Depression and self-harming

Self-harm is defined as intentionally directly injuring one’s body surface, usually without intention* of suicide. Self-harm occurs relatively commonly, with some studies showing that up to 13-23% of people have engaged in this behavior in their lifetime. Self-harm is most common in adolescents and young adults, but can occur in people from other age groups. Those who engage in these activities may have depression, other mental health disorders such as anxiety, or no clinical diagnosis. Some of the young adults we interviewed in this study described self-harm activities as part of their experience of depression.

Why people self-harm

There were several reasons why people said they self-harm. Of the people we interviewed, one group of young adults started injuring themselves as a way to manage intense emotions. Ryan describes: “I started feeling hopeless again and a lot more depressed than I had in my entire life. And I became very self-destructive. I started doing things like hitting myself and I really didn’t realize why I was doing it.” Crystal, who experienced abuse as a childhood, began to associate pain with emotions that she could not name.

Sierra Rose used self-harm to cope with anger.
Interview Transcript

I went to school one day, ended up talking to a girl, I wouldn’t necessarily call her a friend, but an acquaintance, and she pulled out a razor and she sat there and she started cutting her arm, she said, I asked her, “Why are you doing that? Why do you do that?” And she said, “Because it makes the anger go away.” And that was the spark in my head. It was, this is something that can help, I was so angry all the time and I just wanted it gone and so I started cutting. I had, we had fish, we had razors to scrape the algae off the side of the fish tank, well I, just, you know those were the only thing sharp I could find in my house, so I grabbed one of those and took it to my room and I started cutting then.

DEP Sierra Rose
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 11

Background: Sierra Rose lives in an apartment with her boyfriend, another roommate, and three beloved cats. She spent a week in the hospital shortly before her interview, and was continuing with out-patient care but struggling to pay for some of it. She is Italian and Jewish.

Click here to view Sierra Rose's profile page

Another group of young adults described engaging in self-harm because pain was something they could feel in the midst of the “flat emotions” that often go along with depression.

Crystal managed her emotions about past abuse by using self-harm.
Interview Transcript

I realized without that abuse as present in my life as it was before, that I actually needed it, and what I mean by that is that I needed to express in other ways. And so part of me at least, how I, you know talked about this with my therapist and how I understand is, that to replace the abuse that I had before, I abused myself. And so that is when, you know, active suicidal attempts, and cutting and everything, and self-harm, that’s when that arose because I just needed something, and what’s interesting is that, when I have panic attacks, I tend to really tense up and then I claw at myself, just because I’m just like, “I need something to hurt me.” Because when I was little, if I didn’t know what was going on or I thought that I did something wrong, I would expect to be hurt in some way, right?

DEP Crystal
Profile Info
Age at interview: 20
Sex: F
Age at diagnosis: 15

Background: Crystal is an African American college student. She works campus jobs during the year and internships in the summers.

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Other young adults described turning to self-harm to deal with a specific intense emotion or negative core belief. Devin describes feeling “like he was not good enough for his parents”. Here, Sierra Rose describes learning about cutting from an acquaintance and trying it as a way to deal with the anger she was feeling.

Brendan describes his experience using self-harm to manage a break-up.
Interview Transcript

Well, one of two biggest depressive episodes of my life. And it stretched on for several months, throughout basically being age 15. And — getting over her took a very long time and I’m still not sure I totally did it [laughs], which very much informs where I’m at now. I definitely think nowadays that part of my depression is that — it’s, you know, it’s the one — it’s that she’s the one that got away. There was no reason why the relationship couldn’t have worked out besides just pure circumstance. And because we never — we never really, really went for it because we couldn’t really ever go all in, there was always something in the way. So we can’t even say that it didn’t work or that it wouldn’t work, you know, makes it hard to move on. But yeah, that, that led to just a huge depressive episode that, as I said, went on for months. It was very interesting — at that time, you know, I’d begun. I’d begun cutting myself a little bit for the first time in my life.

DEP Brendan
Profile Info
Age at interview: 21
Sex: M
Age at diagnosis: 15

Background: Brendan has three jobs and is a fulltime college student and musician. He lives in an apartment with a roommate. Ethnic background is White.

Click here to view Brendan's profile page

(For more information about relationships, see ‘Depression and relationships’).

The addictive nature of self-harming behavior

Because self-harm can provide a temporary reprieve from disagreeable emotions it can often lead to cravings to engage in more self-harm and difficulty stopping*1. Sierra Rose describes that her “cutting is just as addictive as alcohol” and she has relapses. Similarly, Ryan describes that despite telling himself “I don’t want to do this…it just got worse”.

Self-harm as a sign of the seriousness of depression

For many people in our study self harming was a sign of the seriousness of their depression. Teddy describes “I kind of slipped back into my depression it got really, really bad to the point where I started cutting.” Sometimes self harm prompted a person to seek help or others to seek out help for that person. Many people said a family member or friend noticed signs of self-harming such as the cuts on their skin and became concerned. People we interviewed also thought that sometimes parents blamed themselves for the self-harm. Kate describes that once she realized this was hurting her father she “decided at that point she wanted to stop”. Other people described however that their parents thought “it was a phase” or did not know how to respond to this behavior.

Mara describes how self-harm was difficult for her parents to understand and a visit to the emergency room led to her getting professional help.
Interview Transcript

So basically what happened was that, they realized I had been self-harming from a very young age. So it was at that point when, when I was 14 years old that I had an episode that required me to go to the emergency room. And immediately following that, they realized, “our daughter has a problem,” and they wanted me to start seeking help for it. Partially ’cause they were concerned and partially ’cause they were so distraught, so I, I think that’s just kind of what instigated everything, and instigated sort of like my experience with health care professionals.

DEP Mara
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 14

Background: Mara is a student at a large university. She lives in a dorm room on campus. She is Vietnamese and White.

Click here to view Mara's profile page

Treatment for self-harm

Certain kinds of therapy and medication can help self-harm*2. Crystal identified the origins of her self-harm behavior through therapy: “to replace the abuse that I had before, I abused myself”. Mara felt her self-harm was rooted in something deeper than the desire to express her emotions, and said medication helped her in addition to “going to regular therapy and having someone to talk to”.

For more about treatment for depression, see ‘Therapy and counseling’ or ‘Depression, medication and treatment choices’.

References

*Jacobson, Colleen M., and Madelyn Gould. “The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature.” Archives of Suicide Research 11.2 (2007): 129-147.

*1Victor, Sarah Elizabeth, Catherine Rose Glenn, and Elisha David Klonsky. “Is non-suicidal self-injury an “addiction”? A comparison of craving in substance use and non-suicidal self-injury.” Psychiatry research 197.1 (2012): 73-77.

*2 Hawton, K., et al. “Psychosocial and pharmacological treatments for deliberate self harm.” Cochrane Database of Systematic Reviews 3 (1999).

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