Mental Health and Self Harm: Is There a Connection?

Paper by Elaina Johnson, Friends University 2024

Abstract

Self-harm is becoming a growing and common behavior of people of all ages. This research will aim to provide information on the prevalence of self-harm, why self-harm is chosen among teens and young adults, types of self-harm, and reasons and effects of self-harming. The focus area of this research surrounds the question, is there a correlation between self-harming behaviors and mental disorders, and if so, which mental disorders have a higher frequency of this behavior? Once this research is conducted, then treatment on how to help self-harming individuals can be explored in a more in-depth and an individual-specific way. Overall, the goal is to gain understanding on a possible correlation between self-harm and mental illnesses to provide society with healthier outlets and treatments for this type of behavior.

Keywords: Self-harm, Self-Harming, Behaviors, Suicide, Mental Disorders, Research

Mental Health and Self-Harm: Is There a Connection?

“How will you know I am hurting if you cannot see my pain? To wear it on my body tells what words cannot explain” (Blount, 2017, p.6). In our world today, self-harm is a growing outlet for teens, young adults, and even some older adults. Psychology Today (2023) gives a detailed and accurate definition of self-harm:

Self-harm, or self-mutilation, is the act of deliberately inflicting pain and damage to one’s own body. Self-harm most often refers to cutting, burning, scratching, and other forms of external injury; it can, however, also include internal or emotional harm, such as consuming toxic amounts of alcohol or drugs or deliberately participating in unsafe sex (p. 1).

This research seeks to better understand self-harm by exploring different aspects around this behavior.

Objective

To unwrap why self-harm is a common behavior among individuals, it is important to look at the prevalence of self-harm, why self-harm is chosen among teens and young adults, types of self-harm, and reasons and effects of self-harming. When society looks at these aspects surrounding self-harm, there will be better avenues for treatment and reduction for this type of behavior. Therefore, it is important to ask, is there a correlation, or relationship, between self-harm and certain mental disorders or illnesses, and if so, which disorders or illnesses are more likely to have individuals who show behaviors of self-harm? As these questions are researched, I believe that we will find that depression is one of the leading mental disorders where individuals choose to engage in the behavior of self-harming.

Literature Review

As the definition from Psychology Today (2023) states above, “self-harm, or self-mutilation, is the act of deliberately inflicting pain and damage to one’s own body…” (p.1). There are several ways that one can inflict pain or harm themselves. One type of self-harming behavior is for someone to harm themselves physically. According to Nixon et. al. (2008), the most common forms of physical, non-suicidal self-harm in teens and young adults are cutting, scratching, and self-hitting.  All these types of physical self-harming behavior leave a visible mark on one’s body. Most of the time, this visible mark of cutting or scratching is done on the wrists, arms, and upper thighs. These are areas for the self-harmer to have easy access to wounding themselves, and these are areas that can be easily seen by others around them.

Another form of self-harm that is common for teens, young adults, and especially older adults is the abuse of drugs and/or alcohol. The type of self-harm when an individual seeks and is compulsive in using drugs or alcohol despite the harmful consequences, is known as an alcohol or drug addiction (U.S. Department of Health and Human Services, 2023). Though it can be hard to physically see the effects of self-harm with most addictions, it is nonetheless, deliberately inflicting harm to one’s own body causing internal damage and could even result in death. Many individuals who participate in the abuse of drugs and/or alcohol develop illnesses, such as cancer or poor liver function. This type of destruction of the body can also be deadly over time, or even cause a potential overdose that leads to immediate death. Because drugs and alcohol are easily accessible, self-harming through theses avenues are often common in most suicides across the United States.

There is an additional form of self-harming behavior that is often overlooked by society. This type of self-harm has to do with the consumption of food. Some individuals cause harm by overly and excessively eating, and some individuals cause harm by either starving themselves or purging the food that they take in during the day. When a person has a binge eating disorder, they “may continue eating long after feeling full, and they often feel distressed about their eating and about body shape and weight” (Ranzenhofer, 2024). This can cause poor functioning of organs in the body, especially from the heart, as well as excessive weight gain leading to limited mobility and stagnancy of the body. On the flip side of binge eating, there are also individuals who starve themselves or purge food from their bodies causing short and long-term problems on their bodies. When people do not get enough food or the right nutrition that their bodies need daily, their bodies do not function properly and can deteriorate quicker than individuals who do not have this type of self-harming behavior. An example of how this behavior can harm one’s own body is by lacking the right amount of calcium to keep bones healthy and strong, causing brittle skeletal structure.

 All these types of self-harm show that individuals will choose several different options to either physically harm themselves or harm their bodies internally. However, what these types of self-harm do not tell us is why individuals choose to self-harm in the first place. Next, this research will take a deeper look into why individuals choose to harm themselves and how that choice affects their bodies and their livelihood.

Reasons and Effects of Self-Harm

According to the article What is Self-Harm? by the Cleveland Clinic (2024), individuals who choose to self-harm do so to help them cope, direct emotion inward, and to communicate with others. When self-harm is chosen to help with coping, some people do so because it feels good to them, to prove the tolerance of pain, or to relieve negative feelings (Cleveland Clinic, 2024). Physically self-harming to cope can be a way for individuals to see their pain in a visible form. When individuals direct their emotions inward, they may be affected by low self-esteem and become angry at themselves. This type of self-harm is more of a way to punish themselves as they may feel they deserve this type of treatment. When self-harm is inflicted, this may also be a way for them to try and communicate with others who are around them and can see their wounds. This is a cry for help without having to come out and say they are in need of mental health support.

Some explanations for why individuals may self-harm can stem from either a traumatic life event in childhood or adulthood, or it can stem from a mental illness or disorder, or possibly, both. In traumatic life events, individuals handle situations differently. For example, as a kid, I had two other siblings, a sister and a brother. All three of us went through the nasty, hard trial of the divorce of my parents, which was a traumatic life event.

All three of us began to have spouts of long-term depression and anxiety. However, all three of us had different techniques and coping skills to handling this challenging time. My brother developed a disorder that caused physical self-harm, forcing an amputation of his left leg. My sister developed an eating disorder that was self-harming internally, and I developed an addiction that was self-harming mentally. All of these are mental health illnesses that could be rooted back from our childhood trauma.

In the research conducted by Singhal et. al. (2014), they found that individuals who have depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia, and substance abuse all had risk rates of self-harming that were well above individuals without these mental illnesses (p.13). Singhal et. al.’s research coupled with my own personal experience, led to my belief that self-harm may be correlated with specific mental health diagnoses.

There are numerous effects that self-harm can have on an individual. However, there are two major consequences of self-harm that are the most common. The first effect of self-harming can be the ultimate physical detriment, causing death to an individual. Suicide and accidental overdose are the two biggest self-harming effects that we hear about that take the life of family, friends, and individuals all over the United States. The other consequence of self-harm may not cause death in a person; however, it can cause visible wounds and scars. The aspect of self-harm that causes visible wounds is a consequence that lasts one’s lifetime. The scars left behind on a person can be a constant reminder of the pain and trauma they have endured, even after they become mentally well.

After talking about the types of self-harm and the reasons for why individuals choose this behavior, it leads to the question of, who is engaging in these actions? The answer is teens, young adults, and older adults. Essentially, anyone has the choice of self-harming if they choose this behavior. However, teens and young adults ages 15-24 are the peak ages for individuals who choose to self-harm, along with suicide being the third leading cause of death among this age group (Singhal, 2014). The prevalence of self-harm among these young individuals shows that this is a difficult and trying time in people’s lives. Adolescence and early adulthood are the periods of life where people began to figure out who they are in this world while combating the trials of peers, childhood trauma, school, career decisions, relationships, heartbreaks, marriage, and/or child rearing. All of these life changes can cause stress, anxiety, and depression among individuals, therefore, leading them to grasp for an outlet to deal with these feelings and emotions.

Though the peak age for self-harming is earlier, there are still individuals who are twenty-five years or older who resort to self-harming.  In the scholarly journal,Self-harm in older adults: Systematic review: The British Journal of Psychiatry, Troya et. al. (2019), found that self-harm and suicide can be higher in adults if they have low education, housing issues, financial problems, social isolation, increased access to medications, heavy alcohol/drug use, have or had a previous psychiatric diagnosis, or a history of self-harm. Personal situation and mental state are two determining factors that can contribute to self-harming among certain individuals.

Treatment for Self-Harm

Whether someone is a teen, young adult, or older adult, there can still be risk of self-harming. Knowing more about self-harm—types of self-harm, reasons for self-harm, effects of self-harm—helps psychologists better understand how to incorporate treatment or behavioral plans to mitigate the use of this type of behavior. One way of combating self-harm among individuals is cognitive behavioral therapy (CBT). In the article titled Cognitive Behavioral Therapy by Psychology Today (2023), they give an understanding into what this type of therapy entails:

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. Considered a “solutions-oriented” form of talk therapy, CBT rests on the idea that thoughts and perceptions influence behavior (p.1).

This type of therapy will allow individuals to open up about their emotions, thoughts, and reasons for the self-harming behavior with a well-trained therapist. CBT will also help the self-harming individual to build a relationship with the therapist and feel comfortable enough to talk about coping skills, healthier alternatives to self-harm, and moving on in their life with newly developed techniques that nourish their mental health.

            One other way to help treat the growing behavior of self-harm is prevention. Prevention of self-harm could happen in many different avenues. As mentioned above, due to the fact that the peak of self-harm is 15-24 years old, schools should be a major place to start. Self-harm and suicide prevention seminars can be held during school hours to inform teens of the causes, effects, and treatment to help them with issues common to them. If teens have information on where they can go to get help, they may be more likely to use a healthier avenue of receiving help rather than turning inward and self-harming.

            Prevention of self-harm can also be done at home. Parents need to know the information about suicide and self-harm and its prevalence so they can have conversations with their children. The hope of prevention is to give more information about what kind of help is offered to individuals who may choose self-harming behaviors, that way they do not feel trapped or feel as if they only have one way to relieve their pain and suffering. Knowing someone cares for their well-being may be the difference in someone self-harming vs. someone seeking help from a professional or loved one.

Methodology

            The questioning of a possible correlation between self-harm and mental disorders will be best used by the qualitative-comparative analysis. Simister and Scholz (2017) give clarity and understanding to what this research entails:

QCA is a methodology that enables the analysis of multiple cases in complex situations and can help explain why change happens in some cases but not others…Basically, QCA is a methodology that helps people look for patterns across multiple cases to better understand why some changes happen and others don’t (p.1).

Using this type of research can help provide insight on relational correlations between self-harm and mental disorders.

Due to the many different mental disorders, this research will specifically look at the relationship between self-harm and depression, anxiety, bipolar disorder, and schizophrenia to determine if there is any correlation of higher self-harming behaviors. Data will be collected qualitatively through one-on-one interviews and questionnaires. This research is looking to interview 20-40 individuals along with having 100-150 returned questionnaires. The hope of collecting data through personal interviews and questionnaires—while being gentle and mindful of the individual’s sensitive situation and confidentiality—is to gain accurate details of self-harming behaviors while having a diagnosis of one of the listed mental illnesses. If it is found that there is a higher frequency of self-harm behavior and these mental disorders, then psychologists can provide accurate data to be able to facilitate treatment plans.

Conclusion

Overall, the proposed research should be conducted because of the growing instances of self-harming behaviors. According to the CDC (2023), the suicide rate increased 2.6% from 2021 to 2022, with 49,449 suicides in 2022. On average, that is 136 suicides per day. Self-harming behavior is increasing, and it is claiming the lives of so many of our friends and loved ones. This study will help provide more clarity on a possible correlation between self-harm and mental disorders, such as depression, anxiety, bipolar disorder, and schizophrenia. Through the methodology of a qualitative-comparative analysis, psychologists can analyze the complexity of cases involving mental disorders and self-harm on a deeper scope. These results will impact the treatment that individuals will receive by being able to pinpoint what works for these people in case-by-case situations. This study will benefit society in a healthy and knowledgeable way, causing a hopeful decrease in self-harming behaviors and suicide. Human lives are precious gifts, and we owe it to ourselves and future generations to provide a knowledgeable and safe world for thriving, both physically and mentally.

References

Blount, C. (n.d.). Self injury, self harm quotes provide insight. HealthyPlace. https://www.healthyplace.com/abuse/self-injury/self-injury-self-harm-quotes-provide-insight

Cleveland Clinic. (2024, January). What is self-harm? https://my.clevelandclinic.org/health/diseases/12201-self-harm

Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008, January 29). Nonsuicidal self-harm in youth: A population-based survey. CMAJ. https://www.cmaj.ca/content/178/3/306.short

Psychology Today (2023). Self-harm. Psychology Today. https://www.psychologytoday.com/us/basics/self-harm

Ranzenhofer, L. (2024, February 8). Overeating vs. binge eating disorder: What is the difference? Columbia University Department of Psychiatry. https://www.columbiapsychiatry.org/news/overeating-vs-binge-eating-disorder-what-difference

Simister, N., & Scholz, V. (2017). Qualitative comparative analysis (QCA) – INTRAC. INTRAC.ORG. https://www.intrac.org/wpcms/wp-content/uploads/2017/01/Qualitative-comparative-analysis.pdf

Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014, May). Risk of self-harm and suicide in people with specific psychiatric and physical disorders: Comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023515/

Suicide Data and Statistics. (2023, November 29). Centers for Disease Control and Prevention. Retrieved February 27, 2024, from https://www.cdc.gov/suicide/suicide-data-statistics.html

Sussex Publishers. (2023, January). Cognitive behavioral therapy. Psychology Today. https://www.psychologytoday.com/us/basics/cognitive-behavioral-therapy

Troya, M. I., Babatunde, O., Polidano, K., Bartlam, B., McCloskey, E., Dikomitis, L., & Chew-Graham, C. A. (2019, February 21). Self-harm in older adults: Systematic review: The British Journal of Psychiatry. Cambridge Core. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/selfharm-in-older-adults-systematic-review/F8B3EBA9C6032E3E802B4388C464294E

U.S. Department of Health and Human Services. (2023, December 21). Understanding drug use and addiction drugfacts. National Institutes of Health. https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction