If you are thinking about suicide, READ THIS FIRST!
What is self-harm?
Self-harm is when you hurt yourself as a way of dealing with very difficult feelings, old memories, or overwhelming situations and experiences. The ways you hurt yourself can be physical, such as cutting yourself. They can also be less obvious, such as putting yourself in risky situations, or not looking after your own physical or emotional needs.
Ways of self-harming can include:
- cutting yourself
- poisoning yourself
- over-eating or under-eating
- burning your skin
- inserting objects into your body
- hitting yourself or walls
- exercising excessively
- scratching and hair pulling
After self-harming, you might feel better and more able to cope for a while. However, self-harm can bring up very difficult feelings and could make you feel worse.
If you self-harm, you may feel embarrassed or ashamed about it. You might be worried that other people will judge you or pressurize you to stop if you tell them about it. This may mean that you keep your self harming a secret. This is a very common reaction, although not everyone does this.
Other words that areused to describe self-harm
These terms were previously used to describe self-harm, but are now going out of use:
- deliberate self-harm (DSH): the word ‘deliberate’ tended to blame people for their self-harm
- suicide/Parasuicide: these suggested that harming yourself is the same as wanting to kill yourself – which is often not the case.
It happens more often in:
- young women
- prisoners, asylum seekers, and veterans of the armed forces
- gay, lesbian and bisexual people: this seems, at least in part, due to the stress of prejudice and discrimination
- a group of young people who self-harm together: having a friend who self-harms may increase your chances of doing it as well
- people who have experienced physical, emotional or sexual abuse during childhood.
Why do people self-harm?
There are no fixed rules about why people self-harm. For some people, it can be linked to specific experiences, and be a way of dealing with something that is happening now, or that happened in the past. For others, it is less clear. If you don’t understand the reasons for your self harm, it’s important to remind yourself that this is OK, and you don’t need to know this in order to ask for help.
Any difficult experience can cause someone to self-harm. Common causes include:
- pressures at school or work
- money worries
- sexual, physical or emotional abuse
- confusion about your sexuality
- breakdown of relationships
- illness or health problem
- difficult feelings, such as depression, anxiety, anger or numbness, experienced as part of a mental health problem.
Some people have also described self-harm as a way to:
- express something that is hard to put into words
- make experiences, thoughts or feelings that feel invisible into something visible
- change emotional pain into physical pain
- reduce overwhelming emotional feelings or thoughts
- have a sense of being in control
- escape traumatic memories
- stop feeling numb, disconnected or dissociated (see dissociative disorders)
- create a reason to physically care for yourself
- express suicidal feelings and thoughts without taking your own life
- communicate to other people that you are experiencing severe distress.
Does this mean I’m mentally ill?
Probably not – However, you may be depressed, have personality difficulties, find it difficult to get on with other people or have problems with alcohol and/or drugs. You could still do with some help.
Is self-harm the same as attempted suicide?
Usually not – But if you start to harm yourself, the risk of killing yourself is greater than for people who don’t self-harm. So anyone who self-harms should be taken seriously and offered help.
Warning signs that a family member or friend is cutting or self-injuring?
Because clothing can hide physical injuries, and inner turmoil can be covered up by a seemingly calm disposition, self-injury can be hard to detect. However, there are red flags you can look for (but remember—you don’t have to be sure that you know what’s going on in order to reach out to someone you’re worried about):
- unexplained wounds or scars from cuts, bruises, or burns, usually on the wrists, arms, thighs, or chest
- blood stains on clothing, towels, or bedding; blood-soaked tissues
- sharp objects or cutting instruments, such as razors, knives, needles, glass shards, or bottle caps, in the person’s belongings
- frequent “accidents-” – Someone who self-harms may claim to be clumsy or have many mishaps, in order to explain away injuries
- covering up – A person who self-injures may insist on wearing long sleeves or long pants, even in hot weather
- needing to be alone for long periods of time , especially in the bedroom or bathroom
- isolation and irritability.
Myths and facts about cutting and self-harm
Because cutting and other means of self-harm tend to be taboo subjects, the people around you—and possibly even you—may harbor serious misconceptions about your motivations and state of mind. Don’t let these myths get in the way of getting help or helping someone you care about.
Myth: People who cut and self-injure are trying to get attention.
Fact: The painful truth is that people who self-harm generally do so in secret. They aren’t trying to manipulate others or draw attention to themselves. In fact, shame and fear can make it very difficult to come forward and ask for help.
Myth: People who self-injure are crazy and/or dangerous.
Fact: It is true that many people who self-harm suffer from anxiety, depression, or a previous trauma—just like millions of others in the general population. Self-injury is how they cope. Slapping them with a “crazy” or “dangerous” label isn’t accurate or helpful.
Myth: People who self-injure want to die.
Fact: Self-injurers usually do not want to die. When they self-harm, they are not trying to kill themselves—they are trying to cope with their pain. In fact, self-injury may be a way of helping themselves go on living. However, in the long-term, people who self-injure have a much higher risk of suicide, which is why it’s so important to seek help.
Myth: If the wounds aren’t bad, it’s not that serious.
Fact: The severity of a person’s wounds has very little to do with how much he or she may be suffering. Don’t assume that because the wounds or injuries are minor, there’s nothing to worry about.
How does cutting and self-harm help?
In your own words:
I used to cut myself just so I could feel pain. [It] let me know I was real and I wasn’t in a dream.
I ‘needed’ to harm to punish myself for being what I believed then to be a terrible person and to clear the fog in my head. As soon as I did, I’d feel in control, calm and as though a reset button had been pressed in my head.
It’s important to acknowledge that self-harm helps you—otherwise you wouldn’t do it. Some of the ways cutting and self-harming can help include:
- Expressing feelings you can’t put into words
- Releasing the pain and tension you feel inside
- Helping you feel in control
- Distracting you from overwhelming emotions or difficult life circumstances
- Relieving guilt and punishing yourself
- Making you feel alive, or simply feel something, instead of feeling numb
Once you better understand why you self-harm, you can learn ways to stop self-harming, and find resources that can support you through this struggle.
If self-harm helps, why stop?
- Although self-harm and cutting can give you temporary relief, it comes at a cost. In the long term, it causes far more problems than it solves.
- The relief is short lived, and is quickly followed by other feelings like shame and guilt. Meanwhile, it keeps you from learning more effective strategies for feeling better.
- Keeping the secret from friends and family members is difficult and lonely.
- You can hurt yourself badly, even if you don’t mean to. It’s easy to misjudge the depth of a cut or end up with an infected wound.
- If you don’t learn other ways to deal with emotional pain, it puts you at risk for bigger problems down the line, including major depression, drug and alcohol addiction, and suicide.
- Self-harm can become addictive. It may start off as an impulse or something you do to feel more in control, but soon it feels like the cutting or self-harming is controlling you. It often turns into a compulsive behavior that seems impossible to stop.
- The bottom line: self-harm and cutting don’t help you with the issues that made you want to hurt yourself in the first place.
What help is there?
a. Talking with a non-professional
You may find it helpful just to talk anonymously to someone else about what is happening to you. Knowing that someone else knows what you are going through can help you to feel less alone with your problems. It can also help you to think about your difficulties more clearly – maybe even see ways of solving them that you wouldn’t think of on your own. You can do this on the Internet or by telephone. Some helplines are listed at the end of this leaflet.
b. Self-help groups
A group of people, who all self-harm, meet regularly to give each other emotional support and practical advice. Just sharing your problems in a group can help you to feel less alone – others in the group will almost certainly have had similar experiences.
c. Help with relationships
Self-harm is often the result of a crisis in a close relationship. If this is the case, get some help with sorting out the relationship – it may be more difficult in the short-term, but it will be better for you (certainly less dangerous) in the long-term.
d. Talking with a professional
One-to-one talking treatments can help, such as:
- problem solving therapy
- cognitive behavioral therapy
- psychodynamic psychotherapy.
e. Family meetings
If you are still living with your family, it may help to have a family meeting with a therapist. This can help to relieve the tiring, daily stress for everyone in the family. It is not always appropriate, for instance, if you are the victim of physical or sexual abuse within your family.
f. Group therapy
This is different from a self-help group. A professional will lead (or facilitate) the group to help the members to deal with problems they share, for example, in getting on with other people.
What works best?
There isn’t much good evidence yet of which therapies work well for people who have harmed themselves. However, what evidence there is, suggests that problem-solving therapy and cognitive-behavioral therapy are useful. A health professional will make suggestions based on your individual problems and on what is available locally.
When to see a doctor?
Getting appropriate treatment can help you learn healthier ways to cope.
- Reach out for help. If you’re injuring yourself, even in a minor way, or if you have thoughts of harming yourself, reach out for help. Any form of self-injury is a sign of bigger issues that need to be addressed. Talk to someone you trust — such as a friend, loved one, health care provider, religious leader or a school official — who can help you take the first steps to successful treatment. While you may feel ashamed and embarrassed about your behavior, you can find supportive, caring and nonjudgmental help
- Emergency help. If you’ve injured yourself severely or believe your injury may be life-threatening, call 911 or your local emergency services provider.
When a friend or loved one self-injures
If you have a friend or loved one who is self-injuring, you may be shocked and scared. Take all talk of self-injury seriously. Although you might feel that you’d be betraying a confidence, self-injury is too big a problem to ignore or to deal with alone. Here are some options for help.
- Your child. You can start by consulting your pediatrician or family doctor who can provide an initial evaluation or a referral to a mental health specialist. Don’t yell at your child or make threats or accusations, but do express concern
- Teenage friend. Suggest that your friend talk to parents, a teacher, a school counselor or another trusted adult
- Adult. Gently encourage the person to seek medical and psychological treatment.
When you want to harm yourself
The feelings of self-harm will go away after a while. If you can cope with your distress without self-harming for a time, it will get easier over the next few hours. You can:
- Talk to someone – if you are on your own perhaps you could phone a friend. Some helplines are listed at the end of this leaflet.
- If the person you are with is making you feel worse, go out.
- Distract yourself by going out, listening to music, or by doing something harmless that interests you.
- Relax and focus your mind on something pleasant – your very own personal comforting place.
- Find another way to express your feelings such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
- Give yourself some ‘harmless pain’ – eat a hot chili, or have a cold shower.
- Focus your mind on positive things.
- Be kind to yourself – allow yourself to do something harmless that you enjoy.
- Write a diary or a letter, to explain what is happening to you – no one else needs to see it.
When you don’t feel like harming yourself
When the urge has gone, and you feel safe, think about the times that you have
self-harmed and what (if anything) has been helpful.
- Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there.
- Think about where you were, who you were with, and what you were feeling?
- Try to work out why you began feeling like you did.
- Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn’t damage you.
- How did other people react?
- Could you have done anything else?
- Make an audio recording. Talk about your good points and why you don’t want to self-harm. Or, ask someone you trust to do this. When you start to feel bad, you can play this back to remind yourself of the parts of you that are good and worthwhile.
What if you don’t want to stop self-harming?
If you decide that you don’t want to stop self-harming, you can still:
- reduce the damage to your body (for example, by using clean blades if you cut yourself)
- keep thinking about possible answers to the things that make you harm yourself
- every so often, re-consider your decision not to stop.
Self-harm can be very damaging physically and psychologically – in the end, you’ll do better by stopping.
There are a number of questions to ask yourself to see if you are ready to stop. If you can honestly say YES to half of the questions below, or more, then why not try stopping?
- Are there at least two people who are willing to help me stop?
- Do I have friends that know about my self-harming who I can go to if I get desperate?
- Have I found at least two alternative safe ways that reduce the feelings that lead me to self-harm?
- Am I able to tell myself, and to believe, that I want to stop hurting myself?
- Can I tell myself that I WILL tolerate feelings of frustration, desperation, and fear?
- If necessary, is there a professional who will also give me support and help in a crisis?
If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Emergency Department. Many Emergency Departments now have easy access to a health professional who knows about self-harm, such as a psychiatric nurse, a doctor, or a social worker. They will be able to talk with you about how you are feeling, and to see if there are any ways of helping you. They should be able to properly assess all your needs, whatever they may be. You should be able to go through your assessment with them. Staff may want to go through a questionnaire with you, to try to judge how at risk you are.
What can I do if I know someone who self-harms?
It can be very upsetting to be close to someone who self-harms – but there are things you can do. The most important is to listen to them without judging them or being critical. This can be very hard if you are upset yourself – and perhaps angry – about what they are doing. Try to concentrate on them rather than your own feelings – although this can be hard.
- Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation onto other things.
- Take some of the mystery out of self-harm by helping them find out about
self-harm, perhaps by showing them this leaflet, or by using the Internet or the local library.
- Find out about getting help – maybe go with them to see someone, such as their GP.
- Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
- try to be their therapist – therapy is complicated and you have enough to deal with as their friend, partner or relative
- expect them to stop overnight – it’s difficult and takes time and effort
- react strongly, with anger, hurt, or upset – this is likely to make them feel worse Talk honestly about the effect it has on you, but do this calmly and in a way that shows how much you care for them
- struggle with them when they are about to self-harm – it’s better to walk away and to suggest they come and talk about it rather than do it
- make them promise not to do it again
- say that you won’t see them unless they stop self-harming.
- feel responsible for their self-harm or become the person who is supposed to stop them. You must get on with your own life as well. Make sure you talk to someone close to you, so you get some support.
Tips for talking about cutting and self-harm
- Focus on your feelings. Instead of sharing sensational details of your self-harm behavior—what specifically you do to hurt yourself—focus on the feelings or situations that lead to it. This can help the person you’re confiding in better understand where you’re coming from. It also helps to let the person know why you’re telling them. Do you want help or advice from them? Do you simply want another person to know so you can let go of the secret?
- Communicate in whatever way you feel most comfortable. If you’re too nervous to talk in person, consider starting off the conversation with an email or letter (although it’s important to eventually follow-up with a face-to-face conversation). Don’t feel pressured into sharing things you’re not ready to talk about. You don’t have to show the person your injuries or answer any questions you don’t feel comfortable answering.
- Give the person time to process what you tell them. As difficult as it is for you to open up, it may also be difficult for the person you tell—especially if it’s a close friend or family member. Sometimes, you may not like the way the person reacts. Try to remember that reactions such as shock, anger, and fear come out of concern for you. It may help to print out this article for the people you choose to tell. The better they understand self-harm, the better able they’ll be to support you.
Talking about self-harm can be very stressful and bring up a lot of emotions. Don’t be discouraged if the situation feels worse for a short time right after sharing your secret. It’s uncomfortable to confront and change long-standing habits. But once you get past these initial challenges, you’ll start to feel better.
There are a number of organizations you can contact that offer support and advice for people who self-harm, as well as their friends and families. These include:
- Samaritans – call 08457 90 90 90, email: firstname.lastname@example.org or visit your local branch
- Mind – call 0300 123 3393
- Harmless – email email@example.com
For more Self-harm hotlines, click here.
Compilation by Xiluva Costa