Self-harm has increased in frequency in recent years; however, it is still treated as if it were a new event. Research conducted on it is still very scarce due to the controversy behind this condition. Self-harm isn't as simple as cutting yourself. It is as complex as the individual who relies on it. There are different categories and different degrees based on how the person uses self-harm and to what extent. There has been some debate recently as to whether or not this should be its own disorder or just a symptom of other mental disorders such as borderline personality disorder. The general public has difficulty understanding the idea of ​​self-harm. It is difficult to imagine that pain could be self-inflicted to relieve stress. The truth is, however, that these people need help. They need someone they can confide in who can help them overcome these emotions and find new ways to deal with them instead of hurting themselves. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Pain. What is pain? The definition widely used by the International Association for the Study of Pain states that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain motivates a person to remove themselves from harmful situations, to protect a damaged body part while it heals, and/or to avoid similar experiences in the future. However, some do the opposite of avoiding it. They crave it. It is their path to stress relief that society throws at them. They inflict it as punishment, or they do it to feel something other than the numbness that consumes them, to know that they are alive. It's an insatiable need that grows with each passing day. The more you do it, the more you need it and the worse the pain must be. Start with a moment. A moment of weakness. You've hit rock bottom and all you want to do is scream and cry to chase away the pain and sorrow hidden deep in your mind. To end the suffering that destroys you from the inside. Self-harm gets swept under the rug like a dirty mess that you don't want your guests to see. It hides under jeans, long sleeves and 10 or more bracelets in the height of summer. Those who suffer from the pain they not only inflict on themselves, but also from the pain that society throws at them, are forced to keep their suffering a secret for fear of rejection and the judging eyes of their peers. No one finds pleasure in being called an "attention whore" or being called "crazy." The fear of being trapped in this taboo ritual is extreme. “Normal” people would shudder at the thought of taking a blade to their forearm and pressing to cut into their own flesh and finding temporary peace in this unfathomable habit. But there are those who find comfort in these nocturnal ceremonies in which he takes the sharpest object in his possession and watches the blood flow freely from his skin. This condition has received increasing attention in recent years. Public awareness has also increased since 1997, when Princess Diana admitted on national television that she had deliberately harmed herself to cope with her disastrous marriage. Johnny Depp also revealed to the public that he bears the scars of self-inflicted wounds. The plot of “Female Perversions,” a recent film based on the book of the same name by Louise Kaplan, centers on the discovery of a young girl who cuts herself. And Steven Levenkron recently published "The Luckiest Girl in the World," about a self-harming teenager. However, despite all the recentpublications in the media, there is still much to be done to increase awareness and understanding of the problem of self-harm. (Egan 1997, VJ Turner 2002) The most important issue is to deal with the myths and stereotypes surrounding this disorder and begin to find practical treatments such as those applied to anorexia nervosa and bulimia. It is important that professionals, parents and the general public stop shivering in fear, panic or freezing in shock when they hear about or witness a person repeatedly cutting or burning themselves. For years, mental health specialists have debated whether self-harm is a disease in itself or whether this behavior is one of the symptoms of health problems, such as depression, anxiety or borderline personality disorder. Researchers specializing in this field say that the fear of lawsuits arising from studying such dangerous behaviors if a subject harms himself, and the lack of general agreement on whether self-harm is a distinct disease or simply a behavior linked to suicide, have prevented progress in understanding the phenomenon. (Lazar 2013, VJ Turner 2002) There is still much work to be done to improve the understanding of self-harm, as well as to develop new treatment strategies that work and to conduct further studies as has been done for alcohol, drug abuse, anorexia nervosa and bulimia. Determining what works best for which type of person and developing newer methods are still topics that require a lot of research. It is suggested that, in addition to discouraging self-aggressive behavior, it is also necessary to intervene on the conditions that keep it active. These interventions include: exploring other methods to reduce distress, teaching mental and behavioral strategies to deal with stress-inducing situations and painful internal thoughts, strengthening the ability to control internal emotional ups and downs so that external methods (such as 'self-harm) ) feel less needed and reduce stress and symptoms that can motivate self-harm behaviors. The indisputable truth is that acts of self-harm are disturbing to the general public and even mental health professionals. The impulsive nature of these patients is sometimes frustrating to deal with, but no more so than the impulsiveness of alcoholics when they take another drink. (VJ Turner 2002) What is self-harm? It has been defined as intentional harm to the body or part of the body, not with the intent to commit suicide, but to manage painful emotions that words cannot express. It may include cutting or burning your skin or getting bruises from a planned accident. It can also mean scratching the skin until it bleeds or interfering with the healing process of a wound. In extreme cases, a self-harmer may break bones, amputate fingers, eat harmful substances, or inject toxins into their body. While self-harm can bring a temporary sense of calm and a release of tension, it is usually followed by guilt, shame, and the return of painful emotions. And with self-harm comes the possibility of more serious and even lethal self-injurious actions. This disorder usually begins in adolescence and continues for many years. Just like in other addictive disorders, there are repetitive episodes that increase in recurrence and severity as time passes. In other words, over time tolerance builds, just like in alcoholism or substance abuse, and more is needed to achieve that “high.” (Conterio 1998, Mayo Clinic 2012, VJ Turner 2002) The question still remains open: what happens in the mind of a person who self-harms? In 1983 two authorsthey wrote about the emotional and psychological side of self-harm. They describe the emotional/psychological symptoms frequently observed in people who self-harm as follows: sudden and recurring urges to harm themselves without the ability to resist, the feeling of being “trapped” in an unbearable situation that cannot be addressed or controlled, a increasing sense of agitation, anxiety and anger, a limited ability to think about more reasonable action options, a sense of mental relief after self-harm and a depressive mood although no suicidal intent is present. However, there are aspects of this disorder that are found among “normal” people and among people with milder disorders. Self-harm encompasses a range of behaviors, some of which are not that different from the distressing habits of the healthy population. How many people do you know, including yourself, who get acne, bite their nails, or scratch mosquito bites until they bleed? How many people go on a starvation diet to fit into a certain pair of jeans? Where is the line drawn between harmless things people do to their bodies and those that require serious attention? (VJ Turner 2002, Conterio 1998) Self-harm has been classified into three main types: major self-mutilation, stereotyped self-mutilation and superficial (or moderate) self-mutilation. Major self-mutilation is the most extreme and also the least common. This type of self-harm is classified by the fact that, although the acts are infrequent, they involve the removal or destruction of a large amount of tissue. This may include self-castration, amputation, or eye gouging. Major self-mutilation is most commonly associated with psychosis or acute drug intoxication. Stereotypical self-mutilation consists of fixed and repetitive patterns. The most common form is head hitting, in which a person repeatedly hits the head with a hard object to overwhelm emotional pain. This type of self-harm is predominantly found in mentally retarded people in institutions, but has also been found in individuals with autism or schizophrenia. (Holmes 2000) Superficial self-mutilation is non-lethal and results in relatively little tissue damage. This type of self-harm can develop addictive qualities and can become a constant fixation for the sufferer. The most common method of self-harm in this category is cutting, which involves making severe cuts or scratches on different parts of the body with a sharp object. Other forms of self-harm include: burning oneself (with lit matches, cigarettes, or hot, sharp objects such as knives), cutting words or symbols into the skin, breaking bones, hitting or punching, piercing the skin with sharp objects, banging the head, biting, pulling hair and persistent picking or interfering with wound healing. This category of self-harm can be further divided into three subcategories: compulsive, episodic, and repetitive. (Holmes 2000, Mayo Clinic 2012) Compulsive self-harm manifests itself in hair pulling, skin picking, and skin rubbing to remove perceived flaws or imperfections in the skin. These acts are common in patients with OCD. The person tries to relieve stress and prevent something bad from happening by engaging in self-harm. OCD is characterized by persistent unwanted thoughts (the obsession) along with repetitive behaviors (the compulsion) that are supposed to relieve feelings of discomfort. (Holmes 2000) The difference between episodic and repetitive self-harm is that episodic self-harm is committed from time to time by people who otherwise don't think about it and don't consider themselves to be self-harming. It is commonly asymptom of some other psychological disorder. However, what begins as occasional or episodic self-harm can become repetitive self-harm. Repetitive self-harm is characterized by thinking about self-harm even when one is not involved in it and the person recognizes themselves as self-harming. Episodic self-harm becomes repetitive when what was just a symptom of illness progresses to become an illness in its own right. (Holmes 2000) Most self-harmers develop a routine of self-harm that they plan and engage in daily. Others are more casual and only act when difficult feelings strike them. Some hide razor blades in cabinets, nightstands, or other places so they are ready to deal with any need. They also have a multitude of opinions about their own behavior. Many may admit that their actions are harmful but feel unable to stop because of the comfort it provides them. They believe they are sending the message that they are tough and can face anything. They find pride in their scars. Their distorted thinking is complex and has multiple sides. One patient might have a limb almost amputated and say “I'm not as bad as the others,” while others say they are ashamed of the vandalism they left on their bodies and would do anything to erase it. (Conterio 1998) It has been estimated that approximately 2 million people self-harm in the United States. This daunting number includes people from all walks of life, from actors like Johnny Depp, to the typical teenager in your community. Females are at greater risk of self-harm than males. Most people who self-harm are teenagers and young adults. Some people who hurt themselves have been neglected or have suffered sexual, physical, or emotional abuse, or have experienced other traumatic events. Additionally, self-harm is commonly associated with some mental disorders, such as borderline personality disorder, depression, anxiety disorders, post-traumatic stress disorder, and eating disorders. People who harm themselves often do so under the influence of alcohol or illegal drugs. However, there are many other characteristics found in self-harmers. These people may experience strong feelings of self-hatred and feel that they are not good enough compared to others. They may be very sensitive to rejection and seem constantly angry (usually at themselves) or have aggressive feelings. They tend to suppress these feelings or direct them inward. They also tend to be impulsive and act directly based on their mood at the time. Furthermore, they tend not to plan for the future, are suicidal or depressed, self-destructive, suffer from chronic anxiety and can be irritable. They also don't feel they have much control over their lives and don't believe they are skilled at coping, and in fact usually don't have a set of coping mechanisms. (Holmes 2000, Mayo Clinic 2012) Self-harmers may also have a low ability to form and sustain stable relationships. They complain of having poor social skills and an inability to respond to the needs and concerns of others. A self-harmer may also fear change. This change can manifest itself in any type of new experience, be it people, places, or events. They may have an inability or reluctance to take proper care of themselves, such as following a nutritional diet, getting sufficient exercise and sleep, and good hygiene. They may tend to have low self-esteem along with a strong need for love and acceptance from others. They will go to extremes to receive demonstrations of love and care from others, includingtaking on too much blame for what happens in a relationship or adopting a caretaker role when it is unhealthy or even dangerous for them to do so. (Conterio 1998) How many times have you or someone you know been so angry or frustrated that you banged your fist on the table to express how you felt? Have you ever punched a pillow or a wall or broken something? Or even just bite your lip to hold back tears? Regardless of whether or not you engage in acts of self-harm, you can probably relate to the occasional need to release emotional tension through physical means. The activity releases endorphins which in turn calm the nervous system. A patient who has self-harmed will often have an intense or extreme experience of this sensation. They believe that it is easier to deal with physical pain than emotional pain. Their definition of pain varies greatly from that of other people. (Conterio 1998) What drives these people to cause such harm to themselves? One might assume that people who cut themselves do so because of an inability to express emotions. While this may be a plausible reason, the following explanations shed further light on why some may self-harm. Self-punishment is a common reason among self-harmers, inability to express emotions that perhaps seem too painful or confusing to put into words, regaining self-control, feeling lost and abandoned, a way of saying, 'Look, I'm in control now.' It can also be due to feelings of revenge, anger or resentment towards someone. The cutter does not want, or does not have the ability, to confront the person, so the cutter's body becomes the only way to communicate with the other person. Self-harm can also be used to show mortality or regain the meaning of life. Pain from self-harm or the sight of blood serve as tangible proof to the cutter that they are, indeed, alive. It can also serve to relieve tension or release anger just like another physical coping mechanism, crying. Both normally result from negative feelings of hurt or anger, both involve the loss of bodily fluids, both are often described as uncontrollable, and both leave the person tired, relieved, and calm afterwards. (Spiratos 2003) Self-harm is not currently classified as a psychological disorder by the American Psychiatric Association. Instead, the APA's comprehensive reference work on psychological problems, the Diagnostic and Statistical Manual of Mental Disorders, includes self-mutilating acts as part of another psychological problem called borderline personality disorder. This disorder is characterized by a pattern of unstable relationships, impulsive behavior, and immediate or drastic changes in self-image. The nine criteria for this disorder are: frantic efforts to avoid real or imagined abandonment, a pattern of unstable relationships, an unstable self-image, impulsiveness regarding two areas that could be considered dangerous (substance abuse, reckless driving, uncontrolled, etc.), ongoing suicidal behavior or self-mutilating behavior, instability due to mood swings, chronic feelings of emptiness, intense anger or difficulty controlling angry feelings, and brief episodes of paranoid feelings. However, there is evidence that borderline personality disorder is often misdiagnosed. In 1992, a study was conducted on 89 patients diagnosed with BPD and it was found that only 36 actually met the minimum of 5 criteria needed to be correctly diagnosed with this disorder. This indicates that the disorder may be overdiagnosed and that perhaps some doctors misclassify them“problematic” patients such as patients with borderline personality. (Holmes 2000) Other mental health specialists believe that OCD can also cause, or lead to, self-harming behavior. OCD is characterized by persistent obsessions or compulsions that are severe and cause the person distress. An obsessed person will attempt to ignore or suppress the thought, or will attempt to neutralize it with another action or thought. This is the compulsion. Compulsions include behaviors or mental acts aimed at reducing anxiety or stress. Among those diagnosed with OCD, self-injurious behavior usually manifests as trichotillomania (compulsively pulling hair on the head or body) or compulsively picking or scratching the skin. (Holmes 2000, Conterio 1998, VJ Turner 2002) Among the problems commonly associated with self-harm are symptoms of post-traumatic stress disorder. This disorder is more common in children who have been physically or sexually abused or neglected. Sufferers of this condition may experience the following: intrusive and distressing memories and dreams of a traumatic event, a desire to avoid anything that might remind them of the traumatic event, reduced interest in activities previously enjoyed, withdrawal from other people , inability to experience emotions involving intimacy and tenderness, and persistent feelings of anxiety, anger, and irritability. (Holmes 2000, Conterio 1998) It is common for people who self-harm to also suffer from eating disorders such as anorexia nervosa or bulimia. Anorexia nervosa is an eating disorder classified by the fear of showing off weight. People with this disease may feel overweight even if their actual body weight is 15% less than it should be for their height and age. Anorexia is similar to self-harm in many ways. Generally this disorder is found in young adult women. The main causes of anorexia, like self-harm, include stress, childhood trauma or sexual abuse. Anorexic people attempt to regain control of their lives by controlling what they eat and how much they weigh, just as cutters attempt to control their emotional suffering through physical pain. (Holmes 2000) Bulimia is much more common than anorexia and is found in women who are usually older than anorexics. It is also very common for a person to suffer from both disorders at the same time. It is estimated that around 50% of anorexic people also suffer from bulimia. People with bulimia nervosa engage in regular bouts of binge eating (eating a large amount of food at one time) and then proceed to force themselves to vomit up what they have just consumed, this is called purging. This purging, which is usually done at least once a day, can be uncomfortable or even painful, but for bulimics it offers the same relief from emotional stress that a person who self-harms gets by cutting or burning themselves. (Holmes 2000) In 1993 two mental health scientists examined self-harm not only as a symptom of other mental disorders, but also as a disorder in its own right. They divided self-harm into the three basic types explained above and proposed that a repetitive superficial self-harm syndrome should be considered as a separate psychological disorder, classified under the subsection “Impulse Disorders”. The criteria outlined for the diagnosis of the disorder are the following: concern about harming oneself physically, recurrent inability to resist the impulse to harm oneself resulting in destruction or alteration of body tissues,increasing sense of tension immediately before the act of self-harm. , gratification or sense of relief when committing the act of self-harm, and the act of self-harm is not associated with suicidal intent and is not in response to a transsexual delusion, hallucination or fixed idea or mental retardation. (Holmes 2000) Self-harm shares some characteristics with addiction. The sufferer experiences the need to engage in the behavior in ever-increasing amounts to achieve the desired effect. Such behavior shares some characteristics with addictive substances in that it provides relief from tension. This calming or paralyzing effect is the most common consequence of the damage. People hurt themselves because it makes them feel better. They turn to physical pain to deal with deeper, intolerable emotional pain related to feelings of anger, sadness, or abandonment. The injury is used to relieve the pressure that these emotions can cause. It can also jolt people out of states of numbness and emptiness. These mood-changing effects and the increased tolerance seen in self-harmers have prompted research to suggest that cutting is very similar to alcoholism because the emotional pain is now made physical. When the body enters an adrenaline-like state, the brain releases natural opiates and other chemicals. Although it has not yet been proven, it is suggested that when a person cuts, the body releases these chemicals and produces a state of euphoria that can be addictive. (Conterio 1998, Egan 1997, Spiratos 2003) Numerous studies support the claim that self-inflicted pain can lead to feeling better. For example, scientists scanned the brains of people with a history of self-harm during a painful experimental task designed to mimic self-harm. They found that pain led to decreased activity in areas of the brain linked to negative emotions. This poses a confusing question. How could self-inflicted pain lead to feeling better? New research now suggests that the key is the relief that occurs when something that causes intense pain is less REMOVED. (Franklin 2010) Imagine that one morning you visit the doctor for a routine checkup and later that afternoon the doctor's office calls to tell you that you are in an advanced stage of cancer and that you have weeks to live. Now imagine that the doctor's office calls back five minutes later and tells you that they mixed up your lab work with someone else's and that you are actually healthy. You wouldn't immediately go back to how you felt before the first phone call, but you would feel extreme relief, which would last for hours or even days. It wasn't a reward that made you feel better, just the introduction and removal of something unpleasant. Scientists conducted a study in which it was found that the removal of various forms of experimental pain was associated with a reduction in negative emotions in people with no history of self-harm. This relief was especially strong for people who had higher levels of negative emotions. This second finding may help explain why people with higher levels of negative emotions are more likely to self-harm. They have more negative emotions to reduce and therefore more relief to obtain. These new findings are particularly interesting because it turns out that both general and pain-induced negative emotions are processed in the same areas of the brain. This means that pain relief and emotional relief are essentially the same thing. (Franklin 2010) When people experience emotional pain, the same areas of the brain become activated aswhen people experience physical pain. In one study, these regions were activated when people experienced social rejection from peers. In another, more real-world study, the same regions were activated when people who had recently broken up with their partners looked at photos of their ex-partner. This leads to the question: If physical and emotional pain have similar brain signals, then why not take Tylenol for grief, loss, or despair? People who had experienced recent social rejection were randomly assigned to take acetaminophen versus a placebo every day for three weeks. People in the acetaminophen set reported fewer hurt feelings during that period. When their brains were scanned at the end of the treatment period, those taking acetaminophen had less activation in brain areas where pain is processed. (Fogel 2012) There are many myths and stereotypes about self-harmers. In an effort to dispel these misconceptions, it is important to clarify that, first and foremost, not all self-harmers suffer from borderline personality disorder. Self-harm is just one possible indicator of Borderline Personality Disorder. Second, not all self-harmers have experienced sexual abuse. The stereotype was that if someone self-harms, they have been abused. This is not always the case and many have no history of abuse whatsoever. Third, self-harm is not a form of attention seeking. A “copycat” self-harmer may do it because they think it is “cool.” However, most do so because they don't know how to deal with their emotions. And finally, those who self-harm are not “crazy”. Based on observations made by mental health professionals, they generally tend to be intelligent, creative, highly sensitive, and caring individuals who express difficulty communicating. These patients use their behaviors as a voice to cope. Many present themselves very well and others are surprised to find that they harm themselves on purpose. (Styer 2006) Another myth about self-harmers has to do with the relationship between self-harm and suicide. It is important to clarify that self-harm is not a suicide attempt. Contrary to popular belief, there is a difference between self-harm and suicide. It is difficult for the general public, and indeed for many doctors, to understand why people purposely harm themselves to feel better. Logically, this makes no sense. If someone cuts themselves on purpose, then it is logically seen as a suicide attempt. But self-harm is not logical. Self-harm is an unhealthy way to survive and cope with whatever happens in your life. Suicide is a way to not make it at all. All a therapist has to do is ask and patients will openly say whether the marks on their body were self-harm or a suicide attempt. They know the difference. They just need to be asked. (Styer 2006) Despite evidence that self-harm is reaching epidemic proportions, it is still considered a “rare” and “unusual” syndrome in the healthcare community, just as anorexia and bulimia were twenty years ago. The goal now is to bring self-harm out into the open and remove the shame surrounding the topic so that self-harmers can seek the help they need without fear. The mental health community also needs to be better educated in hopes of finding ways to provide the best treatment to these patients. Self-harm is not a strange habit among modern teenagers, it is a growing occurrence that began more than sixty years ago. Self-harm is a powerful coping mechanism, and to help those who self-harm, therapists need to understand the role it plays in life, 28(2), 101-113.