Ronnie is an isolated woman who suffers from self-harm: she cuts and burns herself when relationships end and she periodically drinks and uses drugs excessively. She doesn’t have friends or outside support.
Currently Ronnie is in a group with other survivors of trauma who are also self-harmful. She describes herself as having a primary relationship with her dog. The group leaders and the group members have been very supportive of this relationship and Ronnie now brings her dog to the group with her. Although she is uncomfortable talking in the group, she has been willing to engage in group activities, such as breathing exercises, stretching, simple movement to music, outdoors explorations, and drawing.
For single adults like Ronnie, being in several types of groups or communities is especially helpful. Because these women are so isolated, often cut off from families, fearful of intimate relationships and even wary of commitment in friendships and/or one-on-one therapy relationships, finding connection in a group is both desirable and challenging.
It is important that the group not force any type of participation that is threatening. Sharing the stories of past pain and trauma may be overwhelming and create an increase in self-harmful activities. Groups that focus on self-care, non-verbal expression, and that give women new ways to understand and cope with their pain, are safer.
See our Trauma and Abuse Questions.
One in 12 adolescents self-harm but most will stop in early adulthood, according to a study of the scale of the problem and the reasons why young people want to hurt themselves.
The extent of the problem – which is worse among girls, of whom one in 10 self-harm – is exposed in the study published in the Lancet, which followed nearly 2,000 young people from the age of 14 to 29. It points to the emotional vulnerability of teenagers, prey not only to a maelstrom of hormonal changes but also complex developments of their brain. Many of the same young people who self-harm in secret are also drinking to excess, taking drugs and suffering depression and anxiety.
The study was carried out among young people in the state of Victoria in Australia, but the authors say the picture is no different in the UK.
These teenagers, said Professor George Patton, from the centre for adolescent health at the Murdoch Children's Research Institute in Melbourne, who is one of the authors, "could be said to be on a fast track to adulthood. They are the kids who are at the margins of their family, on the margins at school, who are engaging with early sexual activity, who are using drugs and alcohol from an early age. This group of kids is at the highest risk of self-harm. It may be something to do with the emotional hazards that they are facing at this age".
Such young people were identifiable and could be helped. "We are talking about a window of vulnerability which lasts through the mid-teens, where we believe a social scaffolding for young people is very important," he said. "By that I mean young people are going to be most protected from self-harm by good connections and good involvement with their families and good engagement and commitment with their school and good engagement with their peer group."
During puberty, said Patton, important changes to the brain take place, but the frontal cortex matures later than the limbic system, causing an imbalance. Added to that is what Dr Paul Moran, of the Institute of Psychiatry at King's College London, another of the authors, described as the "chemical melting pot" of hormonal changes.
Under those circumstances, a teenager exposed to stress and emotional difficulty could respond by self-harming. Moran talked of the importance of family factors. A lot was made of childhood maltreatment and abuse, but also important was "how affection is shared out in families – how striving behaviour is encouraged", he said. Teenagers may feel pressure on them to succeed. "Affection can be conditional on success. That can be very toxic in a family."
Self-harm is one of the strongest predictors of suicide, the authors say. It is especially common, and seems to be on the rise, among young women between the ages of 15 and 24. The study recruited nearly 2,000 schoolchildren in 1992 and tracked them through to 2008, collecting data nine times in total on a whole range of behaviours. Self-cutting and burning were the most common forms of self-harm in adolescence; some of the other methods included poisoning, overdosing and self-battery. Self-harm in adolescence was associated with depression and anxiety, antisocial behaviour, high-risk alcohol use (which doubled the risk), cannabis use and cigarette smoking.
Sue Minto, head of the NSPCC's ChildLine, which last year dealt with 30,000 contacts from children about self-harm, suicide and depression, said it was vital to find out why a child self-harms. "Something is obviously making them extremely unhappy or frightened and until this is resolved, it is likely they will continue to injure themselves or, in extreme cases, be driven to suicide," she said.
"Many of the children who contact ChildLine start to self-harm because they are being abused in some way. They need help to resolve these problems and they also need to be reassured that whatever is causing them deep anxiety is not their fault."
Lucie Russell, director of campaigns at Young Minds, said self-harming was very common and getting more common. "What's made it worse are the online communities around this. It is the same as with the pro-anorexia sites. It is about supporting each other, but it isn't always about supporting each other – it is about 'this is OK to do'." One of the reasons it appeared to be on the rise, she said, could be "that it is so pressurising, growing up in this society, with all the social networking and bullying as well".
Case study: 'I couldn't cope'
Helena Fraser started to self-harm when she was just 11 years-old, because she was being sexually abused by a teacher. "I didn't know how to cope with it and hadn't told anybody," she says. "I was on my own at the beginning of a lesson and I started prodding myself with a pair of scissors and I quite liked the sensation of it. By the time I was 14 years-old, I was cutting myself on a daily basis."
Fraser is 30 now. In 1992, when it began, she had never heard of self-harm. "It wasn't the sensation of the pain itself but the body's reaction," she said. "It was a kind of numbed feeling. When I hurt myself I felt I completely calmed down, my mind focused on the pain and the wound and made me very calm and All the other upsetting thoughts and troubles left my mind while I was focusing on the pain."
There is a misunderstanding that self-harm is an attempt for death, she says. "It really is the exact opposite. At times when I felt I didn't want to live any more, I would do it and feel more alive. It was a survival mechanism."
Fraser could not tell her parents or teachers, because she was ashamed. She loathed herself but she could not stop. "Now there are services like ChildLine and I feel if I could have talked to somebody online, I would have done. They wouldn't think I was a freak and the doctor wouldn't have taken me away."
She hid it for four years, until somebody at school suspected. The headteacher talked to her parents who, as she had feared, were angry and upset and did not understand. But they found her help. "And we got through it together," she says.
But it was hard. Fraser had become and addict. She would stop and then relapse. But now it has been seven years and, finally, she considers herself recovered. And her urgent message to those who self-harm as she used to is that there is real help available.