Self-harm

This factsheet aims to explain self-harm. You will find a description of self-harm, its symptoms and the treatments available. If you are a person who self-harms, you will find suggestions about self-help and the support options open to you. You will also find ideas on how friends and family may help.

What is self-harm?

Self-harm is the deliberate physical harming of a person’s own body. This can be done in a variety of ways including:·

Cutting
Burning
Scalding
Scratching
Hair pulling
Bruising
Inserting objects
Ingesting toxic substances

Why do people self-harm?

Self-harming behaviour is an expression of underlying mental or emotional distress. Often people may feel that they have no other way of coping with the pressures in their lives. People who self-harm may have low self-esteem, feel isolated, pressured at work or study, be bullied, have family problems or a history of physical or sexual abuse. People may often have another mental health issue to deal with, and conditions such as eating disorders or substance abuse frequently co-exist with self-harming behaviour. There are many reasons why people may self-harm, including:·

To distract from emotional pain

To punish themselves
To relieve tension or stress
To communicate their distress to other people
To take control when they feel powerless
To feel real if they are feeling numb or remote from the world around them
To nurture themselves through caring for their wounds

Is self-harm the same as attempted suicide?

People who self-harm do often have suicidal feelings, but this must not be assumed. In some instances the intent of self-harming is to inflict the least possible amount of damage, and as such can be seen as an exercise in self-restraint or damage limitation. Self-harm may be a survival strategy for someone who does feel suicidal, enabling them to have some form of release for their distress and helping them get through a period of suicidal or other very distressing feelings.

How common is self-harm?

Self-harm generally affects more women than men, and younger people are more likely to self-harm than older people. It is difficult to estimate the numbers of people who self-harm since many keep it hidden. Some may never seek treatment, while others may present at accident and emergency departments claiming “accidental” injuries. Many people may harm themselves in such a way that they either do not need medical treatment or they can treat their injuries themselves. It is known that at least 140,000 young people present at casualty departments in the UK each year as a result of self-harm but it is believed that the actual incidence of self-harm is much higher.

What treatments are available?

Many people who self-harm find it difficult or embarrassing to talk about. People often try to hide the fact they self-harm and may be very reluctant to seek medical treatment for the physical harm, or psychological treatment for the behaviour itself. Sometimes people are reluctant to seek medical treatment for their injuries because of unsympathetic reactions they have received from medical staff in the past. Most people seeking help would initially access services via their GP or their local accident and emergency service. Some people may then be referred to a psychiatrist or a member of the local Community Mental Health Team for more specialised help. Depending on your symptoms, the severity of the condition, and your circumstances, the doctor may suggest medication, some form of talking treatment or a combination of both.

Talking treatments
Talking treatments alone can be effective in tackling self-harm for some people, for others a combination of talking treatments and anti-depressant drugs may be most effective. Talking treatments aim to help people recognise the stress factors in their lives and work out coping strategies in order to be able to deal with these.

A wide variety of talking treatments are available, ranging from counselling and psychotherapy to dialectic behaviour therapy (DBT). A referral for talking treatments can be arranged by your doctor. However, frequently there are long waiting lists for these types of treatment on the NHS. Free or low-cost counselling is also provided by a number of charities and voluntary organisations and, for those who can afford to pay, there are many private practitioners.

For more information on talking treatments please see: Talking Treatments

Drug treatments
Antidepressant drugs are the most commonly prescribed treatment for self-harming behaviour. Antidepressants affect the chemicals in the brain that regulate your mood. These drugs can be effective in treating the distress underlying self-harming behaviour, however, they are not in themselves a cure for self-harm. This is why talking treatments are often prescribed in conjunction with antidepressants, so that people can be helped to address the reasons why they self-harm in the first place. As with any medication, some people may experience unwanted side-effects. If this happens to you, it is important that you discuss this with your doctor as they may be able to prescribe a different antidepressant drug for you. There are several different types of antidepressant drugs available. Some types are more appropriate and effective for some people than others and it can take a bit of time to find the right one.

For more information on drug treatments please see: Medical Methods of Treatment

Admission to hospital
In extreme cases of self-harm, in-patient hospital treatment may be appropriate. This could occur when the physical harm caused requires treatment, where the person is so emotionally distressed that they cannot cope at home, or where the person is assessed as being at a high risk of suicide.

Hospital admission can provide someone with levels of care and attention that could not be provided at home. It can give medical staff the opportunity to accurately assess a person’s condition over a period of time, and to provide a broader range of drug treatment than might be possible at home.

Most people who are admitted to hospital go in voluntarily. However, in some extreme situations you can be admitted to hospital compulsorily under the Mental Health Act 2007 England & Wales, or the equivalent in Scotland and Northern Ireland.

Which treatment may be right for me?

Individuals respond to different treatments in different ways. What works well for one person may not work well for another. Speaking to your doctor will help you weigh up the pros and cons of the different treatments available. Your doctor should be able to provide you with information on how treatments work, how effective they are, and what side-effects you may experience. Drug treatment may be extremely effective for some people, while others may find talking treatments the best option. Sometimes a combination of drug treatment and talking treatments may work most successfully.

What can I do to help myself?

There are many ways in which you can help yourself cope with self-harm. It is important that you come to understand the nature of your condition, its causes and triggers. If you can recognise the early signs of a relapse or deterioration in your mental health, you can seek help and treatment before your condition worsens.

When you feel like self-harming, it can be difficult to see beyond the day-to-day problems in life. It can be very difficult finding the energy and motivation to actively try to help yourself. However, if you are able to take an active part in your treatment it may help your situation improve.

Find ways to harm yourself less

Find other ways to vent your anger and relieve tension: slam doors, throw pillows
Exercise can release adrenaline and endorphines that can make you feel better
Try to share the emotional pain with someone you trust, a friend or counsellor
Draw on your body with markers or paint instead of cutting yourself
Make use of telephone helplines, chatrooms, discussion boards, or other sources of support
Keep busy and try to distract yourself
Hold something that feels comforting
Rub ice on your skin where you might usually cut
Put elastic bands on wrists etc and flick them instead of cutting

Self-help groups
Many people find it helpful to meet with others in a similar position. It can be very useful to share experiences with those who may be going through the same thing you are. There are opportunities for mutual support, and you may get ideas of what things other people have found helpful to them. Above all, it is an opportunity to help you realise that you are not alone in how you are feeling.

Care for yourself
When you feel like harming yourself it is extremely important that you care for yourself. Many people lose the motivation to look after themselves properly. However, people generally feel better if they eat properly, pay attention to their physical appearance, and don’t abuse alcohol or drugs. Be kind to yourself, allow yourself treats, and try not to isolate yourself from other people. It may be worth ensuring you have a good understanding of basic first aid and appropriate supplies, so that if you do harm yourself, you are able to tend to the wound, if necessary.

Complementary therapies
Some people find complementary treatments helpful. However, it is important that you discuss such treatments with your doctor first in case of any interaction with any treatment they have prescribed. Massage can help to alleviate stress and make you feel better. Some people benefit from meditation, yoga, homeopathy and acupuncture. You may find creative therapies such as art and poetry can help channel energies.

What can friends and family do to help?

Supporting a friend or relative who self-harms can be distressing, frustrating, confusing and draining. However, it can also be rewarding and an opportunity to build a closer relationship. Friends and relatives can be of great help. They can provide emotional and practical support and encourage people to seek appropriate support and treatment. Friends and family can become involved in treatment plans and, above all, make the person feel wanted, needed and loved. It is important for friends and relatives not to blame themselves for someone else’s self-harming behaviour. The person has initiated this behaviour and they need to take responsibility for stopping it. If you are feeling stressed by the self-harming behaviour of someone you care for, you don’t have to shoulder the burden alone, there are organisations that can help you.

Where can I find help and support?

There is a wide a range of services available that can help provide care, support and information to people who self-harm, their friends, relatives and carers. You may find some of the following useful:

SANEline / SANEmail
1st Floor Cityside House, 40 Adler Street, London, E1 1EE
helpline:0845 767 8000
email: sanemail@sane.org.uk
web: www.sane.org.uk
SANEline and SANEmail offer emotional support and information to those experiencing mental health problems, their families and carers.

Bristol Crisis Service for Women
PO Box 654, Bristol BS99 1XH
tel: 0117 925 1119 - Friday and Saturday 9pm-12.30am, Sunday 6-9pm
email: bcsw@btconnect.com
Web: www.users.zetnet.co.uk/bcsw
Supports women and girls in emotional distress, especially those who self-harm. Interpreters available.

British Association for Behavioural and Cognitive Psychotherapies (BABCP)
The Globe Centre, PO Box 9, Accrington BB5 0XB
tel. 01254 875 277, fax: 01254 239 114
email: babcp@babcp.com
web: www.babcp.com
The full directory of psychotherapists is available online.

British Association for Counselling and Psychotherapy (BACP)
BACP House, 35–37 Albert Street, Rugby CV21 2SG
tel. 0870 443 5252, minicom: 0870 443 5162
email: bacp@bacp.co.uk
web: www.bacp.co.uk
See website or send A5 SAE for details of local practitioners.

British Confederation of Psychotherapists (BCP)
West Hill House, 6 Swains Lane, London N6 6QS
tel. 020 7267 3626, fax: 020 7267 4772
email: mail@bcp.org.uk
web: www.bcp.org.uk
A linking body of psychoanalytical psychotherapist societies.

Carers UK
20–25 Glasshouse Yard, London EC1A 4JT
carers line: 0808 808 7777, tel. 020 7490 8818
minicom: 020 7251 8969, fax: 020 7490 8824
email: info@ukcarers.org
web: www.carersonline.org.uk
Information and advice on all aspects of caring.

Crisis Recovery Unit, Bethlem Royal Hospital
Monks Orchard Road, London BR3 3BX
tel: 020 3228 6000
web: www.slam.nhs.uk
National specialist service for people aged 17 and over who persistently harm themselves. Needs a professional referral.

Lifesigns
email: info@lifesigns.org.uk
web: www.lifesigns.org.uk
Information and emotional support for those who self-harm and those who care for them.

National Self Harm Network
PO Box 7264, Nottingham, NG1 6WJ
email: info@nshn.co.uk
web: www.nshn.co.uk
Support and information for people who self-harm.

Samaritans
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF
helpline: 08457 90 90 90, fax: 020 8394 8301
email: jo@samaritans.org
web: www.samaritans.org
24-hour telephone helpline offering emotional support for people who are experiencing feelings of distress or despair, including those that may lead to suicide.

United Kingdom Council for Psychotherapy (UKCP)
167–169 Great Portland Street, London W1W 5PF
tel. 020 7014 9955, fax: 020 7436 3013
email: ukcp@psychotherapy.org.uk
web: www.psychotherapy.org.uk
Umbrella organisation for psychotherapy in UK.Regional lists of psychotherapists are available free.

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