I’m sorry. But I’m just gonna say it. Mental and behavioral health in our society is a dumpster fire. 🔥 It is a travesty of human dignity and anyone who tries to argue otherwise is lying out of their lying liar hole and I hope their pants literally catch on fire. 👖🔥 #NotSorry 😒

As a nurse, I want to be able to help people by providing the best care and resources. That’s going to mean, in part, asking difficult questions. Unfortunately, there are a lot of misconceptions and misinterpretations in healthcare and mental health. So, what if patients don’t completely answer my questions? 😲 More importantly, what if they only *think* they know what I mean?

What if I told you that the majority of us only have a very superficial understanding of mental health and self injurious tendencies? 😳 With so much stigma and fear surrounding mental health, is that really such a surprise?

Let’s discuss.

Self injury or self-harm sounds pretty self explanatory. 🤷🏻‍♀️ It refers to the deliberate act of inflicting pain and damage to one’s own body. This is most commonly associated with cutting, 🔪 burning, 🔥 scratching, 🪒 one’s body or other form of external injury. 😢 At least, those are the manifestations with which we’re most familiar.

With me so far? Awesome. But hang on, it actually goes much deeper than that. Keep reading.👇🏻

Self-harm can also be internal or emotional. ❤️‍🩹 There are numerous behaviors that pose significant short-term risks or long-term, potentially permanent or even deadly consequences. Yet many of us do not associate them with self-harm. 🤔 This is a huge problem. 😱

Incredibly vulnerable people who are engaging in some of the most destructive behavior, when asked if they are having thoughts of, or currently acting on impulses of harming themselves, will say, “No.” 😨

This is not because they’re being intentionally vague or disingenuous. But because they’ve never known self-harm to be anything except cutting or other visible damage. (Thanks for the super broad perspective, networks who brought us the defibrillator shock to treat asystole and ultra realistic physicians who never need to consult any other specialists before performing virtually any procedure. 🙄)

So, what are some of these lesser known harmful actions I mention? I’m glad you asked. 🙃

You’ve probably known someone who has exhibited some of these behaviors. You just didn’t know it at the time.

Have you ever known a young girl or woman, maybe in college, high school, or even middle school, with a reputation for sleeping with a lot of people? What about a guy who had a reputation for drinking so much that he transformed into a completely different person and/or made himself physically ill? Ever known someone who drove really recklessly, weaving in and out of traffic, 25, 35, 40 miles, or more over the speed limit, particularly when they were upset? Maybe you were always amazed they never had an accident… or maybe you remember the day they weren’t so lucky. 😔 How about someone who punched trees or banged their head against walls?

Some of the most risky behaviors that we tend to NOT associate with self-harm include participating in unsafe sex, 🛌 consuming toxic amounts of drugs 💉 or alcohol, 🍻 extremes in eating, such as starving one’s self 🦴 or binge eating 🤢 {with or without inducing vomiting or abusing laxatives/diuretics to purge}, compulsive hair pulling 💇🏻or skin picking, 🤏🏻 punching, kicking, or head butting trees, walls, or other objects,💥🥊 and even unreasonably excessive exercise.🚴

Studies have shown that around 15% of teens and as many as 35% of college students have inflicted self-harming behaviors. Of those, about 1 in 3 are known to ALSO cut themselves. About 30% who participate in bingeing behavior {with or without purging} also cut themselves or practice another form of self-harm behavior.

My point? These things are a lot more common than most of us realize. 🥺

Still, if you’ve never felt or acted on these kinds of urges, you may be wondering why someone would engage in such behavior. Is it an attempt to die by suicide, a cry for help, attention seeking, or a form of manipulation? 🤨 The short answer is D.) None of the Above.

While accidents can certainly happen, self-harm, in and of itself, is not a suicide attempt. Individuals who engage in these behaviors typically do not express any desire to end their lives. And although these individuals may desperately NEED or WANT help, they usually won’t ask or tell anyone what they’re going through. They may be ashamed or afraid. They may believe they are a lost cause, beyond the point of being helped or that they’ll be burdening someone.

And as for attention seeking or manipulation…🤨🤦🏻‍♀️ *sprays with spray bottle*🚿 No. Just no. 🙎🏻‍♀️

They usually do everything in their power to HIDE these feelings and behaviors, even from the people who mean the most to them. Perhaps… 🤔 I don’t know… because people ask questions like, “Is this attention seeking behavior or manipulation?” 🤷🏻‍♀️

For an individual who has experienced trauma or is struggling with a deep internal conflict, self-harm meets a need. For many, the physical pain inflicted by self-injurious behavior serves as a temporary distraction or numbs emotional pain they’re experiencing. For some it is a form of punishment in response to intense feelings of shame or guilt. Others explain that they are numb to emotions and resort to self-harm in an effort to feel SOMETHING, even pain, fear, and self-loathing. 😞

This often leads to a vicious, self-destructive cycle. For instance, an individual may be experiencing anxiety and feel the only way to cope is through the short-lived physical connection to another human being, albeit a stranger from the internet. The encounter provides temporary distraction, comfort, and relief. However, after the instant gratification dissipates, there are immense feelings of shame, disgust, and guilt. Subsequently, to cope with these new uncomfortable feelings, the individual may turn to cutting or burning themselves to temporarily escape or manifest their self-loathing.

In essence, maladaptive behaviors are the only way they know to express, change, or suppress negative or overpowering emotions. Individuals who engage in self-harm may be unable to effectively verbalize and process emotions, leading them to use their bodies for expression.

These individuals also have a propensity to exhibit body dissatisfaction or dysmorphia, low self image or self-esteem, feelings of worthlessness and emptiness, impulsiveness, and cognitive distortions or self-criticism.

To help this vulnerable population, we have to stop stigmatizing and recognize and address underlying causes such as depression, impulsiveness, low self-esteem, abuse, poverty, homelessness, and family dysfunction and conflict. Then we can collaborate with these individuals to develop healthier coping strategies and a network of support and empathy.

But before we can ever get there, we have to take the time to make sure people understand exactly what we’re asking when we ask about self-harm. Because some of the deepest scars aren’t visible.