Introduction

Self-harm is when somebody intentionally damages or injures their body. It is a way of expressing deep emotional feelings such as low self-esteem, or a way of coping with traumatic events, such as the death of a loved one.Learn 

If you are self-harming, you should see your GP for help. You can also call the Samaritans on 116 123 for support.

Read more about where to get help if you self-harm.

Self-harm is an expression of personal distress, rather than an illness, although it can be linked to other mental health conditions such as depression. Read more about the causes of self-harm.

Research has suggested that self-harm is most common among 15-19 year olds, and those suffering from anxiety and depression.

Signs of self-harm

Types of self-harm may include:

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. It may, therefore, be 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. Read more about the signs of self-harm.

Someone who is self-harming can seriously hurt themselves, so it is important that they speak to a GP about the underlying issue and about any treatment or therapy that might help them.

Signs

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
  • 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 alcohol or drug misuse

The person who is self-harming may feel deep shame and guilt, or may feel confused and worried by their own behaviour. It’s important to approach them with care and understanding.

They may not wish to discuss their self-harm with you, but you could suggest that they speak to an anonymous helpline or see their GP.

Causes

There are many reasons why people self-harm, but the causes usually stem from unhappy emotions.

Self-harming has been described as a "physical expression of emotional distress". If somebody is feeling overwhelmed with unhappy emotions, they may find that the physical act of hurting themselves makes them feel better.

If you are feeling like this, you can speak to your GP or call the Samaritans on 116 123 for support.

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

Emotional distress

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:

  • anger
  • guilt
  • anxiety
  • loneliness
  • grief
  • 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 and finding a way to cope with your problems. It is not usually an attempt to seek attention, but a sign of emotional distress.

Some research has suggested that people who self-harm may have difficulty managing or "regulating" their emotions. They use self-harm as a way of managing tension and anger. Research has also shown that people who self-harm are poorer at problem solving.

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.

Psychological causes

In some cases there may be a psychological reason for the self-harming (where the cause is related to an issue with your mind). 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)

Treatment

It is important for anyone who self-harms to see their GP, who will aim to treat the underlying emotional cause as well as any physical injury.

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.

Specialist referral

Recent research indicates that most teenagers who self-harm are able to give up this behaviour as they learn to manage feelings in healthier ways, for example, by talking to others.

However, some young people who self-harm continue to do so into adulthood and if you fall into this category, your GP may refer you to a mental health professional. This could be:

  • 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

For example, if you have lost a close relative, you may be referred to a specialist grief 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 in eating disorders and a dietitian or nutritionist (somebody who specialises in nutrition).

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.

Assessment

You may be offered a psychosocial assessment, which aims to investigate all the factors that contribute to your self-harming, including:

  • social factors – for example, your relationships with others
  • psychological factors – your feelings and emotions
  • motivational factors – what made you want to do it

You will be asked about your current feelings, particularly if you are feeling hopeless or considering suicide. If you have any other symptoms, either physical or emotional, you will also be asked about these.

After the assessment you will be allowed to read through what has been written to make sure that you agree with it. Any further treatment will, if possible, be decided jointly between you and your mental health professional. 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.

Seeking immediate help for an injury or overdose

Some physical injuries may need treating in an accident and emergency (A&E) department. 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 you would like to talk to somebody immediately about the way you are feeling, call Samaritans on 116 123.