The UK has the highest self-harm rate of any country in Europe, according to the Mental Health Foundation. An estimated 400 in every 100,000 adults is said to be struggling with self-injury disorder or compulsion. The Mental Health Foundation estimates that a third of “self-harmers” have drug and alcohol issues.
One of our experts explains, “self harm and addiction is a dangerous combination. Many addicts and alcoholics struggle with depression and low self-esteem. Self-harming behaviours further reinforce feelings of shame and self-loathing. Many addicts who self-harm are at a loss to explain why they do it – causing them to fall into a deeper spiral of hopelessness.”
What is Self-Harm?
Self-harm is an intentionally injurious act with a vague feeling of “wanting to punish” oneself. Common behaviours include:
- Cutting or burning the skin – often with knives, razor blades and cigarettes or lighters
- Punching or hitting oneself, banging ones head against a wall
- Poisoning oneself with medications, toxic chemicals or household cleaning agents
- Misusing alcohol and drugs
- Starving and bingeing – whether episodically or as part of anorexia/bulimia
Most people struggling with self-harm will be secretive about their behaviour. The combination of shame and fear of being discovered means that many sufferers hide their injuries and are often reluctant to discuss their difficulties. Some might admit that they have self-harmed “once or twice” but, just as with conversations about drug or alcohol use, the sufferer will minimise the problem.
What Causes Self-Harm?
The reasons why someone self-harms are varied and complicated. It is generally thought that self-harm, like addiction, is a way of coping with overwhelming feelings. Sufferers typically come from families where feelings are not expressed or talked about. It is also thought that most self-harmers will have an underlying depression and occasionally, a personality disorder, such as borderline personality disorder.
External factors which are thought to contribute to self-harming, include:
- Problems at school or work, such as being bullied, or feeling overwhelmed with work or study.
- Difficult relationships with friends and family, or the break-up of an intimate relationship
- Trauma – especially physical or sexual abuse, being attacked or suffering a bereavement
- Struggling with sexual or gender identity or cultural expectations, such as an arranged marriage or conforming to a hetero-normalcy
There are many other factors but what we do know is that self-harm is extremely dangerous. If an individual is using drugs and alcohol, the risk of serious or lethal injury greatly increases and the condition develops into dual diagnosis.
What to do if a friend or family member struggles with self-harm and addiction?
It can be extremely difficult to talk to a loved one who is self-harming and using drugs and alcohol. It is important to approach the sufferer with gentleness and compassion, even if their behaviour makes us angry or afraid. Family members might want to talk to a GP or experienced mental health professional first.
Sometimes the best intervention is simply to express worry and offer support and help. Help might take the form of simply listening, but it could be the offer to help the sufferer find a form of treatment.
If there is a drug and alcohol problem or an eating disorder alongside self-harming, it is vital to seek specialist treatment. The sufferer may need inpatient treatment to withdraw from alcohol or drugs and stabilise any eating disorders. Often an experienced psychotherapist or counsellor can offer the right sort of support on an outpatient basis, to enable a physical recovery.
It might be necessary for a GP or psychiatrist to prescribe a course of antidepressants or mood-stabilising medication, if there is a history of depression or mood disorder.
Whatever the immediate treatment, it is important that sufferers address the underlying reasons for their behaviour(s). Support groups such as 12-step recovery groups can help anyone struggling to maintain sobriety or abstinence. There are a number of self-help groups specifically for people struggling with self-harming behaviours. GPs and mental health professionals should be able to signpost anyone to groups.
However, most people with a history of self harm and addiction need a more in-depth form of treatment such as psychotherapy and counselling. Psychotherapy helps sufferers look at the issues underlying the self-harming and addictive behaviours. An experienced addictions and self-harm expert will also support the sufferer with strategies to better manage difficult feelings and to avoid acting out.
Recovering from Addiction and Self-Harm
Recovering from self-harming behaviours, and recovery from addiction, can be a long process. Physical recovery must come first, with a sufferer maintaining his or her abstinence from alcohol and drugs, as well as being able to tolerate periods of stress and anxiety without resorting to self-harm.
Psychotherapy and counselling will help sufferers identify their “triggers” – situations or emotional states where someone would act out and harm themselves. This can be a complicated process, as there may be stressors in everyday life, but often there is a cluster of unresolved feelings and traumas from the past, which exacerbate the urge to self-harm. An experienced therapist will help identify and better understand feelings and situations which trigger the urge to self-harm.
Psychotherapy can help sufferers find better ways of managing strong and distressing feelings. Often the process of talking in the therapeutic environment helps process and contain difficult feeling states. Some therapist offer specialist techniques, such as “DBT” or Dialectic Behavioural Therapy. DBT was devised in the 1980s and is designed to help people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states. Sometimes, sufferers will be encouraged to practice a Mindfulness technique or Yoga – all of which have proven benefits for emotional regulation.
There is no one cure or simple pathway to recovery for these complicated conditions. However, it is important to find specialist help and Help 4 Addiction has a wealth of resources to guide you in the right direction.