What is self-harm?

Self-harm is the act of deliberately causing harm to your body. Self-harm is most common in adolescence and early adulthood; according to a recent Lancet Psychiatry study most self-harm occurs between the ages of 16 and 24. Self-harm is one of the leading causes of hospitalisation in adolescents in the UK. It is estimated that 13-14% of adolescents have engaged in self-harm (1). 

Self-harm in childhood is more rare but rates have been increasing. According to the NSPCC, it is the fourth most common worry that children and young people contact ChildLine about.

Self-harm in adulthood is less common, but it can emerge as a coping mechanism at any phase of life and in response to any challenging situation in which people feel trapped and powerless. Self-harming behaviour is not limited to humans; captive animals have also been known to exhibit self-harming behaviour. 

Examples of self-harm

• Cutting
• Burning
• Bruising
• Scratching
• Hair-pulling
• Falling over intentionally
• Self-poisoning/overdosing

Behaviours associated with substance abuse/addiction and eating disorders are not always classified as self-harm, as the damage done to the person’s body is often considered a side-effect, rather than the main intent. However, people who abuse substances or perform behaviours associated with disordered eating with the intention of causing their body harm could be said to be self-harming. 

Self-harm was once thought to be more common in girls and women, but rates amongst boys and men have increased in recent years. Men are also more likely to engage in 'indirect self-harm' such as substance abuse, reckless driving, and putting oneself in physical danger (2).

Signs and symptoms of self-harm

It can be difficult to spot self-harming behaviour, as those who carry out self-harm are most often very secretive about their behaviour. Most self-harm is carried out on parts of the body that are easily concealed. 

Physical signs

Cuts, bruises, scratches, bite marks on the body can all be signs of self-harm. Common places for self-harm injuries include the chest, arms, wrists, legs and head. 

Emotional and psychological signs

• Low mood
• Becoming withdrawn from friends and family
• Showing little pleasure in doing things
• Low self-esteem and self-blame
• Substance abuse

Why do people self-harm?

The motivation to self-harm varies between individuals. In most cases, self-harm is the expression of psychological or emotional pain that the individual feels unable to tolerate. In a study of over 30,000 adolescents, the main reasons for self-harm cited desires to escape or find relief from their situation (1). Physical pain can provide relief from intense emotional pain. Self-harming can be addictive; it can become a dangerous compulsion.

Examples of why a person might self-harm include

• Relief from intense emotional feelings such as anxiety or despair
• Self-punishing for feeling like a failure
• A reaction to low self-esteem and perfectionism
• Exerting control or overcoming feelings of powerlessness
• Relief from feelings of numbness and disconnection

Self-harm is often a symptom of an existing mental health issue, such as personality disorder, depression, anxiety, schizophrenia, eating disorders, addiction, and trauma. However, not all those who self-harm have a diagnosis of a mental health issue. Remember, too, that a person might have no idea why they self-harm, and it may not be easy to pinpoint what is triggering such behaviour. Often the reasons are very complex, whether or not self-harm is a symptom of a diagnosed mental health problem. 

People who have autism are also at more risk of performing self-harming behaviours, with an estimated 30 per cent of those with autism engaging in self-harming behaviour at some point, most commonly violent slapping, head-banging and skin picking. This is often referred to as ‘self-injurious behaviour’ rather than self-harm.

People who have experienced trauma, such as physical, emotional or sexual abuse, and those who have suffered a bereavement are also at higher-risk of self-harming. Experience of bullying, difficult family/personal relationships, pressure at work or school and being the victim of prejudice can also prompt people to self-harm. 

Self-harming behaviour is not necessarily associated with suicidal ideation. It is important however to note that self-harming behaviour can increase the risk of suicide. Self-harming behaviour is found is 40-60 per cent of suicide cases. It is still inaccurate to describe most people who commit self-harm as suicidal.

There is a common belief that self-harm is an act of attention-seeking however in most cases this is highly inaccurate. The majority of people who self-harm are very self-conscious about their wounds and self-harm can instil deep feelings of guilt and shame and go to lengths to hide their injuries or make excuses for them. 

If you are worried about your self-harming behaviour

You have taken a really positive step by reading up about self-harm to educate yourself and hopefully explore avenues to get help. If you are worried about a particular injury, you should contact your doctor immediately, or if possible open up to a friend or family member.

Self-harming is usually a coping technique. Try to identify what triggers your need to self-harm and find ways of addressing this trigger. You can also try to use other, less harmful coping techniques. This could take many forms, such as expressing your feelings creatively. If you find it difficult to identify your triggers and find coping techniques, don’t be hard on yourself. 

It is important that you confide in someone about how you are feeling. This can be extremely scary, but it is the best first step you can take towards getting better. If you don’t feel ready to talk to a friend or family member, it might be worth seeking help from a professional.

A professional counsellor or therapist can support you in many ways, including helping you prepare to tell your family or friends about your difficulties.

You can recover from self-harming behaviour with the right support. You can contact ChildLine on 0800 1111, Get Connected on 0808 808 4994, and Mind on 0300 123 3393. You can also find a therapist here on welldoing.org.

What you can do to help someone who self-harms

Discovering someone close to you is self-harming will undoubtedly prompt a strong emotional response. Your initial reaction may depend on whether you have been confided in or have discovered the behaviour yourself. However it is important in all cases that you try to be understanding. 

Try not to jump to immediate conclusions or offer purely practical solutions right away. Listen to them, talk to them and provide them with a non-judgemental space in which they can share their feelings. A person who self-harms is likely to be in a delicate frame of mind, often unsure of why they are doing what they are doing. Becoming angry will only perpetuate feelings of guilt, shame and isolation and will potentially promote further self-harming. Try not to blame yourself or take the person’s self-harming behaviour personally. 

If the person who is self-harming is finding it difficult to express themselves face-to-face you could suggest they write down their feelings in a letter or email. And if you think they would benefit from talking to a professional, you can direct them towards ChildLine on 0800 1111 (for children or young people) or help them to find a therapist. 

You can also help by trying to help the person identify what triggers their self-harming behaviour. Once identified, they are more easily addressed and/or avoided. Addressing the cause of self-harm is usually more effective than removing the means of self-harm, as a person who is in the frame of mind to want to inflict self-harm will likely be resourceful. 

How can therapy or counselling help support those who self-harm?

Recovering from self-harm is possible, and highly probable with the right support. It can be a long and difficult journey however, often more challenging the longer that a person has been self-harming. 

Psychotherapy and counselling can help support those who self-harm, especially those who have underlying mental health issues such as a personality disorder, depression, anxiety, schizophrenia, substance abuse problems, eating disorders and PTSD.

Working with a therapist can also help gain a better sense of self-worth and engage more self-compassionate behaviours, working towards relieving feelings of failure, guilt and shame. 

Find a therapist for self-harming behaviour

Further reading

How to support a child or teenager who self-harms

Practical ways to support one another through self-injury

References

(1) Rasmussen, S., Hawton, K., Philpott-Morgan, S., & O’Connor, R. C. (2016). Why do adolescents self-harm? An investigation of motives in a community sample. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(3), 176–183. https://doi-org.uoro.idm.oclc.org/10.1027/0227-5910/a000369 

(2) Green, J. D., & Jakupcak, M. (2016). Masculinity and men’s self-harm behaviors: Implications for non-suicidal self-injury disorder. Psychology of Men & Masculinity, 17(2), 147–155. https://doi-org.uoro.idm.oclc.org/10.1037/a0039691

Last updated 7 April 2022