Self-harm

Published by Bupa's Health Information Team, April 2011.

This factsheet is for people who self-harm, or who would like to know more about it.

Self-harm is when a person deliberately and often repeatedly injures themselves. It's most common in people aged between 11 and 25, although anyone can self-harm at any age.

About self-harm

You may self-harm because you feel it helps you to deal with distressing or overwhelming thoughts and emotions. It can act as a temporary release from negative feelings and can help take your mind off things that make you feel low. For some people it can be a way of communicating their feelings to others.

If you self-harm you may injure yourself by:

• cutting your skin
• scratching or picking your skin
• burning your skin
• hitting and punching yourself
• pulling out your hair or eyelashes
• swallowing poison
• taking an overdose of tablets or medicines
• breaking bones
• banging yourself against objects

Other, less obvious ways such as drinking too much alcohol, taking recreational drugs, smoking, working long hours, starving yourself or binge eating are also forms of self-harm.

Self-harm is most common in young people but it can occur at any age. Young women are more likely to self-harm than young men, although the number of young men who self-harm is increasing. It's difficult to know the exact number of people who self-harm as many people do it secretly and never seek medical help.

Symptoms of self-harm

It can be very difficult to tell if someone is self-harming. People who self-harm often go to great lengths to keep it a secret from friends and family. Other people may use self-harm as a way of communicating their feelings and want people to see their injuries.

If you self-harm you may cover your injuries with clothing and avoid activities that expose your body such as swimming and sunbathing. You may be depressed, or become socially withdrawn and isolated.

Complications of self-harm

Most people who self-harm aren't trying to attempt suicide. People usually self-harm to deal with overwhelming feelings and thoughts. Occasionally self-harm can be a failed genuine suicide attempt. About a quarter of people who commit suicide have been to hospital because of self-harm in the past year.

Cutting your skin can cause permanent scarring and numbness.

Causes of self-harm

People self-harm for a number of reasons. Often people have low self-esteem and feel hopeless. You may self-harm as a way to manage the problems and pressures of everyday life. It can help you gain control of a difficult situation or can be used as self-punishment if you feel guilty. If you’re unhappy or feel helpless, you may self-harm to release your negative emotions. It can also be a way to express yourself, perhaps to get the attention of people when other ways of communication haven’t been heard.

Certain painful and difficult experiences can lead to self-harm, these include:

• losing someone close to you such as a parent, friend or relative
• being neglected
• physical or sexual abuse
• relationship problems
• poor health
• alcohol misuse
• being bullied

People with mental health problems such as schizophrenia, depression and bipolar disorder are more likely to self-harm.

Around one or two in ten people who self-harm will do it again within one year.

Diagnosis of self-harm

Telling someone about your self-harm can be difficult. You may feel embarrassed or guilty about harming yourself. You may fear that no one will understand you and you will lose control over your problem. You may also be worried that you won’t be taken seriously. It's important that you talk to someone who you trust such as a relative, a friend or your doctor.

Treatment of self-harm

There are a number of treatments available for self-harm. It's important that your doctor diagnoses and treats the underlying causes of your self-harm.

Self-help

Keeping a diary of your feelings and making a note of when you feel the need to harm yourself may be helpful. Lifestyle changes such as eating a healthy diet, making sure you get plenty of sleep and doing some physical activity can help to make you feel better about yourself.

When you feel the need to self-harm, try distracting yourself by:

• calling or visiting a friend or relative
• being creative – draw, paint or write about how you're feeling
• listening to music or reading a book
• taking a hot bath

Support groups may also be helpful. As well as offering support, it’s often comforting to know that someone else feels the same as you.

Getting help

Visit your GP and he or she can give you advice on how to care for your injuries. He or she can also give you information about support groups and tell you about the treatments that can help you. If your self-harming is severe, your GP may refer you to local psychiatric services for further assessment and treatment.

Talking treatments

Your GP may suggest cognitive behavioural therapy (CBT) and can refer you to a therapist. This type of therapy will help you change the way you think, feel and behave. It will help you identify the thoughts and feelings that act as triggers for self-harm. CBT can make you feel more able to deal with the challenges in your life. For more information about CBT, please see related topics.

Other forms of therapy such as psychodynamic therapy aim to identify past experiences that may have caused you to self-harm. Dialectical behaviour therapy may also be helpful for self-harm.

Medicines

Research into medicines for self-harm is very limited. If you're depressed your GP may prescribe you an antidepressant.

Hospital treatment

If you're at risk of suicide or seriously harming yourself, you may have to stay in hospital.

You may be admitted to hospital if you have taken an overdose or if your injuries are very severe. Most Accident and Emergency departments have a psychiatric liaison nurse or a social worker who will talk to you about why you have hurt yourself. He or she will assess your physical, mental and social needs so you can get the right treatment.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.