There are many struggles that are related to self-harm or that happen alongside it. Self-harm may also be a symptom of another disorder that should be treated in a different way.
This page aims to give you a little bit of understanding of the different issues self-harmers might also face, but it’s important not to diagnose yourself or anyone else without the input of a professional. If you recognise any of the following symptoms, it’s important to see a doctor to discuss them, whether that’s a GP or psychiatrist.
Major depressive disorder…
For people with clinical depression, the normal everyday sadness that we all feel some of the time is constant and severe enough to interfere with all aspects of daily life. They may feel low for weeks, months, or even years at a time. It can affect decision making, relating to others, appetite and sleep. Chemical imbalance plays a significant part, and many sufferers find that medication makes a huge difference to their ability to function on a daily basis. CBT is also offered as part of NHS guidelines, although availability and waiting times are still a huge issue. Unless it is very severe, it will usually be treated by a GP.
Bipolar disorder used to be called Manic Depression, which some people prefer. Everybody experiences mood shifts, but with bipolar disorder these changes are more extreme, featuring periods of overactive, excited behaviour, known as mania, and periods of deep depression. Between these severe highs and lows there can be periods of stability. Bipolar is categorised into Bipolar I (more mania than depression), Bipolar 2 (more depression and less severe mania, called hypomania), and Cyclothymia (highs and lows less extreme). People who struggle with depression – especially treatment resistant depression – should be screened for bipolar disorder – speak to your doctor if you are concerned. Those most likely to self-harm are those with Bipolar II.
Post Traumatic Stress Disorder (PTSD)…
Psychological trauma, particularly where there is a loss of control, may result in an acute stress reaction. For some people this leads to PTSD, characterised by four primary symptoms: intrusion (recurrent recollections of an event); numbing (emotional distancing from surrounding people and events); avoidance (avoiding triggering situations due to fear); and arousal (an agitated state of constant alertness). PTSD often occurs because the brain has not been able to ‘time-stamp’ memories of an event, leading the sufferer to feel as if past trauma is still as traumatic in the present as it has ever been. Therapy – including EMDR (Eye Movement Desensitisation and Reprocessing) – helps to put past memories into the past in order to stop them being as traumatic in the present.
There are ten different personality disorders, but the most common one associated with self-harm is Borderline Personality Disorder.
BPD describes a pattern of instability that pervades all areas of the sufferer’s life, particularly relationships and self-image. It tends to start with impulsive actions in early adulthood. A diagnosis would be made with the presence of five of the following:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships (characterised by alternating between extremes of idealisation and devaluation)
- Identity disturbance: markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
- Affective instability due to a marked reactivity of mood (e.g. intense moods changes, irritability, or anxiety usually lasting a few hours)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms
It can often take a while and a specialist to diagnose BPD. Psychotherapy is the treatment of choice in helping people overcome this problem, although support groups with others can also be valuable. While medications can usually help some symptoms of the disorder, they can’t help people to learn new coping skills, emotion regulation, or any of the other important changes they may need to make.
Eating disorders are very similar to self-harm in that they use physical sensation and symptoms to deal with emotional pain. Most people with eating disorders develop it in adolescence, but it can happen to anyone at any point in life, and can often go untreated for years because it is something that sufferers keep hidden.
Anorexics severely restrict food intake, bulimics binge and purge, and compulsive eaters overeat, either by bingeing or grazing. Eventually, half of those struggling with anorexia will go on to develop bulimia. Quite often, the symptoms of these eating disorders will cross over, and therefore not fit a specific diagnosis; doctors may call this an eating disorder ‘not otherwise specified’ (NOS).
The important thing to remember is that an eating disorder is a way to deal with emotions using food, and anyone with an eating disorder will require help to find new coping mechanisms. Counselling for an eating disorder should focus on improving self-esteem, but may also involve nutritional advice, discussions of eating habits, looking at the role that food and eating play in one’s life, and exploration of underlying family and interpersonal dynamics.
Dissociation is a mental process where a person disconnects from their thoughts, feelings, memories or sense of identity. We all do this when we daydream, but some people do it as a coping mechanism to block out pain. Actual dissociative disorders occur when episodes of dissociation are persistent and repeated. There are a number of dissociative disorders, all of which can lead to self-harm. The best known of these disorders is probably Dissociative Identity Disorder (previously called Multiple Personality Disorder) in which only one or some of the personalities (or alters, meaning alternative identities) self-harm.
Body Dysmorphic Disorder…
Body Dysmorphic Disorder (BDD) tends to occur in young adults equally in either gender. The sufferer becomes pre-occupied with one of many non-existent or minimal cosmetic defects (nose, cleft chin, blemish, breast size) and may seek medical attention to fix it surgically. They may also engage in acts similar to self-harm, such as face-picking, but the emphasis of the behaviour will be on changing appearance rather than relief of stress.
Some clinicians feel it is a variant of obsessive-compulsive disorder, and symptoms may be better described by another diagnosis (e.g. anorexia).
Cases of BDD can range from relatively mild to very severe. Milder cases may disappear after surgery on the particular body part, but people who have it more seriously may transfer their dislike to other body parts, which perpetuates the condition.