Self-harm

PLEASE READ

If you are self-harming, or care about someone who is, it can be upsetting and potentially triggering to read about self-harm. In the event that you’re feeling vulnerable at the moment, you might want to read this article at a time when you don’t feel distressed.

The information and self-help support provided in this article is not a substitute for seeking medical assistance or advice if required. If you are having thoughts of harming yourself you should seek professional assistance urgently. Call NHS Direct on 111 or the emergency services on 999 if the situation is urgent. If you feel you are unable to keep yourself or others safe then you should attend A&E.

What is self-harm?

Self-harm describes the act of hurting oneself in order to cope with emotional pain or overwhelming situations. Some people explain self-harming as a way to help them to:

  • Feel more in control of their emotions
  • Reduce the intensity of their emotions
  • Express emotional pain that they find difficult to put into words
  • Avoid processing difficult feelings, events or situations
  • Feel better about their life in that moment
  • Feel something other than emotional pain
  • Express sadness, hopelessness or fear to themselves or others around them.

A person may feel a sense of relief after self-harming, but the cycle is likely to continue if the causes of their emotional pain remain unchecked and unexplored.

What causes people to self-harm?

Some people find it difficult to express their feelings or feel so overwhelmed by their life circumstances that self-harm seems to be the only way to feel better in the moment. It’s often not just one stressor that a person is facing that causes them to self-harm, but a combination of factors, including, but not limited to:

  • Being bullied at school, work or home
  • Living in a domestically abusive situation
  • Being a member of a community susceptible to stigma or marginalisation such as LGBTQIA
  • Distress over cultural or societal expectations
  • A traumatic event such as physical or sexual abuse – either recent or in the past
  • Experience of loss such as bereavement, divorce or separation
  • Depression, anxiety or another mental health condition (although having a mental health condition doesn’t necessarily mean someone will self-harm)
  • Living with borderline personality disorder
  • Being a young person who is not under the care of their parents, or a young person who has recently left a care or foster home.

How do people self-harm?

Because descriptions of ways in which people self-harm can be triggering, this article doesn’t describe methods. However, self-harm encompasses anything someone does with the intent of hurting themselves including high-risk behaviours such as sexual promiscuity, taking recreational drugs, binge drinking, speeding, driving while under the influence, as well as methods more commonly associated with self-harm.

Myths about self-harm

Self-harm is:

  • NOT attention seeking or manipulative. In fact, the majority of self-harming behaviours are hidden from others and most often occur in private.
  • NOT a mental health problem. Instead, self-harm is a symptom that someone is distressed and needs support.
  • NOT something that affects only young people. People of all ages and from all walks of life use self-harm to cope.
  • NOT necessarily a sign that someone is suicidal. Granted, the person may feel like ending their life, but self-harming is their way of coping with these feelings.
  • NOT harmless. In fact, people can lose their lives when self-harming if they aren’t aware of how to stay safe.
  • NOT forever. There is support and help for people who self-harm and wish to stop.
  • NOT something about which to feel ashamed. It’s a way of coping, although there are other, healthier ways to deal with distress.

How common is self-harm?

Despite the common belief that self-harm occurs only among adolescent girls, it’s important to know that boys, men and women may also self-harm. However, because self-harm remains stigmatised and often hidden, we are unsure as to the exact number of people affected. It is estimated that about one in ten young people will self-harm at some point (with first incident taking place at around 12 years old). It’s also believed that about 17% of people aged between 16 and 74 have self-harmed at some point in their lives, although only half of these have sought help from a professional.

Signs that someone may be self-harming

Looking out for our friends, family members and colleagues is really important. If you notice any of the following signs it is important not to jump to any conclusions, but these might be warning signs that they could potentially be self-harming:

  • Unexplained marks, cuts, bruises or burns usually on someone’s wrists, arms, thighs and chest
  • Staying fully covered at all times, even in hot weather
  • Negative self-talk and self-blame
  • Keeping sharp objects on hand
  • Frequent reports of accidental injury
  • Engaging in high-risk behaviours such as driving while under the influence of drugs or alcohol, or speeding
  • A decline in wellbeing such as low mood, tearfulness, withdrawal from other people, or a lack of motivation or interest in usually pleasurable activities
  • Withdrawal from other people or difficulties with peers, colleagues and family members
  • Changes in eating or sleeping routines
  • Behavioural and emotional impulsivity and unpredictability
  • Statements of hopelessness or worthlessness
  • Talking about self-harming or suicide
  • Alcohol or drug misuse
  • Signs of low self-esteem such as blaming themselves for any problems, or saying they are not good enough.

It’s critical to note that some people who self-harm show no signs whatsoever – there are many people who go to great lengths to hide it. And of course, some of the signs listed above may also be indicative of another issue such as domestic abuse, child abuse or another problem.

If you self-harm and want to stop

Whatever your age or walk of life, confidential help and support is available whenever you feel ready. The longer self-harm continues, the higher the risk of a critical, possibly life-threatening injury, and the more difficult it is to stop. So, it’s important that you seek help as soon as you feel the time is right for you.

You might want to start by telling a trusted friend or family member that you’re struggling – either in person, or via letter or email if that feels more comfortable for you. You can even ask a close friend to tell someone else on your behalf. There is no need to go into detail as to how you self-harm. What’s more important is that you no longer feel alone and have someone on hand to talk to about how you’re feeling. If you’re worried that the person you’re going to tell won’t understand, or will judge you, you can send them this guidance before you speak.

In addition, you might want to see your GP or practice nurse, remember you can always take a friend or family member with you to support you. If you seek help from your GP, they will need a greater understanding of what’s happening in your life, and what triggers you to use self-harm. It may be that you don’t know why you feel the way that you do, and that’s okay – be as open as you can with them so that they can offer you the best route of help.

Your GP will also ask about your mental health to see if you have any symptoms that need to be treated. You might be offered medication or referred for counselling with a professional who is experienced and skilled in helping people to stop self-harming.

Cognitive behavioural therapy (CBT) has been found to be very helpful for people who want to identify alternative coping methods to self-harm. CBT helps people to build problem-solving skills and stress management techniques to reduce, and finally stop self-harming. Other forms of counselling can also help you to identify the problems that are causing you distress and leading you to self-harm. Your GP will help you to decide what the best course is for you.

It’s really important to remember that you won’t always feel the way you do now. The emotional pain that is causing you to self-harm can, with the right kind of help and support, become more manageable over time – or even go away. Things can and do get better. People recover from self-harm and go on to live happy, fulfilled lives.

Self-help for self-harming

If you find yourself having an urge to self-harm but want to resist, you may find some of the following distraction techniques from the Mental Health Foundation helpful:

  • Write down thoughts and feelings that are distressing you. Crumple the page up, rip it apart and throw the pieces in the bin as a way to let go of that thought.
  • Get some playdough: stretch it or squeeze it to relieve tension.
  • Hit a pillow or cushion to vent your anger and frustration.
  • Have a good scream into a pillow or cushion.
  • Take a minute to breathe or meditate.
  • Go for a walk to take yourself away from triggers. Being in a public place can give you the time and space to reduce the urge to hurt yourself.
  • Make lots of noise, either with a musical instrument or just banging on pots and pans.
  • Scribble on a large piece of paper with a crayon or pen.
  • Call a friend or family member and have a chat; you don’t have to talk about self-harm or anything distressing.
  • Do something creative: make a collage of colours to represent your mood or to remind you of your favourite people, places and things.
  • Listen to music you like or watch a film you enjoy.
  • Contact one of the charities listed below to talk through your feelings; they will listen non-judgementally and suggest the best routes to help.

The following charities offer specialised guidance, support and information for people who are self-harming, as well as those who want to help them.

  • SelfharmUK supports young people impacted by self-harm.
  • Harmless provides a range of services about self-harm and suicide prevention.
  • YoungMinds is for young people and their parents, teachers, friends and carers.
  • LifeSIGNS offers online help about self-harm.

How can I help someone who is self-harming?

People stop self-harming when they feel they are ready, so telling them to ‘just stop it’ isn’t helpful. In fact, if you take the method of self-harming away from someone before they access professional help and learn new ways of coping, they may revert to another way of self-harming which can be dangerous, as they may hurt themselves even more than they mean to.

You might be the first person they have been able to talk to about this issue so be sure to remain non-judgemental, even if you feel uncomfortable with the subject of self-harm. It’s best to support the person in a non-judgemental way while encouraging them to speak to someone best placed to help them to explore alternatives to self-harm.

You might find it helpful to read this guide from LifeSIGNS on supporting people who self-harm before you approach the person.

Some tips for talking to someone about self-harm

Ideally, you will have set aside distraction-free time for a face-to-face discussion, and it can be helpful to ask the person where they’d like to speak – giving them a choice is very empowering. Acknowledge how difficult it must be to open up about their self-harm but don’t focus on or encourage them to tell you details about specific injuries or behaviours. Instead talk about how they are feeling and what they are going through.

Other pointers include:

  • Do your best to not react to whatever they’re telling you with shock or judgement. This might be very difficult for someone who has never come across self-harm, but keep in mind that this is a coping mechanism they’re using to deal with difficult emotions – not something to be judged.
  • Acknowledge that you understand that self-harm is their way of coping and you’re interested to know what they’re finding difficult about life at the moment so that you can help them to find support. 
  • Don’t ask about how they self-harm – they’ll share this with you if they want to.
  • Reassure them that you are there for them and will never give them an ultimatum to stop. This approach can drive self-harm underground, and they may not discuss the topic with you again.
  • Resist the urge to control the outcome. You can suggest they get in touch with their GP (and offer to go with them), or offer to sit with them while they contact one of the organisations listed above. Remember, they’re in control of the pace and might need time to think about it.
  • Be positive and let them know that you’re not judging them but want to help however they want you to.