in my life”

 “I usually feel like I have a black hole in the pit of my stomach, at least if I feel pain it’s better than feeling nothing”

20  I feel relieved and less anxious after I cut. The emotional pain slowly slips away into the physical pain”

Self-injury can regulate strong emotions. It can put a person who is at a high level of physiological arousal back to a baseline state.

Deliberate self-harm can distract from emotional pain and stop feelings of numbness.

Self-inflicted violence is a way to express things that cannot be put into words such as displaying anger, shocking others or seeking support and help.

Self-injurious behavior can exert a sense of control over your body if you feel powerless in other areas of your life. Sometimes magical thinking is involved and you may imagine that hurting yourself will prevent something worse from happening. Also, when you hurt yourself it influences the behavior of others and can manipulate people into feeling guilty, make them care, or make them go away.

Self punishment or self-hate may be involved. Some people who self- injure have a childhood history of physical, sexual and emotional abuse. They may erroneously blame themselves for having been abused, they may feel that they deserved it and are now punishing themselves because of self-hatred and low self-esteem.

Self-abuse can also be a self-soothing behavior for someone who does not have other means to calm intense emotions. Self-injury followed by tending to one’s own wounds is a way to express self-care and be self- nurturing for someone who never learned how to do that in a more direct way.

21 People who self-injure have some common traits:

o Expressions of anger were discouraged while growing up

o They have co-existing problems with obsessive-compulsive disorder, substance abuse or eating disorders

o They lack the necessary skills to express strong emotions in a healthy way

o Often times there is a limited social support network

Self-injury as an addiction

BECOMING A HABITUAL SELF INJURER IS A PROGRESSIVE PROCESS The first incident of self-injury The next time a similar strong may occur by accident, or after feeling arises, the person has been finding out about others who “conditioned” to seek relief in the engage in this behavior same way  The person has strong feelings  The person feels compelled to such as anger, fear or anxiety repeat self-harm, which is before an injuring event likely to increase in frequency and degree  These feelings build, and the

person has no way to express  The person hides the tools or address them directly used to injure, and covers up the evidence, often by wearing long sleeves Cutting or other self-injury Endorphins, specifically provides a sense of relief; a release enkephalins, contribute to the of the mounting tension 'addictive’ nature of self-injury  A feeling of guilt and shame  When a person injures usually follows the event themselves endorphins are released in the body and

22 BECOMING A HABITUAL SELF INJURER IS A PROGRESSIVE PROCESS function as natural pain killers  The feelings of shame  The behavior may become paradoxically lead to addictive because the person continued self-injurious learns to associate the act of behavior self-injury with the positive feelings they get when endorphins are released in their system

 The use of SSRI medications (selective serotonin reuptake inhibitors) such as Prozac and Zoloft, may be helpful in increasing brain serotonin levels and reducing self-injury in cases of moderate to severe depression

Self-injury and suicide

Self-injury is usually not suicidal behavior but rather a way to reduce tensions. Inflicting physical harm on oneself is a poorly learned coping mechanism which is used to communicate feelings and self-soothe. Self- injury is strongly linked to a poor sense of self-worth, and over time, that depressed feeling can spiral into a suicidal attempt. Sometimes self-harm may accidentally go farther than intended, and a life-threatening injury

23 may result which is why intervention and profession help is required sooner rather than later.

Helping a friend or family member who is a self-injurer

No matter how you look at it, self-harm scares people. It is very hard coming to terms with the fact that someone you care about is physically harming themselves. From the depths of your own fear and helplessness you may feel frustrated if you are unable to get the person to stop hurting themselves which can further drive the person away.

Some helpful tips in dealing with someone who self-injures

 Understand that self-harming behavior is an attempt to maintain a certain amount of control which in and of itself is a way of self- soothing

 Let the person know that you care about them and are available to listen

 Encourage expressions of emotions including anger

 Spend time doing enjoyable activities together

 Offer to help them find a therapist or support group

 Don’t make judgmental comments or tell the person to stop the self-harming behavior – people who feel worthless and powerless are even more likely to self-injure

 If your child is self-injuring, prepare yourself to address the difficulties in your family. Start with expressing feelings which is a common factor in self-injury – this is not about blame, but rather about learning new ways of dealing with family interactions and communications which can help the entire family

24 How can a self-injuring person stop this behavior?

Self-injury is a behavior that over time becomes compulsive and addictive. Like any other addiction, even though other people think the person should stop, most addicts have a hard time just saying no to their behavior – even when they realize it is unhealthy.

What you can do to help yourself Acknowledge this is a You are probably hurting on the inside and need problem professional help to stop this addictive behavior Realize this is not This is about recognizing that a behavior that about being a bad helped you handle your feelings has become a big person problem Find one person you Maybe a friend, teacher, rabbi, minister, trust and get counselor, or relative. Tell them you need to talk professional help about something serious that is bothering you Get help in identifying Ask for help in developing ways to either avoid what “triggers” your or address those triggers self-harming behaviors Recognize that self- Learn how to develop better ways to calm and injury is an attempt to soothe yourself self-soothe Figure out what Replace the act of self-harm with learning how to function the self-injuryexpress anger, sadness, and fear in healthy ways is serving Treatments for self-injury

One danger connected with self-injury is that it tends to become an addictive behavior, a habit that is difficult to break even when the individual wants to stop. As with other addictions, qualified professional help is almost always necessary. It is important to find a therapist who

25 understands this behavior and is not upset or repulsed by it. Call your doctor or insurance company for a referral to a mental health professional who specializes in self-injury.

 Cognitive-behavioral therapy may be used to help the person learn to recognize and address triggering feelings in healthier ways

 Because a history of abuse or incest may be at the core of an individual’s self-injuring behavior, therapies that address post- traumatic stress disorder such as EMDR may be helpful (see Helpguide’s article on Eye Movement Desensitization and Reprocessing)

 Hypnosis or other self-relaxation techniques are helpful in reducing the stress and tension that often precede injuring incidents (see Helpguide’s article on Yoga, meditation and other relaxation techniques)

 Group therapy may be helpful in decreasing the shame associated with self-harm, and help to support healthy expressions of emotions

 Family therapy may be useful, both in addressing any history of family stress related to the behavior, and also in helping other family members learn how to communicate more directly and non- judgmentally with each other

 In cases of moderate to severe depression or anxiety an antidepressant or anti-anxiety medication may be used to reduce the impulsive urges to self-harm in response to stress, while other coping strategies are developed.

 In severe cases an in-patient hospitalization program with a multi- disciplinary team approach may be required

26 Alternatives to avoid self-harm :

If you self-injure to…Deal with anger that you cannot express openly, try working through those feelings by doing something different – running, dancing fast, screaming, punching a pillow, throwing something, ripping something apart

If you hurt yourself in order to…Feel something when you feel numb inside, hold ice cubes in one hand and try to crush them, hold a package of frozen food, take a very cold shower, chew something with a very strong taste (like chili peppers, raw ginger root, or a grapefruit peel), wear an elastic rubber band around your wrist and snap it (in moderation to avoid bruising) when you feel like hurting yourself

If you inflict physical pain to…Calm yourself, try taking a bubble bath, doing deep breathing, writing in a journal, drawing, or doing some yoga

If you self-mutilate to…See blood, try drawing a red ink line where you would usually cut yourself, in combination with the other suggestions above .

Thank you (2009-2010)