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Trigger warning: This article talks about self-harm.
We’re in the midst of a mental health crisis, with the traumas of this year building on troubles Americans already faced. The coronavirus pandemic and the national reckoning with racial injustice have led to painful emotional and behavioral struggles ― including thoughts of self-harm, according to recent data.
Like most mental health issues, thoughts and behaviors around self-harm exist on a spectrum, said Racine Henry, a therapist and owner of Sankofa Marriage and Family Therapy in New York.
“Thoughts of self-harm can be as subtle as ‘I wonder how my friends would react if I wasn’t alive anymore’ and as blatant as hiding self-inflicted wounds,” she said.
There’s also a difference between suicidality and non-suicidal self-injury ― that is, hurting yourself and/or having thoughts of self-harm. Both should be addressed.
“Self-harm is an unhealthy coping method that can be fatal but it is not always intended to be such. Someone in danger [of suicide] has the intention of no longer living and is willing to bring about that reality through their own actions,” Henry explained.
Any thoughts of self-harm should be addressed ASAP. They don’t need to be fatal in order to deserve attention. If you just started experiencing these thoughts recently ― or if you’ve had them for a while ― below is some more advice from experts.
First things first: Acknowledge what’s happening.
The most important thing you can do when you have thoughts of self-harm is to recognize that they’re happening ― especially before they get any worse.
“If you are struggling with your feelings and you begin to think to yourself, ‘If I hurt myself, would that take the pain away?’ that is your first sign that something could be wrong,” said Dan Reidenberg, executive director of Suicide Awareness Voices of Education. “You might not actually engage in any self-harming behaviors, but the idea that you have thought of it is your ‘yellow caution light’ that you need to talk to someone before it progresses to actual self-harm.”
Focusing your thoughts elsewhere, even for a few minutes, can help you manage them better in the moment, said Craig Bryan, a professor of psychiatry and behavioral health at Ohio State University focusing on stress, trauma and resilience.
“Some people listen to uplifting music, some people go for a walk, some people watch a funny TV show,” Bryan said. Reaching out to someone who can take your mind away from the harmful thoughts may also be useful, he added.
These are not long-term solutions, but they can help you cope right now so you have more time to address what’s going on.
Identify what triggered those thoughts.
Henry recommended asking yourself a few questions to track the mental process that led you to the harmful thoughts: Are you having these thoughts at a particular time of day? Are you triggered by reading or seeing stories of people inflicting self-harm? Do you find yourself purposely holding back thoughts or not fully expressing yourself to people you trust?
Sometimes you may not even realize that your mental health is deteriorating, but Henry said there are subtle signs that could indicate something is up.
“Potential red flags can be beginning to neglect responsibilities or habits, even small habits like grooming, with the thought that ‘it doesn’t really matter,’” she said. “You don’t have to be sad or withdrawn to have harmful thoughts of self-harm. I believe the red flags can be better recognized by the feeling you get from these thoughts. You may have a sense of relief because this is something you can control and having these thoughts may bring the comfort of having a plan or an answer.”
“You don’t have to be sad or withdrawn to have harmful thoughts of self-harm.”
Tell someone you trust about what’s going on.
It’s important to not keep harmful thoughts a secret ― even if you believe you’re not going to act on them. At the very least, these thoughts are a warning sign that you’re struggling with your mental health, and support can help.
The person you confide in should be someone you trust who is mature and makes you feel safe. This individual should be someone who will listen to you without judgment, can hold space for this type of heavy conversation, and will help you find ways to manage your mental health.
If you know someone who has experienced similar thoughts before and you believe they’re able to talk with you, it might be worth reaching out to them as well, Reidenberg said.
Most importantly, be explicitly clear about what you’re thinking and feeling.
“This is really important because research shows that some self-harming behaviors can become addictive and when or if that happens, you might not be the best reporter of how serious the situation is,” Reidenberg said. “You want to be honest and complete in what you are telling those you trust.”
Talk with a mental health professional.
It’s useful to confide in a loved one, but in the long term, one of the most effective ways to address these thoughts is through therapy.
“Speaking to a mental health professional does not necessarily mean you will be given medication, or that you are going to act on the thoughts, or that you will be admitted into a mental health facility,” Henry said. Your therapist will work with you on a treatment plan that’s specifically tailored to your needs.
Bryan recommended looking for mental health professionals who have training in treatments like dialectical behavior therapy (DBT), brief cognitive behavioral therapy for suicide prevention (BCBT) or the collaborative assessment and management of suicidality (CAMS). Though people differ, these methods have been shown to help deal with suicidal and other harmful thoughts, he said.
Once you start your sessions, it’s important to be completely honest with your therapist. No level of detail is off-limits. The more you tell them, the more they’ll be able to help you.
“In your conversations, be honest and tell everything. If you only tell half of what is going on for you, that doesn’t help you or the person you are talking with about this issue,” Reidenberg said. “Let them know what you are thinking, how often, what triggers the thoughts, if anything has helped you keep them away or not. If you have self-harmed, make sure you are honest about that too.”
“In your conversations, be honest and tell everything. If you only tell half of what is going on for you, that doesn’t help you or the person you are talking with about this issue.”
Finally, know that you aren’t bad or abnormal for experiencing these thoughts, and you don’t have to live with them forever.
You’re not a terrible person, crazy, unworthy ― or anything else your brain is telling you ― for struggling with your mental health. Thoughts of self-injury have occurred in many people and there are ways to manage them.
“If you have just for the first time thought about hurting yourself, it is really important to know that this happens to others too and it does not mean you are going to die or that there is something wrong with you that can’t be addressed and helped,” Reidenberg said. “It is really important for you to know that while it might be scary, and on some level it might feel like a relief to believe you can get the pain to go away, self-harming is not a healthy behavior nor is it a good coping mechanism.”
There are people out there who do care about your well-being, even if your brain is telling you that no one does.
“I want you to know there are people who see value in you existing and are willing to support you until you can get to a better place,” Henry said. “You don’t have to be happy tomorrow and you aren’t wrong for how you currently feel. But if you want to try, if you have even the smallest hope left, feeling better is possible.”