Self-injury, a collateral damage of Covid?

During the last few years, the prevalence rates of self-injury have increased considerably. However, the occurrence of this type of behavior has increased exponentially after the last few months in which we have all suffered the consequences of confinement and a pandemic that is dragging on.

Understanding their origin and what they want to transmit through these behaviors is vital to be able to carry out an effective therapeutic intervention. In addition, the role of the family environment in the management of this situation is key to facilitate communication with the patient.

Psychologists Elena Sánchez and Julia Moraleda, and psychologist Carlos Antonio Rodríguez, from the Centro de Psicología Rodríguez Vidondo, explain in detail everything we need to know about self-injury and the importance of going to therapy.

A problem that is increasing in prevalence and age of onset

We must not forget that the incidence of these behaviors is made taking as a reference the cases treated by emergency services, thus, there could be an underestimation of this phenomenon, because not all cases in which self-injuries occur access to this type of services. Often not even the parents themselves are aware that self-injury is occurring.

A bibliographic review carried out by Cuban researchers, limiting self-injury only to those without suicidal purposes, found the following prevalences:

  • Between 30-40% of adolescents with psychiatric hospitalization have been admitted for self-injurious behavior, with the age of onset even decreasing. While in 2015 the average age of onset was 16 years, in 2017 it has been reduced to 12 years.
  • In the general population, this type of behavior is committed by 13-29% of adolescents at least once in their lifetime. With an age of initiation between 10-15 years and rarely later than 30.
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These behaviors are more frequent among females, especially in adolescence.

What are self-injuries and are they a suicide risk?

Before starting, it is important to dwell on this concept and understand what it consists of. Self-injuries are injuries that a person deliberately causes to him/herself, the method and type of injury is varied, the most common being cuts, burns, blows, punctures and scratches.

Similarly, we must differentiate between suicidal self-injury and self-injury without suicidal intent. While the former are those that carry a high risk of committing suicide and are related to ideas of hopelessness about life, the latter are intended to calm emotional states of anger, despair or anguish that have not been learned to manage and generate great discomfort.

The management of physical pain before the emotional pain

Faced with the difficulty of managing intense and unpleasant emotional states, these people find in non-suicidal self-injury a way to alleviate the discomfort.

Thus, when an event, thought or emotion occurs that generates intense emotional discomfort that is difficult to manage, they try to alleviate this discomfort or emotional distress with a physical cut, blow, pinch or burn. Thus, in an attempt to take control of the situation, attention is distracted from the emotionality, because for these people it is easier to manage the physical pain than the emotional pain.

However, after this relief, calm and relaxation that people experience after self-injury, feelings of guilt, shame, stigma, isolation and abandonment begin. Thus, the discomfort reappears and even increases, making it more likely that the person will resort to this type of behavior and even increase in frequency and intensity.

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An incorrect way of communicating?

Self-injurious behavior without suicidal intent has the function of communicating to the environment the pain that the person is experiencing internally, communicating through the body what perhaps cannot be expressed with words.

To break this vicious circle, the mission of professionals is to provide the appropriate tools to identify, manage and express different emotional states, providing the person with alternative behaviors that allow him/her to face different situations in an adaptive way.

What are the risk factors?

There are some risk factors shared by people who self-injure: difficulty in emotional management, low self-esteem, high levels of perfectionism and self-demand, feelings of rejection, hopelessness and insecurity, impulsivity, low tolerance to frustration, high levels of self-criticism and frequent conflicts with friends and family.

The situation may pose a greater risk if the following circumstances are present: eating disorder, history of sexual and physical abuse, depressive disorder, post-traumatic stress disorder, use of various substances, bullying or cyberbullying.

How can therapy help?

Currently, there is a false belief that, if we talk about suicide or self-injurious behaviors, we incite these behaviors to precipitate, which is what has been called the Werther effect. However, being able to talk about these aspects is fundamental.

In the consultation room, patients find a safe place to discuss suicidal ideation, self-injurious behavior and the feeling of hopelessness with life. A safety and an opportunity for openness that they have probably not found elsewhere. This, far from inciting them, gives them a deep relief, a feeling of understanding and confidence.

The feeling of helplessness in the family environment

As parents, discovering that our child is self-injuring, generates a set of emotions such as: guilt for not having noticed it before, helplessness, sadness, fear for their health, anger towards oneself or towards the child, etc.

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The appearance of guilt is a very common emotion, but let us think that if we have not noticed it before it is not because of carelessness or lack of attention but because the adolescent has done everything possible to keep it hidden.

Therefore, it is important that the feeling of guilt does not paralyze us, before guilt we must always ask ourselves what is it that guilt prevents us from doing? On the contrary, the appropriate behavior will be to approach the adolescent to understand, without judging, what has led him/her to self-injury and to make him/her feel understood and helped.

It is necessary to separate the behavior from the person, to show unconditional acceptance, to encourage open communication without transmitting worries or fears and, of course, to provide the professional help he/she may need.

For more information about self-injury and its treatment, contact a specialist at the Rodriguez Vidondo Psychology Center.