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Self-harm

Please be mindful that this the information below includes information that you may find difficult or distressing to think about. Looking after yourself and your emotional wellbeing is vital. Please see the ‘looking after yourself’ section below for tips and support. This information was co-produced with LPFT's Carers Council.

Self-harm is when you hurt yourself on purpose. Examples of self-harm include cutting, burning, poisoning and bruising. Other forms of more indirect self-harm may be self-neglect or excessive risk taking behaviour.

It’s a general term for any behaviour, action or habit, which can cause damage to your health and it’s a wide area that covers a whole range of actions.

The injuries may be minor, but sometimes they can be severe. They may leave permanent scars or cause serious health problems. Examples are:

  • Cutting yourself (such as using a razor blade, knife, or other sharp object to cut your skin
  • Punching yourself or punching things (like a wall)
  • Burning yourself with cigarettes, matches, or candles
  • Pulling out your hair
  • Poking objects through body openings
  • Breaking your bones or bruising yourself

What people generally don’t realise is that self-harming behaviour is relatively common. At least 10% of adolescents report having self harmed, and it can affect anyone of any age, background or race. It is a problem that needs to be taken seriously.

Self-harm is not a positive way to deal with difficult feelings and experiences, and over time it can become a habit that is quite hard to stop. That’s why it’s so important to spot it as soon as possible and do everything you can to help.

Self-harm is not a mental disorder. It is a behaviour and an unhealthy way to cope with strong feelings. However, some of the people who harm themselves do have a mental disorder. People who harm themselves are usually not trying to kill themselves. But they are at higher risk of attempting suicide if they do not get help.

Why do people do it?

There are a whole number of reasons why people might harm themselves. They can be broadly separated into 8 c’s, however it’s important to identify that people may well relate to one of these only or, more commonly, there might be several in play in any one ‘episode’.

It is likely that the reasons might change each time someone self-harms.

Coping and crisis intervention

Someone might engage with self-harm at times they are feeling overwhelmed, suicidal, or any intense emotion to help manage the crisis and to get through it.

It can also be a response to intrusive thoughts.

This can be life saving for someone. Words that might accompany this might be ‘I can’t bear it anymore’ or ‘I don’t know what else to do’.

Calming and comforting

If someone is experiencing distressing feelings, sometimes these can be hard to tolerate. Someone who self-harms might self-harm to calm down these feelings and possibly for comfort.

There could be different reasons why someone might find comfort in the act of self-harming; the person has learnt that if they harm themselves, they feel calm and comfort, and haven’t experienced anything that works any better.

Words that might accompany this might be ‘I’m alone and scared’ or ‘I’m really stressed/agitated/panicked and I need that to stop’.

Control

Someone may feel that they have little or no control over themselves or their life.

This might be due to a lack of control within relationships, ie parent/child or DV, difficulties with a job, exams, religious or tradition expectations or a health condition amongst other things.

Having control over your body is something that can feel empowering and, if it feels like you’re disempowered somewhere, or everywhere else, then that is a really precious feeling.

This can also be one that someone will struggle with if someone tries to stop them self harming and they aren’t ready. Words that might accompany this might be ‘this mine’ or ‘no one can stop me’.

Cleansing

This is kind of like purging your body is ‘poison’ or ‘toxins’ or from ‘contamination’ or ‘dirt’. The body is obviously not really contaminated or filled with poison, however, someone can feel that there is something inside, and want to get it out, ridding the body of whatever is inside it.

Some people will describe feelings or sensations, some people will visualise it, some people will have emotions associated with being contaminated, and some people might experience flashbacks.

Words associated with this might be ‘I need to get it out of me!’ or ‘I won’t be evil/dirty and I’ll be OK’.

Confirmation of existence

Some people can struggle to feel alive or connected to the world, especially when struggling with trauma (or past trauma) and knowing that they actually exist can be helpful, especially if they don’t feel it, for whatever reason.

This might be about seeing blood (i.e. what gives us life), feeling pain, seeing a wound, or something else. Words that might go with this might be ‘am I alive?’ or ‘am I part of this world?’ or ‘am I real?’ or ‘I need to feel real’.

Creating comfortable numbness

In some ways this is similar to the calming and comforting, however, this is often about numbing intense feelings or any type.

If someone has these intense feeling and can’t tolerate them, then numbness can be some respite or relief from the waves of emotion rolling over them.

Words that might go with this are ‘I need it to stop’ or ‘I need a break from this’.

Chastisement

Some feel that they need to be punished, that they aren’t good enough, that they deserve the pain/marks/to not eat or to self-harm and feels really low, down angry or disgusted at themselves.

Self-harming can be a form of punishment and that can be directly related to the act or, it can be a way to sabotage something positive in their life (such as a relationship) because the person feels they don’t deserve it.

Words that might go with this are ‘I deserve this’ or ‘I deserve to hurt’ or ‘I don’t deserve to have X in my life’ or ‘this is my fault, I need to pay’.

Communication

This is the one most often confused with ‘attention seeking’, however, this is not. It can be hard for people to truly communicate the depth or intensity of their pain.

This might be due to having no one to hear, or no one wants to hear, or someone doesn’t have words for it (and this is really common for many reasons), or something else.

Self-harm can be used to communicate to someone else, or it can be used to communicate to the person who self-harms.

Needing to communicate, needing to connect, is a healthy, basic need, and to only have self-harming as a way to communicate can show the loneliness that person may feel.

Words that might go with this are ‘things really are this bad’ or ‘I feel this bad’ or ‘I want you to know how bad I feel’ or ‘please hear me’ or ‘please help me’.

So self-harm is a way to find temporary relief from emotional overload. Breaking the cycle and helping someone to find other ways they
might manage these feelings is really important.

The cycle of self-harm

So self-harm is a way to find temporary relief from emotional overload. Breaking the cycle and helping someone to find other ways they might manage these feelings is really important. This can include distraction or stress management techniques, and thinking of alternative methods of discharging, getting rid of those extreme emotions.

The cycle may include a trigger event which increases distress, self-harm taking place, relief from tension, guilt or shame at the self-harm, self-disgust building up, and back to a trigger event which causes distress.

Some people find that putting off harming themselves can decrease or get rid of the urge.

Reducing the accessibility of objects that might be used for self-harm may also help to delay the impulse to self-harm.

The urge to self-harm is strongest for 15 minutes after the urge starts. Finding a way to distract yourself during this time can make all the difference. There are some excellent Apps to help people manage the urges to self-harm, such as Calm Halm and DistrACT.

Alongside learning coping strategies to distract from the need to self-harm it can really help to explore the issues behind the self-harming behaviour. For some people these may be obvious and resolvable, but for many others less so. Many people stop self-harming when the time is right for them.

It’s a way of coping right now, and, although we talked about it becoming habit forming, doing it now does NOT mean that they will have to do it forever.

Remember, self harm is not a failed suicide attempt, although some methods of self harm could be fatal. That said, research has shown that approximately 50-60% of people who die by suicide will have a history of self-harm, so it is important to encourage the person to seek professional help. If they are not ready to do so, you can seek advise by contacting any support services to talk things through.

Where to get help/sources of information

Helpful strategies

It can be really tricky to know how to respond in the immediacy of discovering that someone you care for has harmed themselves.

Do

Calmly assess the situation – do they need medical attention/what is their current emotional state/are they safe?

  • Listen!
  • Encourage them to seek professional support – this may be contacting the team they are under or accessing new help or help for the first time.
  • Remind them of their strengths.
  • Remind them that you are there for them.
  • Help create a list of distraction strategies – look online for plenty of ideas, but remember everyone is different and they may need to try a few strategies before they find one that works for them.
  • Offer to support them with creating a safety plan.

Do not

  • Be dismissive.
  • Totally freak out.
  • Change the way you treat them – they are still the same person!
  • Promise to keep it a secret.
  • Force them to explain why they have self harmed – they may not know themselves.
  • Try to fix things – its unlikely you will be able to and trying might make the person feel worse. Listening and showing you care is enough.

 

Looking after yourself

It’s important to look after yourself. If you are not well, either physically or emotionally, then it makes it very difficult for you to care for someone else. If you are struggling it is important to seek help.

Below are a few tips that you may find useful to support your own wellbeing.

  • Take time for yourself and do something that you like, even if it is for 30 minutes or an hour a day (e.g. read a book or have a relaxing bath).
  • Find someone to talk to. Having a friend or peer to offload to can be really beneficial to your own mental health. You could also join LPFT’s carers WhatsApp group, which consists of LPFT carers who support each other and will understand what you are going through. Email donna.bradford@nhs.net to join.
  • Join LPFT’s carers education and support group and learn about your relative’s condition, how services are run, and meet others in similar situations to you. Email donna.bradford@nhs.net to join.
  • Email the LPFT carers email address and let us know that you need some support - lpft.carers@nhs.net
  • Ask about family therapy available through the Trust.
  • Take courses through Lincolnshire Recovery College. There are lots of courses suitable for carers.
  • Remember our Mental Health Helpline (0800 001 4331) or the Samaritans are also available if you need support.

A printable version of this information can be found here.