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Self-harm: attitudes and approaches to treatment

Janet Webb
BSc(Hons) RGN DiPN(Lond)
Practice Nurse
Lindum Medical Practice
Lincoln

Emma is 19, blonde, petite and well-dressed with expertly applied makeup and a polite manner. She had asked for an appointment in the minor illness clinic for dressings to injuries on both legs. It was something of a shock when she immediately revealed long, sloughy and oozing lacerations running the length of both shins. When I asked what had happened, she calmly replied, "It was self-harm." I found it hard to understand and asked her why. Politely, but avoiding eye contact, Emma simply said, "It's a long story. I'm getting help, I just need the dressings, please." Her business-like approach disturbed me. I explained the need to take culture swabs, the application of dressings to de-slough and absorb exudate, and the need to return for further reassessments and dressing changes.
At a later study session I discussed self-harm with some colleagues and was surprised by the strength of feeling generated. The consensus seemed to be that self-harmers were wasting resources that should be spared for those who were really ill, not "just attention-seekers". I wondered how much of this came from the same feelings of frustration and inadequacy I had felt when confronted with the incomprehension of another person's destructive action. I considered how Emma's behaviour compared with that of a lifelong smoker who went on to develop COPD, or a persistent overeater who became obese and diabetic, since surely self-harm could equally be described as a chronic disease.
Deliberate self-harm describes a wide range of destructive behaviour, such as overdose, cutting, burning and substance misuse. It is increasingly common among young people, particularly girls, and more specifically attractive and intelligent young girls. ChildLine alone counselled more than 4,000 young people during 2003-2004, 91% of whom were girls who were self-­harming.(1) It is seldom an isolated incident and reflects an abnormal coping mechanism, a desperate attempt at release from overwhelming distress.(2,3)
The local hospital's psychotherapist explained this to me as the build-up of emotional arousal, which for many of us is diffused by just talking to another person. For some, though, increasing emotional distress reaches such a level that destruction is the only way it can be released and damage of self can seem the only available option.
Some estimates suggest that between 40 and 50% of successful suicides have a history of self-harm.(4) Causes and contributing factors include having a history of sexual abuse, depression, rejection, distress, frustration or anger about their situation and low self-esteem.(2,3) Like many other long-term health conditions, people may feel unable to change their destructive behaviour, and may indeed hide it and deny it to other people. Surveyed nationally, young people who self-harm indicated that they benefited from feeling people cared about them and accepted them. They also found information helpful; to some, simply being aware that other people behave similarly helped build confidence. Websites and telephone helplines can help, as well as access to confidential discussion for people who self-harm, and access to people who want to understand and help them. Simply recognising a problem exists and asking for help can assist with more "normal" coping strategies.
Similar to chronic disease, this is likely to be a long-term problem. Recurrence is very likely, since few lives are free from trauma, particularly adolescent lives. Like any other chronic disease, it is life-threatening, and its sufferers are likely to be frequent users of primary care settings.(3) Patients will benefit from information, support and ongoing care based upon individual need and in conjunction with secondary care.

References

  1. Self Harm UK. Available at URL: http://www.selfharmuk.org
  2. Camelot Foundation. Young people and self-harm: a national inquiry. First interim inquiry report. London: Self Harm UK; 2004.
  3. Poustie A, Neville R. Deliberate self-harm cases: a primary care perspective. Nurs Standard 2004;18(48):33-6.
  4. Bird L, Faulkner A. Suicide and self-harm. London: Mental Health Foundation; 2000.

Resources
National Self-Harm Network
W:www.nshn.co.uk
42nd Street -Suicide/Self-Harm Worker
Mental health service for young people in Manchester
T:0161 8320169
ChildLine
T:0800 1111
W:www.childline.org.uk
YoungMinds
T:0207 336 8445
W:www.youngminds.org.uk/selfharm