Why do people self-harm?

Suicidal thoughts and self-harm are related to mental health although they are not as yet in themselves mental health diagnoses. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists non-suicidal self-injury as a proposed condition under the category of conditions in need of further study.

According to the mental health charity Mind, 1 in 14 people self-harm, 1 in 5 people have suicidal thoughts, and 1 in 15 people attempt suicide. Because of the hidden nature of the act, the current understanding of the prevalence of self-harm is largely based on emergency hospital admissions data for intentional self-harm.

There is information from the Nuffield Trust showing that rates of hospital admission as a result of self-harm in children and young people (aged 10 – 24) are considerably higher for females than males, and that rates of hospital admission as a result of self-harm in children and young people are considerably higher for children and young people between the age of 15 – 19, than children aged 10 – 14 years, and young people aged 20 – 24 years. However, admissions data alone is unlikely to provide a fully representative picture as it excludes those who self-harm and who don’t seek medical help.

Anecdotal evidence shows that self-harm isn’t uncommon, especially in adolescents and young adults, and whilst for many young people self-harm is used as a coping mechanism, self-harm can affect any person at any age and is not something that only young people struggle with. In this article, we will examine self-harm and look in more detail at who self-harms and the reasons for why they do.

What is self-harm?

 “Self-harm refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act, and is an expression of emotional distress.” (The National Institute for Health and Care Excellence – NICE). 

The term self-harm usually refers to someone intentionally causing themselves harm. There are many different ways people can intentionally harm themselves. These include:

• Cutting with sharp objects to break through or injure their skin
• Scratching or rubbing that leads to skin damage
• Picking at and deliberately interfering with healing wounds
• Piercing the skin with sharp objects (not as a part of a piercing)
• Carving words or symbols into the skin
• Burning their skin with something hot such as cigarettes, matches or heated sharp objects, or with chemicals such as household cleaning products, bleach, etc.
• Punching or hitting themselves with solid objects or punching a wall which can lead to impact injuries
• Hair pulling (Trichotillomania), pulling out their hair, this can be from any part of the body not only the head
• Poisoning themselves with tablets or toxic chemicals
• Misusing alcohol or drugs
• Deliberately starving themselves or binge eating
• Exercising too much
• Casual, usually unprotected sex

Self-harm can also include suicidal behaviours such as overdoses. So any behaviour that causes harm or injury to someone as a way to deal with difficult emotions can be seen as self-harm.

Self-harm is poorly understood in society and people who harm themselves are often subject to stigma and hostility. It is often a secretive form of behaviour, hidden because of the shame and stigma that the behaviour attracts. Keeping self-harming secret helps to protect the person from judgement, and can easily be justified as self-protection. 

Self-harming is one of the top five causes of acute medical admission, and those who self-harm have a 1 in 6 chance of repeat attendance at A&E within the year.

The reasons why people self-harm

It is often very difficult to identify exactly what causes a person to self-harm. Self-harm is a complex, painful, and difficult behaviour, it is a way of coping with or expressing overwhelming emotional distress, this could be caused by social problems, trauma, or psychological reasons. 

Social problems might include but are not limited to:

• Being bullied
• Coming to terms with sexual orientation or identity
• Coping with expectations of themselves or others
• Having difficult relationships with friends or family
• Having problems at work or school

Trauma might include but is not limited to:

• Physical or sexual abuse
• Domestic violence
• Repeated and prolonged exposure to stressful events
• Accidents such as motor etc.
• Death of a close family member or friend
• Living with medical conditions
• Having a miscarriage

Psychological causes might include but are not limited to:

• Borderline personality disorder (BPD)
• Having repeated thoughts or hearing voices telling them to self-harm
• Depression
• Eating disorders, especially anorexia nervosa
• Gender dysphoria
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

One person’s reason for self-harm can be very different from other people who self-harm. Everyone has different things that cause them stress and worry, whilst some people can manage these difficulties, for others the situation can be overwhelming and the pressure can build up and become unbearable. Engaging in self-harm is for some people, a way to release tension, relieve feelings of sadness or anger, or distract themselves from their problems, particularly if they have not been able to talk about their difficulties with others. 

There are some people who feel that they have no control over their lives or certain situations, and they may use self-harm as a way of feeling in control of their body or their environment or to distract themselves from their problems.

Self-harm is also associated with multiple mental health conditions, such as mood disorders, borderline personality disorder (BPD), schizophrenia and attention deficit hyper activity disorder (ADHD). These are often the result of imbalances in the neurotransmitters involved in emotional regulation, which impact a person’s ability to cope with anxiety and distress, and they may self-harm in order to experience emotions.

Although self-harm is often a very secretive act, it can also be used by some to subconsciously communicate distress to other people, particularly if they do not have the language to express the enormous emotional suffering that they are experiencing.

Signs of self-harm

There are many different types of self-harm and they are not always easy to notice. Most people who self-harm may try to hide it from those around them. They may often wear clothing to cover the signs of self-harming, such as wearing long sleeves, even when the weather is hot. Often they will explain away any injuries as accidents, or of no consequence. However, the signs of self-harming are detectable. Although self-injury can occur anywhere on a person’s body, the most likely body areas for a person to self-harm are:

• Arms particularly their forearms
• Wrists
• Front of their thighs
• Abdomen

You might notice any of the following signs of self-harming:

• Unexplained cuts, bruises or burns, often on their wrists, arms, thighs and chest
• Scabs or scars in a particular shape or cluster
• Multiple burns in the same size or shape, often cigarette burns
• Impulsive and continual scratching an area of skin
• New scratches, bite marks, bruising or swelling explained as accidents 
• Signs they have been pulling their hair out such as small areas of baldness
• Wearing long sleeves and / or trousers or dark tights, even in hot weather
• Blood on clothing, towels, or bedding
• Avoiding or refusing to get changed in front of other people, for example, for PE or in changing rooms
• Exercising excessively
• Changes in eating habits such as over-eating, under-eating or deliberately starving themselves
• Misusing alcohol or drugs
• Poisoning themselves with tablets or toxic chemicals
• Self-loathing and expressing a wish to punish themselves
• Becoming very withdrawn and not speaking to others
• Secretive behaviours 
• Signs of low self-esteem or depression, such as low mood, crying or a lack of motivation or interest in anything
• Thoughts of helplessness, hopelessness, or worthlessness

Self-harm can also include suicidal behaviours such as overdoses, even though these behaviours may not be intended as a suicidal act.

People often try to keep self-harm a secret because of shame or fear of it being seen, so it can be challenging to know when a loved one or friend is engaging in self-harming behaviours.

Who usually self-harms?

The stereotype is that it is teenage girls and young women that self-harm however, whilst there is a prevalence of girls and young women reporting self-harming, boys and young men do also self-harm. Some researchers believe that around 10% of young people self-harm, but it could be as high as 20%. According to recent UK data, the highest rate of self-harm incidents in 2024 is observed among 15-year-olds, and data from Wiltshire Public Health Self-Harm Insight Report states that most male admissions to A&E fell into the 20 – 29 year age group.

The highest percentage of female admissions to A&E was in the 10 – 19 year-old category. Self-harming is also not restricted to young people, it happens across all ages and genders, in fact, over-65s are hospitalised more than 5,000 times a year in England because of self-harm and self-poisoning, figures obtained from NHS Digital show. 

People who have experienced trauma are more likely to self-harm, as are those who have experienced discrimination, such as those in the LGBTQ+ community. People who are socially isolated are also more vulnerable, and researchers also believe that deprivation, poverty and austerity make people more likely to harm themselves, the cost of living crisis could explain the recent rise in numbers of people self-harming.

People who have, or are recovering from drug and alcohol problems are vulnerable to self-harming.

There is a higher incidence of self-harm among prisoners, and veterans from the armed forces. In England and Wales, the number of self-harm incidents in prisons increased by 16% in the 12 months to June 2024 and the rate of self-harm was 852 incidents per 1,000 prisoners in the 12 months to March 2024. Asylum seekers and refugees are also at an elevated risk of self-harm, with younger age and traumatic experiences found to further increase such risk.

Self-harm and suicidal thoughts

Self-harm is sometimes viewed as a suicide attempt by people who don’t understand it, self-harm may, or may not, be a sign that someone is feeling suicidal, however for some it may be an alternative to suicide, a way of coping with difficult feelings and circumstances rather than ending their life. For some though, their self-harming may be so serious that it endangers or even ends their life, and can be seen as attempted or actual suicide. However, self-harming is virtually always used to feel better rather than to end one’s life. The intent of self-harming is almost always to feel better, whereas for suicide the intent is to end feeling altogether.

When a person has engaged in self-harm over a long period time, it can be linked with developing thoughts of suicide. These thoughts can range from fleeting considerations of suicide to detailed planning and intent. Whilst not everyone who experiences suicidal thoughts will attempt suicide, it is a serious warning sign that should never be ignored.

It is essential to be aware of the warning signs of suicide, particularly in individuals with a history of self-harming or mental health disorders. as suicidal thoughts and behaviours and self-harming do share some common risk factors. These warning signs include but are not limited to:

• Social isolation, losing interest in activities or hobbies, or withdrawing from family and friends can signal emotional distress
• Reckless actions, such as driving dangerously, substance misuse, or other risky activities, may indicate a disregard for personal safety
• A sense of despair or belief that there is no way out of their pain can indicate suicidal thoughts
• Whilst depression is often linked to suicide, a sudden improvement in mood after a period of intense sadness can be a red flag, as it may indicate that the person has made a decision to act on suicidal thoughts.
• Talking about death or suicide including direct statements, such as “I wish I were dead,” or more subtle comments, such as “Everyone would be better off without me.”

Self-harm and suicidal thoughts are both often symptoms of deeper emotional pain and / or mental health conditions, however, it is important to remember that self-harm is often carried out using methods designed to cause some pain or to damage the body, but not to injure the body so badly enough as to require treatment or to end life. 

How to stop people from self-harming

Apart from the obvious harm and dangers that self-harming can cause, the impact that self-harming can have to an individual’s long-term physical health can be immense, such as scarring and other disfigurements, or permanent damage to tendons and nerves that cutting can have, or permanent damage to internal organs that the misuse of alcohol and drugs has. The chronic effects of self-harm range from minor abrasions, to severe injuries, to unintentional death and this spectrum of consequences is why it is of vital importance that those who self-harm seek the help of mental health professionals for treatment.

Self-harm is a behaviour that indicates that something is wrong, and although the contributing circumstances are individual for each person, commonly they include difficult personal circumstances, past trauma including abuse, neglect or loss, or social or economic deprivation, and are very possibly connected with some level of mental disorder such as anxiety or depression. 

Families and friends may be frustrated and distressed by the actions of the person who self-harms, however the person needs compassionate care and understanding to recognise why they are harming themselves. It can be very hard to understand why a person would hurt themselves, particularly as most people attempt to avoid any unnecessary pain however, it is important that you do not panic if you discover, or you are told that someone is self-harming. The first step to helping someone is to suspend judgements and any preconceived ideas on people who self-harm, and instead have understanding and empathy. 

Self-harm is a sign of serious emotional distress, so if someone tells you that they are self-harming or it is something that you have noticed, it is important to stay calm and to encourage them to talk to you. It is not always an easy conversation to have, but it is important to ask sensitively and directly if they have been harming themselves, and to explore the reasons behind their self-harm.

Ask open questions caringly about their feelings, and actively listen to their responses. Show empathy by trying to understand what is happening from their point of view. Let the person know that they don’t need to be ashamed of their emotions, and that you are there to listen and support them to find a way through. 

It is essential that people who self-harm receive treatment because it can be extremely difficult to stop the behaviour without professional help. It can be really hard for someone to reach out to support from healthcare professionals, so offering to be there with them when they make a phone call to for example their GP, or to go along to their appointment with them can show them that you are there to support them. 

Don’t expect someone who is self-harming to stop the self-harm immediately and permanently, it will highly likely take some time for them to start feeling better, even with professional help and support. Some practical things that you can do to help to prevent them from continuing self-harming can include:

• Removing everyday items such as razor blades, knives and scissors that don’t need to be left lying around and that could be used for self-harm. Keep them out of reach and even under lock and key.
• Ensuring that any medications that are not needed are disposed of safely, and that any remaining medications are kept in a locked cabinet. 
• Helping the person to engage in healthier coping strategies such as deep breathing, meditation, and mindfulness
• Being aware of any particular triggers or early warning signs of distress that may precede an episode of self-harming, and considering how these episodes could be safely managed
• Encouraging the person to engage in using distraction techniques rather than self-harming when their emotions become too much, techniques such as shouting or singing at the top of their lungs, or calling a friend or help-line to talk about how they are feeling, or placing an elastic band around their wrist and pinging it when they have the urge to self-harm

Recovery from self-harming may be a long process, but one of the best things that you can do to support the person is to be available to just listen. They may not always want to talk, but knowing that you are available when they do can be a great help and can reassure them that they are not alone.

Getting support for self-harm

Addressing and preventing self-harm requires a comprehensive approach that tackles both the immediate needs of the individual in crisis, and the underlying causes of their distress. The type and length of self-harm treatment and support will depend on the individual’s circumstances and the severity and complexity of their condition. The first point of contact is usually the individual’s own GP who can refer them for treatment. If they are hesitant about talking with their GP, offer to support them at the appointment. There is a range of therapeutic interventions that can be tailored to the individual’s needs, these may include:

• Cognitive Behavioural Therapy (CBT) – this helps individuals identify and challenge negative thought patterns that contribute to self-harm. It encourages the development of healthier coping mechanisms and problem-solving skills
• Other forms of counselling, such as psychodynamic therapy – this will help an individual identify the problems that are causing their distress and leading to them self-harming.
• Self-help groups – some telephone helplines offer specialist advice on self-harm, while others operate only as a friendly listening ear
• Medication – whilst there is no medication available to strictly treat self-harming, there are many available to treat some of the disorders, such as depression, that may be leading to this behaviour

There are a number of organisations that offer information and support for anyone who self-harms or who thinks about self-harming, or for friends and family concerned about anyone who may be self-harming, these include:

Age UK Advice Line: 0800 678 1602

CALM Telephone 0800 585858 

Childline: Free confidential advice, national helpline for young people 0800 1111

Get Connected Telephone 0808 808 4994.

Harmless – email info@harmless.org.uk 

PAPYRUS HOPELine UK: Telephone 0800 068 41 41

Rethink Mental Illness advice and information service 0808 801 0525

Samaritans Telephone 116 123

Self Harm Email: info@selfharm.co.uk

Self injury Support Telephone 0117 927 9600 info@selfinjurysupport.org.uk Self Injury Helpline – 0808 800 8088

Staying Safe

The Silverline Call free on 0800 4 70 80 90 

YoungMinds Parents Helpline – call 0808 802 5544 (9.30am to 4pm on weekdays)

Final Thoughts

Whether you approach someone that you are worried about, or someone opens up to you about their self-harming, reassuring them that you are there for them can be the first positive step towards them getting the treatment that they need.