Do you also hurt yourself without realizing it? (Nonsuicidal Self-Injury Disorder) - Let's talk about this!

Sometimes when life's problems come up and you feel a heavy burden on your mind, it can be very difficult to bear. Has that happened to you? At times like these, some people are tempted to hurt themselves in small ways to reduce the mental pain they feel. Although this is something that can be seen among many people to some extent, most of the time no one talks about it openly. That's why, today we will talk a little about this.

What is self-harm? Why do we do it?

Simply put, self-harm is when you intentionally harm your body in some way. This is medically called ``Nonsuicidal Self-Injury Disorder''. The important thing here is that people who self-harm in this way do not intend to end their lives. They do so for other reasons.

Think about it, why would someone want to hurt themselves? There are several main reasons:

• As a coping mechanism: For some people, self-harm may provide temporary relief or relief from stress. For others, it may be a way to prove to themselves how much pain they can handle. Some people do it to relieve negative feelings such as sadness, anger, and frustration.
• Turning emotions inward: Others hurt themselves in this way to punish themselves or take out their anger on themselves. As if they have no other way to release a burden on their minds.
• As a signal to ask for help: Sometimes, people may do this to inform others of their difficulties and stress , or to indirectly say, "I need help."

How can you hurt yourself like this?

There are many ways to harm yourself. Some are more common than others. However, we need to understand that each method carries some risk . Here are some of the most common methods:

• Cutting with a sharp object: Some people use sharp objects, such as razor blades or glass shards, to cut and scratch their skin.
• Burning: Burning the skin with objects such as hot iron rods, cigarette butts, matchsticks, etc. Sometimes even household chemicals , such as household cleaning products, can be used for this.
• Hitting/smashing: Injuring yourself by hitting parts of your body against hard surfaces, such as hitting your hand against a wall. This can cause internal bruises (impact injuries) .
• Scratching/picking: One way is to scratch the skin vigorously with your nails until the skin is damaged.

What are the symptoms of this condition? How do you recognize it?

If you are a self-harmer, you may try to hide it from others. You may wear long-sleeved shirts and long pants, even on hot days, to cover the wounds. Or you may tell stories about how the injuries were caused by an accident. However, others may notice some of the symptoms:

• Scars or spots that have a specific shape or cluster in one place.
• Multiple burn wounds of the same size or shape.
• Injuries, bruises, or swelling caused by new scratches, bites, or other injuries that are often referred to as "accidents."
• Issues with impulse control . For example, not being able to stop picking at the same spot on your skin.

What part of the body is usually damaged like this?

The areas of the body that people who self-harm are most likely to injure are:

• Hands (especially the forearms )
• Wrists
• Front of their thighs
• Abdomen

In addition to these areas, damage can also occur in other parts of the body, but it is somewhat less common.

Why does someone try to harm themselves? What are the reasons?

It's hard to say exactly why someone self-harms. However, some mental health conditions have been found to be associated with it. Some of them include:

• Anxiety
• Autism
• Bipolar disorder – In this condition, feelings of happiness and sadness continuously fluctuate.
• Borderline personality disorder – characterized by instability in emotional control.
• Depression – Symptoms such as extreme sadness and loss of interest in anything.
• Disruptive, impulse-control and conduct disorders – for example, `(Conduct disorder)` and `(Intermittent explosive disorder)` (inability to control sudden anger).
• Dissociative disorders – a state of detachment from reality about who one is and where one is. Especially `(Dissociative identity disorder)` and `(Dissociative amnesia)`.
• Eating disorders – especially `(Anorexia nervosa)` (not eating).
• Obsessive-compulsive disorder ( OCD ) – a compulsion to repeat or think the same thing over and over again.
• Post-traumatic stress disorder (PTSD) – psychological distress that occurs after a traumatic event.
• Sleep disorders
• Substance use conditions and disorders – such as alcoholism, alcohol use disorder, and cannabis use disorder.

Who is most at risk for this condition?

There are several risk factors that can contribute to nonsuicidal self-injury:

• Abuse or trauma: People who have experienced abuse or other severe, traumatic events during childhood are more likely to self-harm.
• Age: These behaviors often begin between the ages of 12 and 14. However, they can start earlier. Once self-harm begins, some people continue to do so for years. This is common among young adults , especially those of college age .
• Sexual orientation: Research shows that people who are gay or bisexual (sexual minorities) have a higher rate of self-harm. Experts believe that this risk is higher because they face negative life experiences, such as social pressure and stigma.
• Social isolation: People who feel isolated and alone, especially school-age children who are bullied or socially isolated for other reasons, are at greater risk of self-harm.

How do doctors diagnose this?

Nonsuicidal self-injury disorder can sometimes be difficult to recognize because people who self-harm often hide their injuries and don't want to talk about them.

Doctors don't use a specific test to diagnose it. Instead, they examine your injuries, looking for scars and patterns from previous injuries. They ask questions about your medical history and social background. They also talk to you about what's going on in your life these days and what's causing you stress . For example, financial problems, a death in the family, problems at school or work, bullying, or a breakup.

What are the treatments for this?

If you see a doctor because you are self-harming, they will first treat your injuries if necessary. In the long term, they may recommend therapy and/or medications to help you manage any underlying mental health conditions and stressors in your life that may be causing this.

Remember, asking for help is a sign of strength, not weakness.

What are the risks if left untreated?

It is very important to seek treatment for self-harm, as it can have several short-term and long-term risks.

Short-term risks

Sometimes, self-harm can cause problems you didn't expect:

• Medical complications: These behaviors can lead to infections , nerve damage , and permanent and/or severe scarring . In some cases, this can lead to serious injury or even death.
• Social problems: Self-harm, whether intentional or unintentional, can affect your relationships with family, friends, or other loved ones. It can also affect how you feel in social settings, such as work and school.

Long-term risks

Self-harm can lead to other problems in the long term:

• Worsening mental health : This can lead to feelings of shame, guilt, and regret. You may try hard to cover up or hide wounds or scars, fearing that others will see them.
• More severe injuries: Often, self-harming behaviors escalate . You may start to hurt yourself more often, or the injuries you do may become more severe.
• Suicide risk: In a condition called ``Nonsuicidal self-injury disorder,'' there is no intention to kill oneself. However, the risk of attempting suicide or dying from suicide is significantly higher among people who self-harm. This is a matter of great concern.

Can this be prevented?

It may not always be possible to prevent someone from harming themselves in the first place. However, seeking help from a mental healthcare provider can reduce the likelihood of someone continuing to harm themselves. So, if you or someone you know is struggling with this, it's best to get help as soon as possible.

When should you see a doctor if you are self-harming?

If you think you (or someone you love) is self-harming, please see a doctor. Your injuries may require medical attention. It can also help to know that you are not alone. Your doctor is there to listen to you and support you. They will recommend the best treatment for you.

When should you go to an Emergency Treatment Unit (ETU) ?

If you feel that you are about to harm yourself or others, go to an Emergency Room (ER) immediately, or call the Suwaseriya Ambulance Service at 1990. You can also call the National Mental Health Helpline at 1926 for mental health help in Sri Lanka.

Additionally, if your injury is severe, especially if you have any of these symptoms, seek emergency treatment immediately:

• Difficulty breathing.
• Bleeding that won't stop.
• A physical deformity.
• Loss of motion in your arm or leg.

How does pain affect these people?

One reason why self-harm is a coping mechanism for some is the way our bodies respond to pain.

When something potentially harmful happens to your body, nerve endings in the area of ​​the injury send emergency signals to your brain. One thing your brain does in response to these signals is release chemicals called beta-endorphins . These chemicals make you feel “good” for a while, like pain is reduced. However, this effect doesn’t last long. Therefore, people who self-harm may be tempted to do this repeatedly when they want to feel better.

For many people, self-harming behavior can be difficult to understand. However, for those who self-harm, doing it can seem like the only way they can feel better or have some control over their lives. Even if people don't mean to harm themselves, there are always risks to self-harming. It's not a way to feel good in the long run, and it can have a negative impact on your physical and mental health and well-being.

If you feel like harming yourself, or if you are already harming yourself, there is nothing wrong with asking for help. Seeking treatment for self-harm is like seeking medical treatment for a physical illness. Even if you don’t feel it right now, you can get to a point where you can feel better physically and mentally. You are not alone.

Finally, the most important things to remember

Self-harm is a complex issue, but there is help and treatment available.

• You are not alone: ​​many people go through this experience, so don't be ashamed or feel guilty.
• Talk: Talk about your feelings with someone you trust – a friend, family member, teacher, or career counselor.
• Get professional help: A psychiatrist or counselor can help you overcome this situation. They can create a treatment plan that works for you.
• Learn coping strategies: When you're feeling down, there are other ways to deal with your emotions without hurting yourself. For example, exercise, listening to music, drawing, or practicing calming meditation techniques.
• Take your time, don't rush it: It takes time to recover from this. You may have good days and bad days. The most important thing is to keep trying.

If you or someone you know is struggling with something like this, please ask for help. There is always hope.