Dismantling the Self Harm Stereotype

For many of us, the topic of self harm can bring up images of rich white girls cutting themselves for attention. This perception comes from popular culture, and while it speaks to one version of self harm, it doesn’t come close to expressing the difficulty and complexity of the issue. Self harm can manifest in a huge variety of behaviors and can stem from an array of psychological and environmental factors. Understanding how and why someone might self harm isn’t a simple proposition - often those who do it don’t have a clear explanation themselves. By dismantling the stereotype above, we can gain a deeper understanding of this issue and create a more compassionate environment where sufferers may be more likely to seek and gain help.

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“Rich White Girls”

The typical portrait of someone who engages in self harm is a teenage girl with “no real problems,” typically white, and typically from a background of some privilege. The stigma against self-harm is closely related to this portrait, as there’s a perception that someone who doesn’t have to worry about status or money might create their own problems out of boredom. Additionally, characterizing self harm as a female problem belittles it, and associates it with gender bias that women are more fragile and unstable than men. 

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While studies indicate that 9th grade girls are the most common sufferers in the U.S., it’s likely that their male counterparts participate at comparable levels but are underreported. Self harm also occurs regardless of race or socioeconomic status. However, the same can’t be said of sexual or gender identity - LGBTQ+ youth are at higher risk for self-harming behaviors than their straight cis-gendered counterparts. Researchers point to a higher incidence of bullying, rejection, and resulting depression and anxiety experienced by this group.

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In short, demographics contribute far less to self harm than emotional or social dysregulation and distress. Underlying mental health conditions and the relative strength of a person’s community are a far stronger indicator. A number of life experiences can also contribute to self harm:

• Bullying and social rejection, feeling out of place, lonely, or persecuted
• Stress related to money, substance abuse, school, or work
• Experiencing sexual, physical, and/or emotional abuse
• Bereavement or the ending of a relationship

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“Cutting Themselves”

This form of self harm is common enough to be memorialized in pop culture, but ignoring other methods restricts diagnosis and treatment. Self harm is clinically referred to as “non-suicidal self injury” (NSSI). While suicidal thoughts or feelings may be underlying causes, sufferers don’t take part in these behaviors with the explicit intention of ending their lives. Injury most often takes forms that are more difficult to notice.

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In addition to cutting, those who self harm may:

• Hit themselves, or strike parts of their body against hard surfaces
• Bite, scratch, or burn their skin either with heat or friction
• Pull out hair, or pick at skin to the point of drawing blood
• Purposefully under-eat, over-eat, or exercise excessively
• Abuse drugs and alcohol
• Purposefully engage in risky behaviors like unsafe sex, or getting into mismatched  fights where injury is inevitable

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This suite of behaviors can be linked to underlying mental health conditions like depression, anxiety, and body dysmorphia. They can also be gender coded to the point that they’re not considered unusual based on the gender of the person performing them - getting into destructive fights may be seen as “brave” if the person is male, and “crazy” if the person is female. 

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“For Attention”

This is the most damaging and stigmatizing aspect of the self harm stereotype. Since behaviors don’t tend to result in actual suicide (at least not from the onset of symptoms, although NSSI is a strong indicator of a future suicide attempt), friends and family may characterize self-harm as a “cry for help,” not to be taken seriously. Sufferers may be confronted with demands that they “get over themselves,” remember that “some people have real problems,”  and to “stop being so selfish.” 

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It’s understandable that loved ones are taken aback and even hurt by the behavior of someone who self harms. If you yourself don’t suffer from the mental health conditions that often presage a self harm incident, it can seem like the other person is trying to bully you into paying attention to them by holding themselves hostage, and literally hurting someone you love. However, many people who self harm do so in secret and take great pains to hide what they’re doing from people who love them. It can be incredibly painful and harmful to have their behavior misunderstood in this way, which can lead to more determined concealment of what they’re feeling and doing. 

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The complex emotions and motivations behind a self harm incident can include any of the following:

• Directing anger or aggression that can’t be expressed towards others towards the self, finding an outlet for frustrated powerlessness in attacking the one thing you can control
• Turning thoughts and feelings that are hard to express in words into tangible, visible signs, or actions, providing a reliable outlet for these feelings when you feel like you can’t take the time to deal with them
• Needing a reset when overwhelmed by difficult or traumatic feelings, thoughts, and memories, feeling a need to “wake up” or “snap out of it”
• Punishing yourself for your feelings, experiences, and identity
• Disrupting feelings of numbness and dissociation, addressing a need to feel “real”
• Creating a reason to care for yourself physically when you don’t feel you can access, or deserve, mental and emotional care
• Expressing suicidal feelings and thoughts you don’t intend to act on 

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The rush of adrenaline or endorphins that accompany an injury, and the grounding experience of an intense physical sensation mean that NSSI can provide temporary relief for the situations above. However, the longer term consequences of self harm overrule whatever benefit is gained in the moment.

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Even the common refrain that self harm is a cry for help has some truth to it - the difficulty with this perception is the assumption that the cry for help is unwarranted. If someone doesn’t have the language, support, or confidence to seek help, self harm may feel like the only way to break through the silence. People who self harm deserve, and are most helped by, a sympathetic response.

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How to Tell if a Loved One Self Harms, and What to Do

In addition to physical signs like cuts, bruises, and dramatic changes in weight, those who self harm typically demonstrate social and psychological symptoms:

• Frequent statements of hopelessness, futility, and worthlessness
• Difficulty getting along with others, or avoidance of social interactions even with close friends and family
• Not dressing for the weather, aka long sleeves when it’s hot out
• Poor impulse control and unpredictability

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If you think that someone you care about is self harming, try to talk to them about it, but don’t be surprised if they get defensive - harmful stereotypes can lead people to be protective of themselves and their problem. Be prepared to listen without judgment if you can, and don’t pressure the person to promise you they’ll stop. Try instead to encourage them to talk to someone, remind them that self harm is a common problem, and that there are many avenues of treatment and healing available. Therapy and psychiatry are both powerful tools to address self harming behavior. Art therapy has been shown to have an especially positive impact, as it combines reflection with action in a way that can redirect the impulse to self harm, and lead to greater understanding and disruption of the underlying motivations.

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If you think your own behavior may qualify as self harm, try to have compassion for yourself. This can be tough, as self harming behaviors are often related to self hatred and a lack of self esteem. It’s important to tell someone what you’re experiencing and to speak with a mental health professional as soon as you can - self harm tends to escalate over time and lead to more dangerous behavior with more severe consequences. 

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Even if you don’t feel you need or deserve help, it’s worthwhile to make someone else aware of what you’re going through in the same way it’s worthwhile to tell someone where you’ll be when you go on a hike by yourself. You never know when you could get lost in your own wilderness, and it’s nice to know someone out there will come looking for you if you go missing. Try to think of what you would do if you could intervene on behalf of a friend or loved one who’s self harming, and give yourself permission to provide yourself with that same support. Don’t let negative stereotypes discourage you from sharing your struggle with someone, and remember that self harm is not selfish, and neither are you.