‘Tis the season of self harm or is it?

The run up to Christmas and New year a time of great joy, of parties and seeing family, of eating, drinking and being merry. A time of general excess followed swiftly by the making of new year’s resolutions or not and of not keeping them. In fact it is also a time when we all think about loneliness, lost love ones and being depressed and the combination of the two which can be seen to result in intentional self harm.

‘Intentional self harm,’ brings all sorts of things to mind for me however I do wonder if to others it doesn’t; or at least not as much as I would hope it would. It seems that when people talk about self harm they often refer only to those who attempt or succeed in taking their own lives however it would be unfair and inaccurate to say that self harmers want to end their own lives. If anything it is their attempt at helping themselves, a way to bring order and control and feeling better. The fact is we all take part in behaviours that are harmful to us, although for most of us these behaviours are not seen as a real problem.

For some of those people they would be quite correct, their forays into harmful behaviours are not a problem however it is to the others in that group whose behaviour is a result of trying to feel more in control or reduce uncomfortable feelings and who are not consciously aware that they are doing it that people are concerned about. For these people it is a problem, it is their coping strategy their way to feel better and if it becomes their only way then they may be in serious trouble. It is estimated that about 1 in 10 young people will self-harm at some point but it can happen at any age Self harm is also used as an indicator of risk for suicide

The most reliable figure for risk of suicide after deliberate self-harm in the UK was based upon a sample of patients identified in the early 1970s ( Hawton & Fagg, 1988): 1% had died by suicide within a year

From BJPsch

however they note that there are no recent statistics on the extent of risk from self harm. This article estimates that there was

The overall age-standardised risk of suicide in the first year after self-harm was 66 (95% CI 52–82) times the annual risk of suicide in the general population of England and Wales during the study period (based on averaging rates for 1978, 1988 and 1998). In males it was 64 (95% CI 46–85) times the general population risk and in females it was 90 (95% CI 62–126) times the risk. The relative risk increased with age. In those aged 10–24 years at initial presentation the risk was 35 (95% CI 16–79) times the population risk in males and 75 (95% CI 35–157) times the risk in females, whereas in those aged 55 years and over the comparable figures were 131 (95% CI 68–252) for men and 158 (95% CI 85–294) for women.

The study population was comprised of people admitted to hospital and identified as having intentionally self harmed themselves as such draws on people who would be considered to be severely self harming.

Often considered a problem of the young self harming is in fact a problem for all ages and in recent times it has been seen to be on the increase. From the Hospital Episode Statistics (NHS information centre hospitaladmission rates ,

Hospital Episode admission rate seasonal variationStatistics, NHS information centre,

 Hospital episodestatistics online )

Year	2006-2007	2007-2008	2008- 2009	2009- 2010	2011-2011	2011-2012
Total	94382	97871	102667	107182	110490	110960
% increase from previous year		3.7%	4.9%	4.4%	3.1%	0.4%

Total % increase in self harm admission since 2006 17.6% which to my mind is pretty horrific. (please forgive the figures but it seems the ratification process has meant that some of them have changed and it’s been difficult to work out exactly which ones are the most up to date and which refer only to hospital stays rather than attendance at A&E.)However these figures are from people who require hospital attention and as such do not include what I feel are the vast majority of people who self harm.

Despite this the figures show that the largest percentage of admissions were in the 15-19 age group and that it had also seen the largest decrease in admissions in the 12 months to Aug 2012 from the previous 12 month period of 6.7% (or 1130 admissions). Rather significantly I feel the largest increase was in the 55-59 age group where there was an increase of 12.1% (from 460 admissions to 1130) Unfortunately there was no other information about this age group published so it is difficult to draw an conclusions as to why however this group are approaching retirement which suggest that it might be income related.

Equally the data shows that the largest admission rates for self harm occur in the North and lowest in London and the counties immediately surrounding it showing an increase in areas of high poverty and with few opportunities to improve the situation.

And lastly please again not that the data shows quite clearly that although self harm varies with the season it is July and not Dec that has the highest admission rates.

Why exactly this should be?

Well I would suggest that this has more to do with the fact that everyone seems to think that Dec is the worst time for people and that they pay far more attention to being nice to people, visiting family and seeing each other than at any other time of year.

This said I am still only talking about admissions to hospital and as I have said this is really just the tip of the iceberg when it comes to self harm.

So what is Self harm?

The intentional harm to oneself by ones own actions

Very broad description and I would like you to consider exactly what this could mean. So many people I have met would say they don’t self harm and yet when I ask them about certain behaviours they not only do not understand it but didn’t consider that they were harming themselves by doing it. This is a quote from the student room on line

People may injure or poison themselves by scratching, cutting or burning their skin, by hitting themselves against objects, taking a drug overdose, or swallowing or putting other things inside themselves. It may also take less obvious forms, including taking stupid risks, staying in an abusive relationship, developing an eating problem, such as anorexia or bulimia, being addicted to alcohol or drugs, or simply not looking after their own emotional or physical needs

You could also add to this, starting arguments/ fights, exercising to excess, setting impossible goals, perpetual one night stands, working too harm.

The question is when do these behaviours become a problem?

Clearly if you’re taking a blade to your skin or deliberately hitting yourself, starving yourself or throwing up it is easy to say it’s a problem however for other types of harm it isn’t so easy. When does exercising become excessive, or working too many, or arguing become a problem? And I don’t think there is an easy answer to it. I could glibly say it takes you to recognise that you are doing it for your own ends, to avoid how you feel, to feel better but it’s not so easy to recognise that, that is what you are doing.

So at a time of year when eating, drinking and being merry are high on everyone’s agenda I wonder if despite the lack of serious life threatening self harm occurring that in fact people are finding other outlets. That more people are self harming but with less obvious results, however if could be that with more outspokenness about loneliness, poverty and stress, and increased awareness of emotional hardship we are reaching out to each other to give and receive more comfort, love and support than we do at any other time of year and this relieves the pressure that we would have otherwise done by self harming.