What is Self-harming?

People often keep the fact that they do it a secret, but the urge to self-harm isn’t uncommon, especially in adolescents and young adults. Self-harm occurs most often during the teenage and young adult years, although it can also happen later in life. According to statistics from Public Health England (PHE) for 2020/2021 there were:

• Emergency hospital admissions for intentional self-harm: 102,472 or 181.2 per 100,000.
• Hospital admissions as a result of self-harm (10–24 years): 41,606 or 421.9 per 100,000.
• Hospital admissions as a result of self-harm (10–14 years): 7,319 or 213.0 per 100,000.
• Hospital admissions as a result of self-harm (15–19 years): 20,335 or 652.6 per 100,000.
• Hospital admissions as a result of self-harm (20–24 years): 13,952 or 401.8 per 100,000.

Most individuals who engage in self-harming behaviour keep their habit hidden, which means that the published statistics for self-injury are likely to be much lower than reality, as the figures only show those seeking medical assistance.

Statistics are also available on self-harm within children and young people’s care institutions. The Children and Young People Secure Estate (CYPSE) provides placements for children aged between 10 and 17, either for a young person’s welfare or through the youth justice system. In CYPSE in the 3 months to 30 September 2021 there were 379 incidents of self-harm involving 97 different children and young people (CYP). The annualised rate of self-harm incidents per 100 children and young people per year was 279 in the 3 months from July to September 2021, an increase of 5% compared to the same period the previous year.

The rate of self-harm incidents in CYPSE fell significantly during the first 9 months of the Covid-19 pandemic but increased sharply in the quarter of April to June 2021. Over the 12 months to 30 September 2021, a total of 407 self-harm incidents resulted in an injury requiring some treatment, 29% of the total, and 57 required hospital attendance, representing 4% of the total.

But self-harm is not only an issue for younger generations; self-harm particularly among the over-65s is rising because of the increased risks associated with the COVID pandemic. Loneliness, bereavement, stigma and reluctance and/or difficulties to access GP services are some of the causes of older people not reaching out to get help and therefore self-harming. Over-65s are hospitalised more than 5,000 times a year in England because of self-harm and self-poisoning, as figures obtained from NHS Digital show.

What is self-harming?

The National Institute for Health and Care Excellence (NICE) provides the following definition of 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.”

In simpler terms, self-harm or self-injury means hurting yourself on purpose. People often try to keep self-harm a secret because of shame or fear of it being seen. They may cover up their skin and avoid discussing the problem.

Self-harm is not recognised as a mental illness, but 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.

Self-harm is sometimes an associated symptom of a mental health disorder. The most common co-occurring, comorbid mental illnesses a person who self-harms struggles with include the following:

• Alcoholism.
• Anxiety disorders.
• Bipolar disorder.
• Borderline personality disorder (BPD).
• Depression and depressive disorders.
• Eating disorders.
• Obsessive-compulsive disorder (OCD).
• Past history of trauma, especially in childhood.
• Personality disorders.
• Post-traumatic stress disorder (PTSD).
• Schizophrenia.
• Substance abuse.

What is classed as self-harm?

There are many different ways people can intentionally harm themselves. The majority of self-poisoning episodes involve:

• Overdosing prescribed or over-the-counter medication.
• Poisoning themselves with tablets or toxic chemicals, household substances, or plant material.
• Misusing alcohol or illicit drugs.

Most often, people who engage in self-injury target their arms, legs and front of their torso because these places are easily reached and can be hidden under clothing. People who self-injure may use one or more ways to harm themselves.

The majority of self-injury episodes involve, but are not limited to:

• Cutting.
• Scratching.
• Biting.
• Burning.
• Breaking bones.
• Hair-pulling.
• Punching or hitting.
• 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.
• Excessively exercising.
• Casual sex.
• Deliberately starving (anorexia nervosa) or binge eating (bulimia nervosa).

It can also include behaviours that have some level of suicide intent, such as overdoses, and even though these behaviours are not intended as a suicidal act, self-harming can lead to serious, even fatal consequences; some of these are described below.

What is self-harm a sign of?

Self-harm is a complex condition that has no simple explanation. Although suicidal feelings may accompany self-harming, it does not necessarily indicate a suicide attempt.

Hurting yourself, or thinking about hurting yourself, is a sign of emotional distress. Self-harming behaviours are the deliberate destruction of a person’s own body. This type of behaviour is normally not an attempt at suicide, but rather an unhealthy way for some people to cope with emotional pain, frustration and anger.

Whilst self-harm may bring a sense of peace and well-being immediately after the act, this is usually followed by feelings of intense guilt and shame, and the painful emotions that initially triggered the self-harming soon return.

Why do people self-harm?

Since self-harming is generally considered to be an impulsive act, becoming upset or experiencing any strong emotion can trigger the behaviour. Many people self-harm only a few times before stopping, whilst others may find that the behaviour serves a unique purpose and it becomes a long-term, repetitive, addictive behaviour.

Risk factors for self-harm include socioeconomic disadvantage, social isolation, stressful life events, mental and physical health problems, and alcohol or drug misuse.

Many mental illnesses, such as those listed above, that can trigger the urge to self-harm are thought to have genetic components. People who are born into families that have a history of mental illness are at a greater risk of developing the disorder themselves. Some people may have repeated thoughts or voices telling them to self-harm or experience disassociating, that is losing touch with who they are and with their surroundings.

Other types of mental illnesses are the result of imbalances in the neurotransmitters involved in emotional regulation. People who have imbalances of neurotransmitters in the brain may self-harm in order to experience emotions, or as a result of the mental illness. Also, people who have experienced physical, mental or sexual abuse are at a greater risk for self-harming behaviours.

Whilst self-harming is sometimes seen as an attention-seeking behaviour, engaging in it is a way for some people to release tension, relieve feelings of sadness or anger, or distract themselves from their problems.

Self-harm is used as a way to cope with overwhelming emotions and trauma, such as, but not limited to, the death of a close family member or friend, having difficult relationships with friends or family, having difficulties at work or school, or being bullied. Some people use self-harm as a way of feeling in control of their body or their environment.

Other self-harm risk factors include:

• Being female – a study by the University of Warwick based on more than 11,000 UK teenagers found that around 15% (approximately 1,650) reported self-harm in the last year. Among them more than seven in ten (73%) were girls, more than double the rate for boys (27%).
• Aged between teens and early 20s, although there has been an increase in the over 65 age group.
• Having friends who also self-harm.
• Unstable personal or uncertain sexual identity.
• Chronic pain.
• Mental health disorders.
• Drug and alcohol abuse and addiction.

Self-harm is closely linked to anxiety and depression. These mental health conditions can affect people of any age.

How to help someone who self-harms

Because it is often done in private, when a loved one or friend is engaging in self-harming behaviours, it can be tricky to notice the signs and symptoms of self-harming. They will vary depending upon the methods a person uses to self-harm, but if you are concerned it may be happening, you can look out for signs including:

• Unexplained cuts, bruises or cigarette burns, usually on the wrists, arms, thighs and chest.
• Keeping themselves fully covered at all times, even in hot weather.
• Pulling out their hair, patches of thinning hair or patches of missing hair.
• Alcohol or drugs misuse.
• Self-loathing and expressing a wish to punish themselves.
• Speaking about 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.
• Unusual weight loss or weight gain.
• Obsessive behaviours such as over-exercising.
• Signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough for something.
• Ongoing questions about personal or sexual identity.
• Signs of depression, such as low mood, tearfulness or a lack of motivation or interest in anything.
• Increased anxiety, especially when unable to self-harm.
• Emotional instability including feelings of guilt, shame or disgust.

Watching a loved one participate in self-harming behaviours can be frightening and heartbreaking. You might be struggling to understand why people would ever want to hurt themselves on purpose. But the important thing to remember is that self-harm is not about you as the parent, friend, or loved one; it is solely about the person acting out the behaviours.

If you learn that a loved one is self-harming:

• Try not to panic.
• Deal with any immediate medical concerns first.
• Listen to them and try to find out what they need.

Pretending that the problem of self-harm doesn’t exist often reinforces the shame, so talk about the self-harm. Provide an open environment where your loved one can freely discuss their thoughts and feelings.

It is essential that people who self-harm receive professional treatment because it can be extremely difficult to stop the behaviour without help, although it is uncommon for people who self-harm to seek out treatment for themselves. Talk to your loved one about what kind of support they might consider. This can help to get them to attend appointments. Talking therapy such as cognitive behavioural therapy (CBT) can be a vital part of overcoming self-harming.

Let them know you will be available to listen whenever they want to talk, but don’t rush them. It is also important to be realistic. Don’t expect the behaviour to stop immediately. It may take a long time to replace the self-harm with a healthier coping strategy. Talking with you may be the first step.

There are other things that you can do to offer support and assistance to someone who is self-harming:

Offer non-judgemental support – people who engage in self-harm tend to be self-critical and struggle with feelings of worthlessness. Show them that you care and that you are concerned about them. Encourage them to talk to a parent, counsellor or doctor. You may not understand their behaviour, but it is important not to dismiss their emotions.

If it is a child or young teenager who is engaging in self-harm, don’t get angry with them, and avoid making accusations or threats. Get advice from a healthcare professional such as your doctor about what steps you should take next. The same goes for an elderly person who may be engaging in self-harming behaviours; anger at their behaviour will not help the situation. Talk to a healthcare professional about your concerns.

What are the long-term effects of self-harm

People who self-harm can seriously hurt themselves. The long-term effects of self-harm can range from minor irritants to severe injuries and even unintentional death. This is why it is important for those who engage in this type of behaviour to seek professional help as soon as possible, so that they can learn healthier ways of coping with stressful or painful emotions.

The most common long-term effects of self-harming include:

• Accidental death.
• Broken bones.
• Feelings of shame, disgust and guilt.
• Infections.
• Injured tendons, nerves, blood vessels and muscles.
• Limb or appendage loss.
• Multi-organ damage.
• Permanent scarring.
• Permanent weakness or numbness in certain areas.
• Poor self-esteem and self-image.
• Septicaemia.
• Social isolation.
• Suicide.

Ways you can look after yourself

Although self-harm serves a specific purpose for the people who act out the behaviour, it is really only a short-term fix for a more severe, underlying problem. Without treatment, that underlying problem will not go away and may even continuously get worse.

You may have found that harming yourself causes an instant release of tension which helps take away any emotional pain that you are feeling. However, that release is very brief and you will come to realise that you need to harm yourself more consistently in order to make it last.

It may seem hard, but reaching out to someone can help you work through some of the reasons for harming yourself. It may take time, but you can move to a happier and healthier outlook. It is important to trust the person you are speaking with.

This might be:

• A friend or family member.
• Your GP.
• Someone on an emotional support line, where you can remain anonymous if you prefer (some contact information is provided at the end of this article).

If you find it hard to talk about what you are going through, try to start with words like:

• Right now, I’m feeling ….
• I think it started when ….
• I’ve been feeling like this for ….
• Lately, school / work / college has been ….

If you can understand your patterns of self-harm, you may discover certain triggers. Learn to recognise triggers. These triggers are what give you the urge to hurt yourself; they could be people, situations, thoughts or feelings. Recognising your urges helps you take steps towards reducing or stopping self-harm.

When you start to feel that you want to self-harm, try to distract yourself. This may pass some time until your feelings become more manageable. This can be done when you feel the urge to self-harm, or as soon as you become aware that you are hurting yourself.

Distraction techniques might include:

• Bite into a piece of ginger or a chilli.
• Choose a random object and think of 10 different uses for it.
• Do something active such as clean the windows, car etc.
• Go for a walk.
• Pamper yourself, such as a long soak in a bubble bath.
• Phone a friend.
• Play a sport, exercise or go to the gym.
• Punch a punch bag or pillow or kick something soft.
• Scream into a pillow.
• Snap elastic bands on your wrist.
• Squeeze an ice cube as hard as you can.
• Write down how you are feeling and then tear it up or rip it up.
• Yoga or meditation can help to reduce anxiety.

It is useful to keep a record of your thoughts and feelings when you feel the need to self-harm.

Note down answers to the following questions:

• Why do I feel I need to hurt myself?
• What has happened to make me feel like this?
• How do I feel right now?
• Have I been here before?
• What did I do to deal with it?
• How did I feel then?
• What have I done to make myself feel better before?
• What else can I do that won’t hurt me?
• Do I need to hurt myself?
• How will I feel when I am hurting myself?
• How will I feel after hurting myself?
• How will I feel tomorrow morning?
• Can I avoid what has made me feel like this, or deal with it better in the future?

These notes can be particularly useful for when you feel ready to open up about your self-harming.

What Support is Available?

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.

For some, sessions with a psychiatrist, psychologist or therapist can provide the support needed to overcome the condition. Others may require a more structured treatment approach, which can include staying at a hospital for the duration of their treatment. It is best to speak to a GP about self-harm treatments.

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

• Harmless.
• Self Injury Support.
• Childline.
• YoungMinds Parents Helpline.
• Staying Safe.
• Papyrus HOPELINE UK.
• CALM.
• Rethink Mental Illness.
• Samaritans.
• Self Harm.
• Get Connected.
• The Silver Line.
• Age UK.

Final Thoughts

Self-harm can be difficult to talk about and hard for other people to understand. A lot of people who self-harm don’t ask for help. If you think you may harm yourself, don’t suffer in silence, tell someone about how you feel. The best place to start might be a health professional, like your GP.