Page 55 - SEN114 September/October 2021

Self-harm
About the author
Beverley Samways is currently conducting research exploring the emotional experiences of people with severe and profound learning disabilities who self-harm. She is a PhD researcher at the School for Policy Studies, University
of Bristol. She is funded by the Economic and Social Research Council.
beverley.samways@bristol.ac.uk @BeverleySamways
“they experience emotions building up inside them like an internal pressure”
or ‘digested’, and we often need help to do this. People with learning disabilities who self-harm have reported that they experience emotions building up inside them, like an internal pressure, leading to them becoming overwhelmed. This mirrors the experiences of people without learning disabilities who hurt themselves.
Adverse experiences
People with learning disabilities also report that adverse experiences are related to self-harm, including experiences of abuse and loss. People with learning disabilities are at greater risk of adverse experiences in every category: they are more likely to have experienced stigma and discrimination; they are at greater risk of abuse; they are more likely to find difficult experiences traumatic; and when they experience loss, they are less likely to have the symptoms of grief recognised as such. Just as people without learning disabilities make connections between adverse experiences and self-harm, so do people with learning disabilities.
Articulating emotions
People with and without learning disabilities who self- harm report that they have difficulty articulating emotional experiences. Complex emotions, such as loss, disappointment, stress, anxiety and anger, can be difficult to find words for; this is sometimes called alexithymia. For those with learning disabilities who have limited communication, this might seem like a straight forward connection. However, people without learning disabilities who self-harm similarly report difficulty articulating what an emotion is and what it feels like. Therefore, difficulties understanding and explaining emotions is a factor for self-harm for people regardless of learning ability.
Others factors for self-harm
It is well documented that people with learning disabilities sometimes resort to extreme self-injury to both mitigate and communicate severe pain, particularly internally experienced pain, such as dental and ear pain. We also know that people with learning disabilities who experience sensory hypersensitivity or dysregulation (including issues with the internal proprioceptive and vestibular senses) sometimes self-injure to try to regulate their senses. Self-injury is also commonly a way for someone with learning disabilities to communicate a need, whether it is to avoid something aversive or gain something needed.
However, the reports of people with learning disabilities who self-harm tell us that - alongside physical pain, sensory issues, and established behavioural functions – overwhelming emotions connected to adverse experiences should also be considered.
In short – just as I threw my coffee across a café because of something that happened six months ago – so unusual behaviour needs to be considered not just in relation to what happened immediately before and after the behaviour, but in relation to a person’s life experiences and
associated emotions.
The principles behind functional analysis are inarguable – self-harm undoubtedly serves a function for each individual. However, the focus on ‘antecedents, behaviour and consequences’ – what happens before, during and after the behaviour – limits possible causes of self-harm to immediate factors only. The evidence from self-reported reasons for self-harm from those with learning disabilities is that the possibility of overwhelming emotion in relation to adverse experiences should also be considered.
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■ Talking to a counsellor. senmagazine.co.uk