Practicing acts of self-harm, and having suicidal thoughts can be an extremely painful experience. Contrary to certain myths and misconceptions, people who go through self-harm and/or suicidal thinking are not doing so in order to seek attention. The reason why most people engage in behaviours of self-harm is because they are experiencing such intense emotional pain, that they feel the only way to handle it is to transform it into physical pain. Similarly, most people who have suicidal thoughts do not want to die: they feel that they cannot deal with the intense pain in their life, that there is no solution to the problems they are facing, and think that the only way for them to find relief, is to escape the situation. But because they are feeling trapped in this situation, they believe that the only way of escaping is by ending their life. Some people might wrongly accuse those who are suffering from suicidal thoughts that they are being selfish for not thinking about the consequences their death would have for the ones they’ll leave behind. But in reality, people who are contemplating suicide are not doing so out of selfishness, but out of desperation. They truly believe that there is no other way for them to escape the pain. Fortunately, there are ways to deal with negative life events and situations, and to get over suicidal thinking and behaviours of self-harm. And, contrary to ending one’s own life or harming oneself, these are constructive, positive ways. If you want to find out more about ways of escaping an abusive relationship, please click here and here.

Being in an abusive relationship can be stressful and painful enough to cause someone to experience suicidal thinking or to engage in acts of self-harm. Indeed, enduring domestic violence has been found to be a risk factor for suicide [1], and being exposed to a violent intimate relationship is associated with self-harm and attempted suicide [2] with 25% of victims of domestic assault engaging in self-harming behaviours [3]. The most common reason why Pakistani women commit attempts of deliberate self-harm has been found to be experiencing domestic violence. The abuser is most commonly the husband, followed by in-laws and parents [4]. Most attempters of deliberate self-harm may have experienced more than one form of domestic violence [5] as we need to bear in mind that apart from physical violence, verbal and emotional abuse is common and these can also lead to feelings of intimidation, emotional trauma, depression, and suicidal attempts [6]. In fact, 60% of Pakistani women who were victims of domestic violence were found to be suffering from depression, and 65% had anxiety [7]. This is a very important finding, since suicidal thinking and self-harming behaviours do not appear all of a sudden: in most cases they appear along with other disorders such as depression and anxiety. For instance, it has been found that victims of domestic violence who are suffering from symptoms of Posttraumatic Stress Disorder (PTSD) are at risk of attempting suicide [8], with PTSD sufferers 15 times more likely to have attempted suicide [9].

Going through self-harm and suicidal thinking can be very lonely. Yet, if you are suffering from such thoughts and behaviours, you do not need to go through this difficult time alone. Even if you are afraid that the people who are close to you will judge you for your feelings, or simply will not understand you, know that there are others out there who can and want to help you. Professional psychotherapists will listen to your problems in a non-judgemental, caring manner with complete confidentiality. Because suicidal thinking and self-harm manifest along with mood and anxiety disorders as we mentioned above, treating those disorders automatically reduces the self-harming behaviours and suicidal thoughts. You can learn about the most widely used types of treatment available to see which one you’d be the most comfortable with by clicking here. Cognitive Behavioural Therapy (CBT) in particular has been found to be tremendously effective in treating suicidal thinking [10][11][12]. The reason behind this could be the fact that CBT focuses on restructuring our negative thought patterns and behaviours, replacing them with realistic, positive ones. It also helps us realise that things we may perceive to be threatening and cause us fear and anxiety, in many cases are only threatening in our mind. By giving us the skills to retrain or brain into thinking in a realistic manner, the downward spiral of depression and anxiety is broken and we feel more and more empowered. Moreover, through CBT one can learn ways of coping with emotional distress, and improve their problem solving skills and social support so that they no longer feel lost, hopeless, alone, or trapped in any given negative situation [13].

It has been suggested that the more fear a woman has experienced during a traumatic event, the more powerless she experiences herself to be and the less likely she is to try to defend herself [14]. Thus, victims of abuse should not feel responsible for ‘allowing’ their abuser to mistreat them by not fighting back. Abusers will most of the times, if not always, accuse their victims for their abusive behaviour, claiming that they were asking for it, that they brought it on themselves, that they deserved it. Over time, these utterly false claims can brainwash their victims into believing them to be true and making them feel guilty or ashamed, which can be detrimental in more ways than one. First of all, feeling extreme guilt or shame after experiencing a traumatic event such as domestic abuse, increases the risk of developing PTSD [15] and, as we mentioned earlier, suffering from PTSD raises the likelihood of experiencing suicidal thinking. Secondly, feeling as though they caused the abusive behaviour, victims of domestic abuse have the false hope that if they are careful enough and do not upset their abuser, there will be no more abusive episodes. In reality, abusers will continue to be abusive and will even set their victims up for failure in order to justify their abusive behaviours. Thirdly, by taking the blame and feeling as if they deserve to be treated badly, victims of domestic abuse are less likely to leave the abusive relationship simply because they have come to believe that their abuser is not the problem: they are. Even though this is certainly not true, one can realise how trapped a person would feel while living in an environment such as this.

If you are going through self-harm and/or thinking about suicide, you may be feeling that you have reached a dead-end, that there is no hope that things will get better. When people are having suicidal thoughts or engage in self-harm, the unpleasant emotions they have can nurture negative thoughts that are not true (for example, ‘there is no way to change my life, my only solution is to kill myself’) while blocking the realistic, positive ones (for instance, ‘I am going through a hard time at the moment, but there are ways to deal with it; all I need to do is to make a plan and talk to those who can help me turn my plan into reality’). But you need to remember that emotions change with time: just as there was a time when you didn’t have suicidal thoughts or self-harming behaviours, there will also come a time when you once more won’t have them. Your current situation doesn’t have to predict your future, and you have already taken a step towards improving your future by visiting Chayn. People overcome such negative life experiences and there are people who can help you get through this as well. If you want to talk to someone about how you are feeling, you can send an anonymous, confidential e-mail to jo@samaritans.org You can find more about the Samaritans by clicking here. If you want to simply get things off your chest, you could always write about your feelings, your situation, and anything else you want to talk about on our Catharsis Room by clicking here and then decide whether you want it permanently deleted or anonymously published on Chayn. Finally, if you can spare five minutes of your time, please feel free to read through a small passage on suicidal thinking by clicking here.

If you know someone who is suffering from suicidal thinking and/or is deliberately harming themselves, recognise that they probably feel very lonely and vulnerable, so they need someone they can trust to listen to them in a non-judgemental way. They need to feel that they are not alone, that there are people who care about them and who accept them unconditionally. Please do not try to advise them on what they should and shouldn’t do as that can feel patronising, and don’t ‘shower’ them with questions since that might sound as if you are trying to interrogate them. Furthermore, please don’t buy into the myth that ‘those who truly want to kill themselves, don’t tell about it to anyone’ or that ‘if they’ve told you they want to kill themselves, they don’t really mean it; they’re just seeking attention’, because that is certainly not true. In fact, almost three quarters of those who commit suicide have talked about their intentions in advance [16] [17]. After all, as we mentioned earlier, most people who think about killing themselves do not really want to die. They simply feel that they cannot cope with their life. They are not thinking about committing suicide out of selfishness, but out of desperation. So if someone has confessed to you that they deliberately harm themselves or are thinking about taking their own life, please do not take it lightly and do not scold them for it, because the last thing they need is to feel even more isolated and alone. Remember that this is their cry for help therefore try to approach them with sensitivity. Self-harm and suicidal thinking are not signs of weakness, so the solution for people who go through these situations is not to ‘be tough’, ‘stop complaining’, ‘carry on’ and ‘just deal with it’. These people are overwhelmed by negative emotions and thoughts, and are most likely suffering from depression and/or anxiety. Luckily, with proper social support there are ways to overcome these issues. Have hope and be strong for those you care about who cannot feel strong at the moment.

If you want to learn more about the most widely used types of psychological treatments, please click here.


REFERENCES

[1] Ali, B.S., Rahbar, M.H., Naeem, S., Tareen, A.L., Gul, A., & Samad, L. (2002) as cited in Haqqi, S. (2008). Suicide and Domestic Violence: Could There Be a Correlation? The Medscape Journal of Medicine, 10(12), 287.
[2] Barrios, L.C., Evertt, S.A., Simon, T.R., & Brener N.D. (2000) as cited in Haqqi, S. (2008). Suicide and Domestic Violence: Could There Be a Correlation? The Medscape Journal of Medicine, 10(12), 287.
[3] Boyle, A., Jones, P., & Lloyd, S. (2006). The association between domestic violence and self harm in emergency medicine patients. Emergency Medicine Journal, 23, 604-607.
[4] Khan, M. (1998) as cited in Chowdhury, A.N., Brahma, A., Banerjee, S., & Biswas, M.K. (2009). Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal. Indian Journal of Psychiatry, 51(2), 96-100.
[5] Chowdhury, A.N., Brahma, A., Banerjee, S., & Biswas, M.K. (2009). Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal. Indian Journal of Psychiatry, 51(2), 96-100.

[6] Sheikh, M.A. (2000, 2003) as cited in Haqqi, S. (2008). Suicide and Domestic Violence: Could There Be a Correlation? The Medscape Journal of Medicine, 10(12), 287.
[7] Niaz, U. (2003) as cited in Haqqi, S. (2008). Suicide and Domestic Violence: Could There Be a Correlation? The Medscape Journal of Medicine, 10(12), 287.
[8] Jones, L., Hughes, M., & Unterstaller, U. (2001). Post-Traumatic Stress Disorder (PTSD) in victims of domestic violence. Trauma, Violence, & Abuse, 2(2), 99-119.
[9] Davidson et al. (1991) as cited in Jones, L., Hughes, M., & Unterstaller, U. (2001). Post-Traumatic Stress Disorder (PTSD) in victims of domestic violence. Trauma, Violence, & Abuse, 2(2), 99-119.
[10] van der Sande, R., Buskens, E., Allart, E., van der Graaf, Y., & van Engeland, H. (1997) as cited in Kring, A.M., Johnson, S.L., Davison, G.C., & Neale, J.M. (2010). Abnormal Psychology (11th ed.). Asia: John Wiley & Sons, Inc.
[11] Brown, G.K., Ten Have, T., Henriques, G.R., Xie, S.X., Hollander, J.E., & Beck, A.T. (2005). Cognitive therapy for the prevention of suicide attempts. Journal of the American Medical Association, 294, 563-570.
[12] Joiner, T.E.J., Voelz, Z.R., & Rudd, M.D. (2001). For suicidal young adults with comorbid depressive and anxiety disorders, problem-solving treatment may be better than treatment as usual. Professional Psychology: Research and Practice, 32, 278-282.
[13] Kring, A.M., Johnson, S.L., Davison, G.C., & Neale, J.M. (2010). Abnormal Psychology (11th ed.) (p.250). Asia: John Wiley & Sons, Inc.
[14] Jones, L., Hughes, M., & Unterstaller, U. (2001). Post-Traumatic Stress Disorder (PTSD) in victims of domestic violence. Trauma, Violence, & Abuse, 2(2), 99-119.
[15] Riggs et al. (1992) as cited in Yehuda, R. (Ed.). (1998). Psychological Trauma, Review of psychiatry series volume 17, Washington, DC: American Psychiatric Press, Inc.
[16] Fremouw, W.J., De Perzel, M., & Ellis, T.E. (1990) as cited in Kring, A.M., Johnson, S.L., Davison, G.C., & Neale, J.M. (2010). Abnormal Psychology (11th ed.). Asia: John Wiley & Sons, Inc.
[17] Shneidman, E.S. (1973) as cited in Kring, A.M., Johnson, S.L., Davison, G.C., & Neale, J.M. (2010). Abnormal Psychology (11th ed.). Asia: John Wiley & Sons, Inc.