This theme captured something about the act of self-harm itself as well as the implications for the disclosure process. Participants reflected on the nature of self-harm as a private behaviour that left them feeling alone and disconnected. The fact that self- harm is often so private runs counter to disclosure which is an interpersonal process. Hence, there is an inherent tension in the act of self-harm disclosure, whereby a very personal experience is being shared interpersonally. This theme had two sub-themes, ‘Disconnected’ and ‘Concealing self-harm’.
Disconnected
Participants felt disconnected from other people due to the private and insular nature of self-harm. Participants described how they felt disconnected from others prior to disclosure:
“Self-harm feels really kind of insular, it feels like a world by yourself pretty much and you lock yourself away and self-harm and you don’t tell anyone and no one else in the world does it; it’s just you.” (Adam)
“It’s sort of a closed kind of closet feeling.” (Anne)
Some participants wanted to keep their self-harm private and did not feel a need to talk about their self-harm:
“It’s kind of unspoken, I just feel like it’s something that doesn’t need to be spoken about, for me it’s a very private thing, it’s always been my secret.” (Martin)
Whereas for other participants feeling disconnected and isolated with their self- harm was what influenced them to disclose:
“I definitely felt very isolated with regards to my self-harm and I didn’t want to be alone with it anymore, so I told my friend.” (Becky)
Whilst receiving a supportive response resulted in one participant feeling less disconnected, receiving an unsupportive response, after disclosing to some friends at University, left another participant feeling rejected and more disconnected:
“This is what I get from telling people, from telling close friends, to just kind of break that a little bit was, kind of yeah, it was just making the world a little less insular and it really helped.” (Adam)
“It was like my first time away from home, I felt a bit like a failure, like rejected and stuff, things like that because I’d lost quite a few friends just by being open about self- harming.” (Matthew)
Although many participants described the insular nature of their self-harm, one participant did not talk about having the same hidden, insular reality the other
participants experienced, either from those around him or internally. Self-harm had been normalised in his social context, which he felt had influenced him to be open in
disclosing his self-harm to others and his disclosure experiences were different because of this:
“I suppose I was brought up in a household where self-harm and especially big scars on the body were almost cool. My [relative] who raised me…was a beautiful man; he was covered in them: massive scars from self-harm and it almost felt like a kind of rite of passage, a coming of age.” (Ben)
Concealing self-harm
Almost all participants spoke about ways in which they concealed their self- harm from others, maintaining the insular nature of self-harm, through either hiding or lying about their self-harm. Concealing self-harm was a constant pressure and part of many of the participants’ experiences. Some participants concealed their self-harm for many years prior to disclosing. For participants who had disclosed their self-harm to some people in their social network, they still concealed it in other aspects of their life, such as at work or in certain relationships. Moreover, some participants continued to conceal their self-harm from significant people such as their closest friends and family. Participants often experienced an inner tension as they had a desire to keep their self- harm private, but also perceived lying and secrecy to be shameful. Concealing self-harm made participants feel disconnected in their relationships because they could not be authentic and lying to conceal self-harm disconnected participants from their own values. Participants described the secretive nature of self-harm, particularly among adults:
“I think it’s very much something that isn’t talked about in the adult population and
isn’t seen; I think it’s hidden a lot. I think people who self-harm can be very secretive about it, and I don’t think that’s necessarily very healthy. I think that can be self- feeding.” (Anne)
Participants spoke about how adult self-harm is also concealed in the media. If self-harm is represented in the media it is framed as a teenage female phenomenon, which may make it more difficult for adults, particularly males, to be open about their self-harm:
“No one ever talks about self-harm and it seems like depression and anxiety’s like this
nice thing, not nice but it’s like consumable for people to understand and take on but we stop that conversation as soon as we start going down self-harm like no one ever talks about self-harm on radio or TV and if they do they frame it within, like a teenage girl kind of thing.” (Adam)
“Self-harm in the context of 14-year-old girls seems to be fairly well publicised but
actually anybody who makes it out of their teens and still self-harms is seen as a bit crackers.” (Anne)
Most participants concealed their self-harm at work, even if they disclosed their self-harm in other areas of their lives. Some participants described work as a gossipy
environment and also worried about being discriminated against if their self-harm was discovered:
“ Once I went back to work I eased off using my arms because I don’t think work would
be supportive.” (Anne)
“I am very careful to not let anyone at work see.” (Jane)
Participants described the internal conflict and shame they felt about lying and creating stories to explain away their injuries in order to keep their self-harm concealed:
“There wouldn’t be no benefit of telling him [brother], but the benefit to me would be not to lie to him, cos at the moment it’s a lie, it’s the shame, I don’t like it, don’t like it, but it’s the easiest way to cover it up.” (Peter)
Participants who regularly told pre-planned lies about their injuries, reflected on an incongruence they experienced between the type of person they believed they were and their behaviour, which did not match their beliefs and values. In some cases, this disconnect influenced their decision to disclose their self-harm:
“To carry that secret with you and all the lies and all the crap that comes with it…
that’s a really nasty side of it… the whole thing didn’t sit well; you know all the hiding and the lying and all the deception… It really didn’t match with where I was and what, you know how I felt about life and myself so that was the big catalyst at that point.” (Wendy)
Participants also spoke about the frustration in concealing their self-harm because they were not able to self-harm in the way they wanted to:
“I always had to make sure there was a way to hide it, you know I used to cut under my watch and stuff like that cause I wear my watch all the time…it was really frustrating, you know I was really frustrated that I couldn’t cut the way I wanted to cut to get the benefit out of it.” (Wendy)
Participants described the many situations in which they had felt forced into telling a lie when they were questioned by others about their injuries. In these cases, participants had an instinctive reaction to a situation where they may get ‘outed’:
“I think I said something really instinctive. I said I cut myself shaving when I don’t shave my legs so like what a stupid thing to say. I’d lied but there was no kind of pre- plan to the lie. It was just like, you can’t just turn round and say, ‘oh, yeah, I cut myself; I self-harm.’ You can’t do that… but at the same time you can’t just ignore it and not say anything cause, you know it’s just a weird thing to do. So, I think an instinctive
made up lie came into my head that was clearly implausible, but it kind of bated it away.” (Adam)
Some participants who were not in intimate relationships wondered about future relationships and the prospect of feeling disconnected to a partner through not being truthful:
“Thinking into the future, I feel like dating would be hard because at what point would you raise it… I’ve got a strong feeling you can’t lie in a relationship because it’s not a relationship if you’re not fully truthful, but then it’s like when, how early into that relationship do you bring it up; would they still want to be with you after they know that.” (Matthew)
This theme captured reasons as to why someone may or may not disclose their self-harm. There appears to be a push and pull of external and internal factors. Feeling disconnected because of the insular nature of self-harm may serve as a barrier to
disclosure but can also act as a prompt for disclosure. Sometimes participants disclosed to others to feel less alone and more connected. Receiving a positive response made participants feel less disconnected but an unsupportive response left participants feeling more disconnected. Concealing self-harm through telling lies, challenged participants’ internal sense of self, disconnecting them from their values and pushing them to disclose, with the hope that this would bring their behaviour more in line with their values, helping them to feel congruent. The insular, often hidden nature of self-harm made it particularly difficult to disclose and is important to understanding disclosure and the risks that disclosing entails.