Depression and Self Harm
The Link Between Clinical Depression and Self Harming Behaviors
Pervasive feelings of guilt and low self-worth are common features of Major Depressive Disorder. If a depressive episode is left untreated, patients are at high risk of suicidal ideation, and suicide attempts. However, some demographics are at high risk of engaging in self-harming, dangerous behaviors that are not attempts at suicide. Typically, self-harming behaviors are maladaptive techniques at coping with painful, overwhelming emotions and frustration.
What is self-harm?
Self-harming is an act of causing physical pain to release pent-up feelings of anger, frustration, sadness, and other facets of emotional distress. In most cases, self-harming behaviors are done in private and in a controlled environment. Most attempts at self-harm are also made in a ritualized manner, and leave physical evidence and patterns on the skin.
What are some examples of common self-harming behaviors?
- Picking at wounds to interfere with the healing process.
- Scratching.
- Pulling out hair.
- Cutting.
- Burning.
- Carving words or symbols into the skin.
- Piercing the skin with sharp objects.
- Hitting or punching.
Why would someone want to engage in self-harming behaviors?
Self-harm should not be confused with suicide attempts. Self-harm does not typically have a single cause. In most cases, self-harm is the result of a person’s inability to cope in healthy ways with painful or distressing emotions. Self-harm isn’t precipitated by one single emotion, but rather a combination of several negative emotions. An individual who engages in the act of self-harm is trying to escape from intense, negative feelings that they can’t otherwise express in healthy ways. They may use self-harm for the following purposes:
- As a release from emotional tension.
- As a way to punish themselves for perceived faults.
- To communicate their emotional distress to the outside world.
- To distract themselves from inner turmoil.
- As a way to break through the depression-induced emotional numbness.
- To find relief from severe distress or anxiety.
- Ritualistic self-harm can give someone a sense of control over their body, feelings, or situation.
Who is most at-risk of engaging in self-harming behaviors?
Children and adolescents are the most likely to self-harm when they are experiencing depression. Young people experience volatile emotions, but don’t often have the tools in place to handle complex, negative feelings in healthy ways. They may also not understand that what they are feeling is something as serious as clinical depression, and are reluctant to reach out for help. Other risk factors include:
- Neglect and abuse.
- Unstable or unsupportive family environments.
- Bullying.
- Issues with sexual identity.
- Having friends that engage in self-harm.
- Other unaddressed mental health issues – anxiety, borderline personality disorder, PTSD, and eating disorders.
Race and socioeconomic status are not significant indicators of self-harm. But young people who struggle with their sexual identity are the most at risk for engaging in self-harm. Young women who self-harm are more likely to cut themselves. Young men are more likely to bruise themselves, poison themselves with alcohol or drugs, or try to get other people to hurt them.
What is the link between depression and self-harm?
Self-harm by itself is not a mental illness, but self-harming behaviors are indicative of a more serious emotional disorder.
Major depression is characterized by several distinct symptoms that can compel a vulnerable individual to engage in self-harm.
- Irritability and anger.
- Worthlessness.
- Anhedonia and lack of emotional range and depth.
Feelings of intense anger or pain usually precipitate the urge to hurt oneself. Injuries can also release endorphins that will temporarily raise someone’s mood. In cases where a depressed person experiences a lack of emotions, self-harm can give them something to feel that can replace emotional numbness.
People who engage in self-harming actions can lead to intense feelings of guilt. This guilt can fuel and feed into depression, worsening the episode. If self-harming behaviors and the depression that causes them are left unaddressed, a one-off act of self-harm can turn into a dangerous habit.
Are self-harm and depression a problem in the US?
Self-harm amongst depressed adolescents and young people is common and a serious problem in the US. Clinical depression alone is one of the leading causes of disability in the country. A full third of college students who report self-injury had injuries so severe they needed medical attention. Studies indicate that out of all surveyed adolescents, 17% of adolescents have engaged in self-harming behaviors. Young people who are diagnosed with an anxiety disorder or other mental health condition are at increased risk of self-harm. Research also finds that people who hurt themselves as adolescents are at high risk of attempting suicide later in life.
How can someone help a person who is engaging in self-harming behaviors?
Self-harm, depression, and feelings of worthlessness are incredibly difficult things to talk about. When approaching someone about suspected self-harming behavior, it’s important to remain open-minded, calm, and supportive. Encouraging the individual to seek help from an experienced therapist or counselor is an effective strategy. People who engage in self-harming behaviors can be taught techniques to deal with their issues and adaptive ways to handle their negative emotions. A therapist can also get them diagnostic help in figuring out what mental health issues the person may be suffering from that is compelling them to harm themselves.
Underlying mental health conditions that are causing the self-injurious behavior can be effectively treated with a myriad of medications and therapeutic strategies. Psychodynamic therapy, cognitive behavioral therapy, and dialectical behavioral therapy can help someone manage overwhelming feelings and prevent them from engaging in self-harm. SSRIs and SNRI medications are usually the first line of defense for major depressive disorder. For depression that doesn’t go away with medication, deep brain stimulation techniques can help. Transcranial magnetic stimulation is highly effective at alleviating depressive symptoms.
Receiving early intervention for self-harming behaviors is the only course of action for preventing future suicide attempts. People who can get help for mental distress and learn healthy coping mechanisms for painful emotions can stop the self-injurious behavior and live a life free from depression.