Self-harm is when somebody intentionally damages or injures their body. It is a way of coping with or expressing overwhelming emotional distress.
Sometimes when people self-harm they intend to die but often the intention is more to punish themselves, express their distress or relieve unbearable tension. Self-harm can also be a cry for help.
If you are self-harming, you should see your GP for help. You can also call the Samaritans on 08457 90 90 90 for support or visit the website of Mind (a mental health charity) for further advice.
Your GP will usually offer to refer you to healthcare professionals at a local community mental health service for further assessment. This assessment will result in your care team working out a treatment plan with you.
Treatment for people who self-harm will usually involve seeing a therapist to discuss your feelings and thoughts and how these affect your behaviour and wellbeing. If you are badly depressed it could also involve taking antidepressant medication.
Why people self-harm
Self-harm is more common than many people realise, especially among younger people. A survey of people aged 15-16 years carried out in the UK in 2002 estimated that more than 10% of girls and more than 3% of boys had self-harmed in the previous year.
In most cases, people who self-harm do it to help them cope with unbearable and overwhelming emotional issues, caused by problems such as:
social factors – such as being bullied, having difficulties at work or school, or having difficult relationships with friends or family
trauma – such as physical or sexual abuse, or the death of a close family member or friend
mental health conditions – such as depression or borderline personality disorder
These issues can lead to a build-up of intense feelings of anger, hopelessness and self-hatred.
Although some people who self-harm are at a high risk of ending their lives, many people who self-harm do not want to end their lives. In fact, the self-harm may help them cope with emotional distress so they don't feel the need to kill themselves.
Types and signs of self-harm
There are many different ways people can intentionally harm themselves, such as:
cutting or burning their skin
poisoning themselves with tablets
misusing alcohol or drugs
deliberately starving themselves (anorexia nervosa) or binge eating (bulimia nervosa)
People often try to keep self-harm a secret because of shame or fear of discovery. For example, they may cover up their skin and avoid discussing the problem.
Therefore, it is often up to close family and friends to notice when somebody is self-harming, and to approach the subject with care and understanding. The signs may include unexplained injuries and signs of depression or low self-esteem.
Someone who is self-harming can seriously hurt themself, so it is important that they speak to a GP about the underlying issue and request treatment or therapy that is likely to help them.
Signs of self-harm
There are many different forms of self-harm and they are not always easy to notice.
People who self-harm usually try to keep it a secret from their friends and family and often injure themselves in places that can be hidden easily by clothing.
If you suspect that a friend or relative is self-harming, look out for any of the following signs:
unexplained cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
keeping themselves fully covered at all times, even in hot weather
signs of depression, such as low mood, tearfulness or a lack of motivation or interest in anything
becoming very withdrawn and not speaking to others
changes in eating habits or being secretive about eating, and any unusual weight loss or weight gain
signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough for something
signs they have been pulling out their hair
signs of misuse of alcohol or drugs
Helping someone who self-harms
If you are worried about someone who is self-harming, there are a some things you can do to help them:
make time to gently and sympathetically discuss the problem with them and listen to what they say without judging them or being critical
try to appreciate how difficult they are finding life and show them you understand
discuss the possibility of seeking professional help
get medical help if any injuries are serious
It's important not to react in a strongly negative or critical way (such as getting angry), as this kind of reaction is likely to make the problem worse.
If they don't want to discuss their self-harm with you, you could suggest they speak to an anonymous helpline or see their GP.
Causes of self-harm
There are many reasons why people self-harm and these can change over time, but the causes usually stem from unhappy emotions.
Self-harming has been described as a "physical expression of emotional distress". Some people find that the physical act of hurting themselves helps them deal with overwhelming emotional and psychological issues.
If you are feeling like this, you can speak to your GP, call the Samaritans on 08457 90 90 90 for support or visit the website ofMind, a mental health charity, for further advice.
Social factors and trauma
Research has shown that social factors commonly cause emotional distress in people who self-harm. These include:
difficult relationships with friends or partners
difficulties at school, such as not doing well academically
difficulties at work
being bullied, either at home, school or work
worries about money
alcohol or drug misuse
coming to terms with your sexuality if you think you might be gay or bisexual
coping with cultural expectations, for example, an arranged marriage
Self-harm could also sometimes be a way of coping with a traumatic experience. For example:
sexual, physical or emotional abuse, including domestic abuse and rape
the death of a close family member or friend
having a miscarriage
The distress from a traumatic experience or an unhappy situation can lead to feelings of low self-esteem or self-hatred. You could also have feelings of:
loneliness or isolation
numbness or emptiness
feeling unconnected to the world
being unclean, unworthy, trapped or silenced if you have been abused
The emotions can gradually build up inside you, and you may not know who to turn to for help. Self-harm may be a way of releasing these pent-up feelings. It can be a way of coping with overwhelming emotional problems.
Self-harm is linked to anxiety and depression. These mental health conditions can affect people of any age. Self-harm can also occur alongside antisocial behaviour, such as misbehaving at school or getting into trouble with the police.
In some cases, there may be a psychological reason for the self-harming. For example:
you may hear voices telling you to self-harm
you may have repeated thoughts about self-harming and feel like you have to do it
you may disassociate (lose touch with yourself and your surroundings) and self-harm without realising you are doing it
it can be a symptom of borderline personality disorder (a condition that causes instability in how a person thinks, feels and behaves)
It is important for anyone who self-harms to see their GP. They can treat any physical injury and recommend further assessment if necessary.
Your GP is likely to ask you about your feelings in some detail. They will want to establish why you self-harm, what triggers it and how you feel afterwards.
Your GP may ask you some questions to see if you have an underlying condition such as depression, anxiety or borderline personality disorder. If the way you self-harm follows a particular pattern of behaviour, such as an eating disorder, you may be asked additional questions about this.
Your height, weight and blood pressure may also be checked, and you may be asked about any drinking or drug-taking habits.
It is important that you are honest with your GP about your symptoms and your feelings. If you don’t know why you self-harm, tell your GP this.
After an initial assessment, your GP should offer to refer you for a further assessment with healthcare professionals at a local community mental health service.
This assessment, which may take place over several meetings, is used to find out more about you and your self-harming behaviour. The results of the assessment will be used to help determine the treatment and support you need.
During an assessment, you will usually be asked about:
your physical health
your relationships with others and your living arrangements
the methods you have used to self-harm
how often you self-harm
any specific events or feelings that occur before you self-harm
any things you have tried to help reduce your self-harming
whether you think you will self-harm again
why you think you are self-harming
whether you have thoughts of ending your life
Any further treatment will normally be decided jointly between you and your team of healthcare professionals. It will be a specific programme for you according to your needs and what is likely to be effective. You will be asked for your consent before any treatment begins.
Your care plan
In most cases, psychological treatment (also known as talking treatment) is recommended for people who self-harm.
Psychological treatments, such as cognitive behavioural therapy (CBT), involve sessions where you meet with a therapist to talk about your feelings and thoughts and how these affect your behaviour and wellbeing. Evidence suggests these kinds of treatments can be effective in the long term for people who self-harm.
If you have a mental health problem such as depression, borderline personality disorder or schizophrenia, your treatment plan may involve medication as well as psychological treatment.
If psychological treatment is recommended, you will usually have a number of sessions with a therapist.
Once treatment finishes, you and your care team should discuss steps you can take to deal with any further crises and you should be told how to contact your care team if necessary.
Specialists involved in your care
During your assessment and treatment, there are a number of different healthcare professionals you may see, such as:
a counsellor – somebody who is trained in talking therapies
a psychiatrist – a qualified medical doctor with further training in treating mental health conditions
a psychologist – a health professional who specialises in the assessment and treatment of mental health conditions by talking (usually CBT)
You may also see some other specialists, depending on the underlying reasons why you self-harm.
For example, if you have lost a close relative, you may be referred to a specialist bereavement counsellor for help coping with bereavement. If you are self-harming after an incident of rape, or physical or mental abuse, you may be referred to someone who is trained in dealing with victims of sexual assault or domestic abuse.
If you have another condition that is linked to your self-harming, such as anorexia nervosa or bulimia, you may be referred to a specialist ineating disorders and a dietitian or nutritionist.
It might also be recommended that you attend a self-help group, for example, Alcoholics Anonymous if you are misusing alcohol, or Narcotics Anonymous if you are misusing drugs. These groups can offer support as you try to stop your self-harming behaviour.
Seeking immediate help for an injury or overdose
Some physical injuries may need treating in an accident and emergency (A&E) department, minor injuries unit or walk-in centre. For example, you may need to call 999 for an ambulance if:
you or somebody else have taken an overdose of drugs, alcohol or prescription medication
somebody is unconscious
you or somebody else are in a lot of pain
you or somebody else are having difficulty breathing
you or somebody else are losing a lot of blood from a cut or wound
you or somebody else are in shock after a serious cut or burn
If your injury is not serious, you could be treated at a minor injuries unit (MIU). These healthcare services are run by doctors or nurses to assess and treat minor injuries, such as minor burns and scalds, infected wounds and broken bones.
walk-in centres, where a nurse can treat you without appointment, are also available for minor cuts and bruises.