originally posted on 24-09-2015 10:40 PM

Here's the full list of Infobus Questions that @SarahS was able to answer!

Gee that's a lot!

If your question wasn't answered or you want to talk more, head to this thread and get the conversation going!

1.       Does self harm always have to be physical? When people talk about it, they always refer to physical injury. But I know in the past I've tried to 'hurt' myself emotionally before, or I've purposely exposed myself to triggering material to feel bad.

Firstly, to clarify, self-harm is an umbrella term that includes all behaviours done by a person, directly or indirectly, with and without suicidal intent, to hurt oneself (this includes ‘self-injury’, which refers to nonsuicidal and direct harm to the body. ‘Self-harm’ that is not physical (such as verbal put-downs or sabotaging relationships) is not generally included in the definition of self-harm, but can still be a significant problem and can respond well to treatment. In fact, most people who hurt themselves physically also hurt themselves verbally and emotionally. It is often associated with low self-esteem and self-loathing, which can be a consequence of bullying or high levels of criticism (both in the family and at school), abuse or other trauma.

2.       Sometimes I play my clarinet until my arm hurts (I have RSI) on purpose, but I don't do 'typical' types of self injury anymore. Is what I do actually self injury? How do I explain it to my psychologist?

It is important to clarify why you do this. If your aim is to feel physical pain for its own sake, it definitely fits the bill of self-injury. If you play until your arm hurts because you are using that pain like a yardstick to measure an ‘adequate’ practice session length, then it might be more related to perfectionism. I would suggest that you monitor your thoughts and feelings before, during and after doing it, to get a clear understanding of why you do it.

In terms of your psychologist, I think saying exactly what you’ve said here would be fine: “I purposefully play my clarinet until my arm hurts”. Also, if you can track your thoughts and feelings before you talk to your psychologist, you will be able to help her to understand even better about what is going on. It might help to remember that these kinds of behaviours are not uncommon, so don’t feel embarrassed about talking about it.

3.       How deep does it have to be to require medical attention?

If your injury is more than half a centimetre deep you should seek medical attention.

4.       I self-injure to punish myself rather than to seek control. Is this normal, or am I just crazy?

This is a very common reason to self-injure. In our national study it was the second most common reason.

5.       I have memories of hitting myself in the head as hard as I could from when I was as young as 3-4 years of age. This would mostly happen when I was particularly upset or for example when I was fighting with or being pestered by my older sibling.  Is it unusual for these behaviours to be exhibited by someone so young, and what are/does this have any significant implications for a person's mental well-being down the track?  I have been diagnosed with clinical depression and generalised anxiety disorder and when I was in late high school often injur myself to control my moods and episodes of heightened stress or anxiety.  Additionally, I have been taking antidepressants for about a year and a half but am in the process of tapering off a medication(edited to meet guidelines) as I am not fond of my dependency on it and the side effects I experience if I forget to take a dose one day.  I apologise for such a long-winded post!  Thank you for the opportunity to send a question in.

It is very rare for a person to deliberately self-injure below the age of about 8 years old and there is very little research about this, including whether it is related to mental health problems later on. The exception to this is in Autism Spectrum Disorder where self-injury at young ages is common (this does not mean that you have Autism Spectrum Disorder). Is it possible that you were mimicking the behaviours of older children? Either way, it sounds like as a young child you had a lot of difficulty regulating your emotions and it continued into your teenage years. My suggestion is to try to take the focus away you’re your past and focus on what you can do now to help build emotion regulation skills.

6.       Why is it so hard to stop it? And why do relapses happen so often?

The reason it is so hard to stop is because self-injury is effective. It actually works to regulate emotions. The problem with it is that the consequences are not so great and sometimes devastating. Relapses are common because your brain has developed a specific pathway between difficult emotions and self-injury, so it becomes an almost automatic response. The longer you are able to abstain from self-injury and deliberately use other methods to regulate your emotions, the easier it will be to not fall back into the habit.

7.       Do you think some of the extreme material on tumblr may contribute to young people beginning to self harm. I only ask because as a young teen I had a tumblr account which was once very innocent however with the wrong mindset I found my self pressured to self harm in tough times because of the extreme material coming through my tumblr feed making me feel more depressed.

Absolutely! There is lots of research to show that social media has a huge influence on behaviour, especially among teens. One of the first things I suggest to self-injuring clients is to get off social media (or at least have a break).

8.       I am terrible at showing or speaking about my emotions. I want to speak to people and tell them I need help, but I can't put that into words. Is there any easy way to ask friends for help other than just secretly hoping they catch a glimpse of my injuries, while I'm trying to hide them?

Your experience is not uncommon, but it is possible to learn how to express your emotions in words. I encourage you to seek counselling to help you learn how to do it, because it is a skill you will need for the rest of your life. Check out this website: http://www.dbtselfhelp.com/html/emotion_regulation1.html
Also, I would encourage you to talk to two or three people in your life that you feel safe with and trust, and let them know that you are planning to start talking about your feelings and asking for help. This way, when you approach them to talk, they will be more receptive and sensitive and might be able to help you to open up when they can see you are having trouble.

9.       How do u talk to new intimate partners about your scars

Firstly, it is totally up to you as to whether or not you talk about your scars. If people ask, you are completely entitled to say “I prefer not to talk about it” and then change the subject. I would hope that if you are being intimate with another person, there would be enough trust in the relationship to be able to say this, or to be able to talk about the scars without feeling embarrassed or ashamed. I have a number of patients who like to call their scars “battle scars”. The scars represent times in life that were really tough but that were survived. While self-injury definitely has negative consequences and is not the preferred option of coping with life, it is still a coping mechanism and this is positive!

10.   Is it unusual for someone to self harm to 'prove to themselves' that they have a legitimate reason to feel bad, or 'give themselves permission' to feel bad?

No, this is very common. When we have a physical sign of pain, it somehow makes it seem so much more real and valid. It sounds like you have learned throughout your life to invalidate your own pain. My suggestion is that if you ever feel the urge to self-harm, try to validate your pain then and there, before actually hurting yourself. You may need some professional help with this, because self-invalidation can be difficult to change.

11.   When I see my daughter’s new scars...what should my words be? So I don't come across judging

Firstly, have you discussed with your daughter whether she wants to talk about her scars with you? If she is getting professional help she may not need to discuss them with you and may have enough external support. If this is the case, you don’t have to say anything, but reassure her from time to time that you are available to talk if she would like to. If your daughter is open to discussing them (or she is not receiving any other help and therefore your support is important), you can say something like “Sweetie/love (etc), I can see another injury/scar on your arm/leg (etc). Are you stressed/worried about something? Would you like to talk about it?” Or if you have an idea about what might be upsetting her (like exams, friendships, a relationship), you could just directly validate her struggle (e.g. it looks like you’re struggling with xyz). There is no need to focus on the injury unless it requires medical attention.

13.   What can you do when normal methods of delaying self harm don't work like drawing on your skin or using rubber bands? Cause in the moment I'm not really thinking about what else I can do... My head is a mess and I get all flustered so alternative methods aren't really on my mind

It sounds like you need a pre-written safety plan that is available to read when you are feeling flustered. It is very common to not be able to think of other coping methods when you feel flustered. There are many, many distress tolerance skills you can use instead of self-harming: see this website http://www.dbtselfhelp.com/html/distress_tolerance1.html

I always ask my patients to give copies of their safety plans to friends, partners and family members as well, so that when you are feeling flustered and can’t find your plan or feel unable to follow it, you can call somebody else to help you through it.

14.   I work in trade and there's the whole blokey culture, what am I supposed to say when someone asks me about the scars? It's clearly self harm scars but if I'm honest about them I'll be disowned and friendless...

That is a tough situation. It is completely up to you as to whether or not you disclose that your scars are from self-harm. You could say “I prefer not to talk about it” or “none of your business” and change the subject. You could also just ignore the question and immediately ask a question in response (e.g. colleague says “where did you get that scar from?” and you say “what time is the xyz job” or “how is your wife”). Your colleague will get the picture that you don’t wish to talk about it, and if they are a respectful person they will not push. If you come across a person who might badger you about it, there is nothing wrong with making up a story: “when I was ten I fell through a window” (or something similar depending on the location of the scars).

15.   Is hair pulling worse than other methods?

What do you mean by “worse”? I suggest we avoid using that word as it can be stigmatising and pejorative and may lead to a less sensitive responsive to the method deemed as “less worse”. Probably a better way to phrase it would be to ask whether one method is more or less “severe”. To determine severity, one needs to take into consideration the extent of physical damage, lethality, frequency, and level of distress it is causing. For example, a person who pulls hundreds of hairs out daily will end up with bald patches, which is likely to cause immense distress. In comparison, a person who makes superficial injuries every three months may be less distressed.

16.   I sometimes day dream about self harm but have no intention of actually doing it, is this serious?

Not necessarily, but it does increase the risk of actually self-harming. Sometimes the thought of self-harm gives thesame relief as actually doing it and after a while the person needs to actually do it to get the same relief. BUT, it could also mean nothing, and you think about it because you see it among friends or in the media etc. Can I suggest you 1) try to identify how you feel before and after thinking about it and 2) write down when you have the thoughts and see if they are in any way related to life events (for example you might find that you have those thoughts after a fight or a disappointment). If you can see that the thoughts are actually helping you feel better or if there is a pattern between life events and the thoughts, it might be a good idea to talk to a psychologist or counsellor.

16.   How does self harming help people cope? I am someone who has suffered a multitude of mental health problems and I still don't understand.

Self-harming triggers our natural endorphins which are the feel-good chemicals in our brain, so it can help to make us feel better. However, research shows that the release of endorphins is much stronger for some people than others, which is why self-harm doesn’t work for everyone (just like eating chocolate helps some people cope and not others). Physical injury can also help some people to self-validate their distress, because they can SEE their physical injury but they can’t SEE their painful feelings. Self-injury is like confirming to themselves “I really am in pain, I’m not imagining it”.

18.   I've tried nearly everything to stop injuring myself but nothing seems to work. Do yous have any suggestions?

It is very difficult to stop! Have you sought professional help? Perhaps there are issues in your life that you need to address before you are ready to stop for good. Have a look at distress tolerance techniques and give them a go: http://www.dbtselfhelp.com/html/distress_tolerance1.html

If these don’t help, it is probably time to see a psychologist or counsellor.

19.   Do most people who significantly and repeatedly self-harm have a background of some variety of trauma or emotional dysregulation? What other causes are there?

Yes, many people who significantly and repeatedly self-harm have a background of trauma, and almost all people who self-harm have emotional dysregulation. Another big factor in self-harm is alexithymia, which means difficulty identifying and putting words on emotions (which is actually a variant of emotional dysregulation). Self-harm is often a way to express emotions when a person can’t identify how they feel or express it properly. Another aspect contributing to self-harm is growing up in a home where your emotions are invalidated (the “invalidating environment”). This means that parents either ignore your expression of negative emotions or they tell you that you don’t actually feel the way you act or say you do. This situation can be very subtle and many people do not realise they actually grew up in an invaliding environment (and it is important not to blame parents for this either, as most parents did the very best they could). A very simple example of an interaction that is invalidating is when a child has had a fight with a friend and comes to the parent crying, and the parent says “don’t be silly, its just a childish fight, you’ll be right”. If this happens once, it won’t have much of an impact, but if this is the way the parents always reacts, it can teach the child that his or her emotions are not valid. Rather than learning to accept,  tolerate, and manage emotions, the child learns to ignore them. Self-harm can become a way to cope with emotions when the person has not learned more healthy ways to do so.

20.   How do you approach someone (sibling/friend/relative) you know is self-harming or hurting themselves? To offer your help and support, especially if they are someone you are close to.

This can be very difficult and a sensitive topic. Remember that you can never force a person to reach out for help or to talk to you about their difficulties, and as difficult as this can be, you will need to respect that. However, I would definitely support the idea of letting your loved one know that you are there for them if they need you. This is pretty simple to do, although it can be scary not knowing how they will respond! My suggestion is to find a time when you can be alone with the person and there is nothing to distract either of you. Start by saying that you really care about the person. Then say that you have noticed scars and that you have a read a bit about self-harm (or you have a personal history of it) and you understand that it means things are not great, and that you want your loved one to know that you are there to talk to if they ever need you. This is all you need to say! You might want to repeat this message every so often, but be careful not to pressure your loved one to open up. Be prepared for an angry or defensive response, which can often happen. Try not to be offended by this and remember that many people who self-harm feel embarrassed and exposed when others bring the topic up. Simply repeat your message, that you are there for them if they need you to be. Even though their response in that moment may make you feel that the conversation did not go well, underneath the anger and defensiveness they will probably feel grateful and a little bit more supported. Its fine to then change the topic.

21.   Can self-harming be attention seeking in that attention seeking is a way of coping for some people?

The majority of people who self-harm do not want attention, they just want to feel better. However, some people self-harm because they want to communicate to others that they’re not ok, but they are unable to verbalise their feelings. Its not that they necessarily want attention, but that they want support.

22.   Is it common for self inflicted injuries to become infected? How do people avoid this?

If your injury is deep and on a part of your body that is in contact with bacteria (i.e. your hand) it is more likely to become infected. If your injuries is more than half a centimetre deep or is gaping, you should seek medical attention. All injuries should be cleaned with antibacterial and if they are likely to come in contact with bacteria you should cover them.

23.   How is the best way to reach out and talk to a friend about your self harm?

Well done for getting the courage to talk about a difficult topic!

Before the conversation, think about what you want from your friend. Do you want him/her to just listen? Or do you think that your friend could offer you some good advice? Also, think about how much information you want to share. When you have worked these things out, you will be more prepared for the conversation.

My suggestion is to find a time when you can be alone with your friend and there is nothing to distract either of you. After a bit of time, there will be a natural pause in the conversation and this is the time to raise the topic. You can say that you have been struggling recently with depression/anxiety/post-traumatic stress (or whatever emotion triggers your self-harm). Then say that you have been self-harming to try to cope with it. Then you can say that you just want to chat OR you can ask for help and advice (whatever you previously decided you wanted from your friend). At this point, you should ask your friend if he/she is comfortable talking about this topic, and if not, you will need to respect that. My sense is that if this person is a good friend, he/she will be fine with it. You might find that your friend has been wanting to talk to you about it but didn’t know how to bring it up.

I would also suggest that you plan a pleasant activity in advance for after the conversation, just in case it doesn’t go as planned. For example, you might schedule the conversation for just before a therapy session, or before an outing to the movies or shopping.

24.   What are some alternatives to self-injury?

Check out this website http://www.dbtselfhelp.com/html/distress_tolerance1.html