Spotlight on self-harm

I followed some breadcrumbs from Impacted Nurse's site to find this article on self-harm. It's not a pretty topic, but we're seeing more and more of it in health care settings. I wonder if kids read about it and decide to try it. But still, I'm glad information is getting out. It's a problem.

Image from

Image from

I clicked on the link hoping to find some nonsensationalistic information, because in the ER we are seeing a LOT of self-harm, particularly in tweens. I feel like self-harmers roughly fall in two categories: those who legitimately use it to make themselves feel better and, now, those who have heard about it and do it to physically show others how much emotional pain they're in. Note that I did not say "just to get attention." Because I think if someone goes to that much trouble to get attention, probably they do need some attention, although maybe not the kind they're shopping for.

What I've NEVER seen is a wrist-scratcher who is really suicidal. People who die from self-harm aren't "cutting." They don't mess around, and the method is largely irrelevant; they could just as easily have hung themselves or shot themselves. It's a totally different phenomenon.

Still, self-harm buys patients some serious freaking out from nearly everyone involved, and I can't remember any screeners or physicians asking why the cutter is cutting. They ask "were you trying to kill yourself?" And the answer doesn't even matter, because if you so much as drag a safety pin across your wrist, you WILL be hospitalized. They should be asking "what caused you to do this? What does it do for you?" The answers to those questions will allow actual help.

It is annoying to be working in a busy ER with actual traumas and sick people and have to drop it all to spend a huge amount of resources on a bratty 13-year-old prima dona who is having a meltdown because she cut herself. It is. But those of us who work with psych patients need to open our minds about self-harm, and we need to start by stopping our knee-jerk reaction that the patient is suicidal. Most likely they aren't. Do we really need to pull out all the stops by making them 1:1 and putting them in a safe room? Maybe not. Most self-harmers are very secretive and ritualistic about their self-harm. It is highly unlikely they're going to engage in those self-soothing rituals in an ER.

Perhaps we could start mentally categorizing self-harm as a kind of deranged self-soothing rather than self-harm. It can look shocking, but people do all kinds of harmful things to themselves to self-soothe that just happen not to leave scars (when you get down to it, getting drunk is literally pouring poison into yourself until you lose consciousness!).