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Self-harm

Self-harm is when somebody intentionally damages or injures their body. It's usually a way of coping with or expressing overwhelming emotional distress.

Sometimes when people self-harm, they feel on some level that they intend to die. Over half of people who die by suicide have a history of self-harm.

However, the intention is more often to punish themselves, express their distress or relieve unbearable tension. Sometimes the reason is a mixture of both.

Self-harm can also be a cry for help.

Getting help

If you're self-harming, you should see your GP for help. They can 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 to help with your distress.

Treatment for people who self-harm usually involves seeing a therapist to discuss your thoughts and feelings, and how these affect your behaviour and wellbeing. They can also teach you coping strategies to help prevent further episodes of self-harm. If you're badly depressed, it could also involve taking antidepressants or other medication.

Read more about getting help if you self-harm.

Useful organisations

There are organisations that offer support and advice for people who self-harm, as well as their friends and families. These include:

Find more mental health helplines.

Types of self-harm

There are many different ways people can intentionally harm themselves, such as:

  • cutting or burning their skin
  • punching or hitting themselves
  • poisoning themselves with tablets or toxic chemicals
  • misusing alcohol or drugs
  • deliberately starving themselves (anorexia nervosa) or binge eating (bulimia nervosa)
  • excessively exercising

People often try to keep self-harm a secret because of shame or fear of discovery. For example, if they're cutting themselves, they may cover up their skin and avoid discussing the problem. It's often up to close family and friends to notice when somebody is self-harming, and to approach the subject with care and understanding. 

Signs of self-harm

If you think 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
  • self-loathing and expressing a wish to punish themselves
  • not wanting to go on and wishing to end it all
  • 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're not good enough for something
  • signs they have been pulling out their hair
  • signs of alcohol or drugs misuse

People who self-harm can seriously hurt themselves, so it's important that they speak to a GP about the underlying issue and request treatment or therapy that could help them.

Why people self-harm

Self-harm is more common than many people realise, especially among younger people. It's estimated around 10% of young people self-harm at some point, but people of all ages do. This figure is also likely to be an underestimate, as not everyone seeks help.

In most cases, people who self-harm do it to help them cope with overwhelming emotional issues, which may be caused by:

  • social problems – such as being bullied, having difficulties at work or school, having difficult relationships with friends or family, coming to terms with their sexuality if they think they might be gay or bisexual, or coping with cultural expectations, such as an arranged marriage
  • trauma – such as physical or sexual abuse, the death of a close family member or friend, or having a miscarriage
  • psychological causes – such as having repeated thoughts or voices telling them to self-harm, disassociating (losing touch with who they are and with their surroundings), or borderline personality disorder

These issues can lead to a build-up of intense feelings of anger, guilt, hopelessness and self-hatred. The person may not know who to turn to for help and self-harming may become a way to release these pent-up feelings.

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.

Although some people who self-harm are at a high risk of suicide, many people who self-harm don't 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.

It's 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'll 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 depressionanxiety 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's important to be honest with your GP about your symptoms and your feelings. If you don’t know why you self-harm, tell your GP this.

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 isn't 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.

NHS walk-in centres, where a nurse can treat you without appointment, are also available for minor cuts and bruises.

Find your local A&E department, MIU or walk-in centre.

Assessment

After seeing your GP, they should offer to refer you for a further assessment with healthcare professionals at a local community mental health service.

If you've attended A&E after self-harming, you'll first receive any necessary medical treatment. You'll then be referred to a psychiatrist or psychiatric nurse for an assessment before leaving the hospital.

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'll usually be asked about:

  • your physical health
  • your relationships with others and your living arrangements
  • the methods you've used to self-harm
  • how often you self-harm
  • any specific events or feelings that occur before you self-harm
  • any things you've tried to help reduce your self-harming
  • whether you think you'll self-harm again
  • why you think you're 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's likely to be effective. You'll be asked for your consent to treatment before any begins.

Your care plan

In most cases, psychological treatment (talking therapies) such as cognitive behavioural therapy (CBT) is recommended for people who self-harm.

This involves attending sessions with a therapist to talk about your thoughts and feelings, 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'll 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've lost a close relative, you may be referred to a specialist bereavement counsellor for help coping with bereavement. If you're 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's 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.

It might also be recommended that you attend a self-help group, such as Alcoholics Anonymous if you're misusing alcohol, or Narcotics Anonymous if you're misusing drugs. These groups can offer support as you try to stop your self-harming behaviour.

 

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