Focus on: Self Harm

What is self-harm?
Self-harm is a way of expressing very deep distress. Often, people don't know why they self-harm. It's a means of communicating what can't be put into words or even into thoughts and has been described as an inner scream. Afterwards, people feel better able to cope with life again, for a while.

Self-harm is a broad term. People may injure or poison themselves by scratching, cutting or burning their skin, by hitting themselves against objects, taking a drug overdose, or swallowing or putting other things inside themselves. It may also take less obvious forms, including unnecessary risks, staying in an abusive relationship, developing an eating problem (such as anorexia or bulimia), being addicted to alcohol or drugs, or someone simply not looking after their own emotional or physical needs. These responses may help someone to cope with feelings that threaten to overwhelm them; painful emotions, such as rage, sadness, emptiness, grief, self-hatred, fear, loneliness and guilt. It can also be a means of self-punishment or an attempt to gain some control over life. Because they may feel ashamed, afraid, or worried about other people’s reactions, people who self-harm often conceal what they are doing rather than draw attention to it.

Why do people harm themselves?

A person who self-harms is likely to have gone through very difficult, painful experiences as a child or young adult. At the time, they probably had no one they could confide in, so didn't receive the support and the emotional outlet they needed to deal with it. The experience might have involved physical violence, emotional abuse, or sexual abuse. They might have been neglected, separated from someone they loved, been bullied, harassed, assaulted, isolated, put under intolerable pressure, made homeless, sent into care, into hospital or to other institutions.

Experiences like these erode self-esteem. Emotions that have no outlet may be buried and blocked completely out of awareness. If a trusted adult betrays or abuses them, and there are no other witnesses, children will often blame themselves. They turn their anger inwards. By the time they become adults, self-injury can be a way of expressing their pain, punishing themselves, and keeping memories at bay.

Who is most likely to self-harm?
According to research, the majority are young women, although the percentage of young men seems to be on the increase. Self-harming behaviour is also significant among minority groups discriminated against by society. Someone who has mental health problems is more likely to self-harm. So are those who are dependent on drugs or alcohol, or who are faced with a number of major life problems, such as being homeless, a single parent, in financial difficulty or otherwise living in stressful circumstances. A common factor is often a feeling of helplessness or powerlessness with regard to their emotions.

Is self-harm a suicide attempt?
Self-harm can be about trying to stay alive – a coping mechanism for survival, and to escape from emotional pain. The majority of people who self-harm are not suicidal, but a small minority will intentionally attempt suicide. Some suicides resulting from self-harming behaviour may be accidental, occurring when someone has hurt themself more than they intended to.

Is self-harming behaviour attention-seeking? Because it can be hard to understand, healthcare professionals, friends and relatives sometimes mistakenly regard people who self-harm with mistrust or fear and see their behaviour as attention-seeking and manipulative. If someone you know self-harms, you may feel helpless when faced with their wounds; your own feelings and fears about the situation may cause you to blame them instead of supporting them. Whether people have deep wounds or slight injuries, the problem they represent should always be taken very seriously. The size of the wound isn't a measure of the size of the conflict inside.

What triggers it?
Self-harming can become an ongoing way of coping with current problems and may occur regularly, on a monthly, weekly, or daily basis, depending on circumstances. The trigger could be a reminder of the past (such as an anniversary) which sets off a hidden memory, or something unexpected could happen to cause a shake-up. But sometimes, ordinary life is just so difficult that self-harm is the only way to cope with it.

Treatment
For advice on treatment for self-harmers visit the NHS choices self-harm treatment webpage which advises on treatment and assessment.

(adapted from: MIND’s Understanding self-harm)