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Self harm
What do we mean by self harm?
“Repetitive Self Harm is any purposeful act or omission that results in harm to the person but is without any direct intent to end life and occurs more than once over time” Smith (2003).
Psychiatry in DSM IV (TR) defines self injury as “The deliberate damaging of body tissue without the intent to end life”.
Clearly, therefore, self harm includes self injury but is a more expansive term.
Self harm and suicide therefore are different things, the key difference being intent. Statistically people who harm themselves are more likely to go on and end their life by suicide but that does not indicate any direct or positive link, especially if you control for life events. We know that for most people separating their motivations to hurt themselves from any possible motivations to die can be a broadly helpful part of building their future resilience and making choices.
We believe that self harm is a survival strategy that helps the person to make sense of the world and to survive today; therefore we never hope or ask that people will stop unless they feel it is right to do so at this point in their life
Crazydiamond trains workers to build their helpfulness and we often start with the following tips
- First separate self harm from suicide, when they co exist treat them as co-morbid
- Self harm is never the problem so don’t focus on it when working
- Self harm is a messenger that there is a problem elsewhere, help the person listen to, understand and heed the message
- Don’t aim for the self harm to stop, aim for the person to have more control or to make choices– and oddly enough it often stops
- Recovery from the problem is natural and we know how long it takes even if we do nothing so workers should be kind human and hopeful.
- Self harm is not simply about getting your attention, don’t over emphasise your importance in your clients lives
- One of the biggest obstacles to overcome is workers and others hopelessness, it is hard for a person to find their hope when they feel desperate, workers must be the holders of hope. When workers are hopeless it is hard to raise your own expectations from being a “cutter” to being a person.
- Help the person to make sense of what is happening and to make choices
- Ownership of the experience is important, workers do not own clients experiences or the recovery process.
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