Self-Harm

Self-Harm

By Asst/P Jacqueline Lee Tilley
Psychology and Child & Human Development Academic Group, NIE, NTU
Published: 16 September 2022



What do we know about self-harm amongst Singapore's students?

Self-harm behaviors refer to a range of behaviors in which a person deliberately causes harm or injury to themselves, with or without suicidal intent (Nock et al., 2006; Uh et al., 2021). Such behaviors include cutting, hitting, burning, self-biting or scratching skin, pulling hair, over-dosing or self-poisoning, and deliberate acts of recklessness (Skegg, 2005). While many youth who self-harm do not intend suicide, they are at an increased risk of death by suicide and other unnatural causes, such as overdose and other risky behaviors (Chan et al., 2016; Hawton et al., 2012).

 

Youth between the ages of 16 and 24 years old are generally at highest risk for self-harm (McManus & Gunnell, 2020); however, research indicates that many youth begin engaging in self-harm in early adolescence (Nock, 2010). Those who start self-harming at a younger age, particularly before age 12, tend to engage in more frequent and more severe self-harm behaviors; hence, early intervention is crucial for this problem behavior (Ammerman et al., 2018).  

 

Causes & Functions of Self-harm

When asked to describe why they engage in self-harm, youth often report that they use it as a way to obtain release or relief from intense feelings, such as self-hate and self-dissatisfaction, and as a means to control or cope with difficult feelings (Stänicke et al., 2018). For these youth, the physical pain from self-harm serves as a distraction from more distressing emotions and psychological pain. Self-harm is also used as a way to communicate “unaccepted” feelings to others (e.g., by expressing their distress outwardly and obtaining help from others) or as a way to protect others from these “unaccepted feelings” (e.g., rather than take out their anger at others, they hurt themselves) (Stänicke et al., 2018).

 

These subjective experiences are consistent with explanations from behavioral science research on how self-harm is developed and maintained. Studies suggest that many youths who engage in self-harm have underlying difficulties with regulating their emotions and communicating with others due to exposure to an invalidating or critical home/social environment. Because many of these youth lack adequate coping skills to manage these emotions and communicate effectively with others, they use self-harm as a way to regulate distressing thoughts and feelings, as well as communicate with or influence others (Nock, 2009).

For example, the pain from self-harm behaviors can decrease or distract a person from difficult thoughts or feelings, generate desired self-punishing or dissociative feelings, facilitate help-seeking, and allow youth to avoid difficult social situations (e.g., confronting people with their strong emotions).

 

Youth also find self-harm to be a particularly effective means of coping compared to other behaviors that serve similar functions, such as the excessive use of alcohol or drugs, because it is more accessible and implementable, and has more rapid effects (Edmondson et al., 2016; Nock, 2009, 2010; Stänicke, 2021).  


Factors associated with Self-harm

In general, female adolescents have a higher tendency than males to engage in self-harm; however, this gender difference seems to disappear in young adulthood (Fliege et al., 2009; Shek & Yu, 2012). Youth who are emotionally sensitive, tend to engage in impulsive, risky behaviors, or have underlying mental health issues, such as depression, anxiety, and aggression, are also more likely to engage in self-harm (Ghinea et al., 2020; Witt et al., 2019; You et al., 2011). Low self-esteem and poor problem-solving abilities also place some youth at a higher risk for self-harm behaviors (Hawton et al., 1999).

 

A youth’s family and social environment can also place them at elevated risk of self-harm. Youth whose parents have difficulties related to emotion dysregulation, or have lower mental well-being, are at greater risk for self-harm as they are both genetically predisposed and socialized to have poorer emotion regulation (Buckholdt et al., 2009; Morgan et al., 2013; Sim et al., 2009). Exposure to childhood experiences, such as separation from parents, emotional neglect, psychological or physical abuse, or sexual abuse, and pervasively invalidating family climates (e.g., highly critical parents) are other notable risk factors (Adrian et al., 2018; Fliege et al., 2009; Gratz, 2003; James & Gibb, 2019), as are negative interpersonal experiences, such as bullying and discrimination (Fisher et al., 2012; Hay & Meldrum, 2010).  

 

The Singapore Context

Anecdotal evidence suggests an increase in self-harm behaviors among Singapore youth since the start of the Covid-19 pandemic in 2020 (Gan, 2022); however, prevalence rates of self-harm among Singapore youth are currently unknown. Most self-harm behaviors in Singapore youth manifest as hitting, cutting, biting, and picking of wounds (Shahwan et al., 2018), with cutting identified as the most common type of behavior (Lauw et al., 2018; Shahwan et al., 2018). Singapore youth tend to use self-harm more as a means to regulate their emotions, than as a way to communicate with others (e.g., social function) (Ong et al., 2017). Specifically, they more frequently endorse engaging in self-harm as a means to stop “bad” feelings, to relieve feelings of numbness or emptiness, to feel relaxed or “something even if it was pain,” and to punish themselves, than to avoid social activities (e.g., work, school) or control a social situation.

 

Studies have shown that self-harm behaviour is relatively more common among the youth with existing mental health issues  (Lauw et al., 2018).  Consistent with broader global literature, Singapore youth who are females, have existing mental health or substance use problems, and have a history of abuse are more likely to engage in self-harm (Lauw et al., 2018; Loh et al., 2013; Ong et al., 2017). The likelihood of self-harm behaviors is further elevated in the absence of social support and a sense of belonging (Poremski et al., 2017).  

 

In Practice

Dialectical behavior therapy (DBT) is a well-established evidence-based treatment for youth who engage in self-harm behaviors (Asarnow et al., 2021). DBT focuses on decreasing ineffective coping behaviors linked to pervasive emotion dysregulation, such as self-harm. It does so by improving youths’ ability to regulate their emotions and increasing their repertoire of positive coping, problem-solving, and interpersonal skills. DBT is more effective than treatments, such as cognitive behavioural therapy and supportive psychotherapy, because it specifically targets underlying mechanisms related to self-harm behaviors and emphasizes the importance of self-management.

 


Singapore youth seeking help and resources for self-harm can contact:

 

CHAT (https://www.imh.com.sg/CHAT/About%20CHAT/Pages/default.aspx)


Tel: 6493 6500 / 6493 6501


Email: CHAT@mentalhealth.sg

 

Samaritans of Singapore (https://www.sos.org.sg/)

Tel: 1-767

Email: pat@sos.org.sg  

 

Takeaways

 


Acknowledgements

The author thanks Amanda Chia Ching Ling for her research assistance. 



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Citation

Tilley, J. L. (2022, September 16). What do we know about self-harm amongst Singapore's students? Child and Human Development, Life@NIE SG®. https://sites.google.com/g.nie.edu.sg/child-and-human-development/topics/at-risk-behaviors/self-harm