- Do you worry someone you know might be hurting themselves?
- Do you know someone who always wears long sleeves even in the warmest of weather?
- Have you seen marks on the skin that can't be explained? Such as scars, scratches, cuts or bruises?
- Do you know that someone is self harming and think if they cared about you they'd stop?
When somebody hurts themselves on purpose it is called self harm. Other terms sometimes used are - self injury, self mutilation, deliberate self harm or cutting. Self harm can be the reason behind someone wearing long sleeves in the summer and having unexplained marks on their body, but this can also be an indication of abuse or bullying. Please try to explore this option too. Remember there may be a fashion or cultural reason behind covering yourself up or this might be because of low self-esteem or negative body image. Use the following links to find out more:
What is self harm and why do people do it?
- hair pulling (trichotilliomania)
- inserting objects
- causing bruising to the body
- Causes of self harm
- abuse (sexual, emotional or physical)
- school/work pressures
- family financial difficulties
- housing problems
- relationship troubles
- family problems
- eating disorders
- drug/alcohol problems
- coming to terms with sexuality
- How you can help
- Medical treatment of self harm and harm minimisation
What is Self Harm?
Self harm is a 'coping strategy' that enables the individual to deal with feelings and emotions. There are a number of ways that people self harm:
This is by no means an exhaustive list.
The most common ways that people self harm are cutting their arms or legs, although many people self harm in other ways. Most admissions to hospital through self harm are because of overdosing.
Why Do People Self Harm?
People self harm to help themselves feel more in control or get an immediate relief from high levels of stress or distress. It is important to remember self harm is not attempted suicide but something that people do in order to survive and stay alive. Sometimes people also harm themselves because of self hate or because they want to punish themselves for something.
You may not realise the individual is experiencing these difficulties; a common theme amongst individuals who self harm is that it is very often hidden from the rest of the world. Individuals can become withdrawn and isolated, and secretive about their feelings and self harm.
It might seem to the outside world that the person has no reason to self harm or feel the way that they are feeling, but what is important to remember is that it is the individuals subjective experience of their world that may cause them distress. What may be upsetting to you may not be to them, and vice versa, what is significant is that THEY ARE feeling bad, and they need and deserve support and care.
Causes of Self Harm
The causes of self harm are the things that set it off in the first place - not necessarily what makes the individual continue to self harm.
The causes of self harm may be:
…or any experience or event that causes negative feelings, thoughts and tensions.
Sometimes individuals go for months without harming themselves and others self harm daily.
For some individuals, an episode of self harm may be triggered by a significant life event, but for others the day to day fluctuation in their thoughts and feelings is too much to bare. Simple stresses such as breaking a glass, or running late for an appointment might be enough to create a tension so overwhelming in the individual that they self harm to cope with this. For some, self harm can become a habit; something they routinely do to survive on a day to day basis because they don't know what else to do.
Sometimes, even 'positive' experiences can create overwhelming feelings in the individual that they do not know how to manage.
For all individuals the starting point for recovery is to become aware of their reasons for, and drives to, self harm; it is armed with this knowledge that they can learn to respond differently to their difficulties. Recovery is always possible, however lost and overwhelmed the person feels.
How You Can Help
Supporting someone who self harms can be very difficult and challenging. Knowing that someone you care about is in emotional distress can create many feelings including fear, anger, frustration, helplessness and sadness. Try to make sure you have a way of dealing with your own feelings as the person you are supporting is going to need all the patience, understanding and support you can give.
Remember that the individual you are supporting is in distress, their actions are not intended to make you suffer. Try to imagine how desperate you would have to be feeling to cause actual physical harm to yourself.
Many people who self harm feel completely ashamed and isolated by their difficulties. The best source of support you can give is to reduce this shame and isolation by providing an unconditional relationship. Allow the person to express their feelings whatever these may be as this might be fundamental to their recovery.
Don't ask the person to stop harming themselves 'for you'. If the individual works towards reducing or stopping their self harm they must do so in their own time and for their own reasons. If they just do it to make you happy it will not be sustainable or may cause them to hide it. It may also leave them feeling like you just want them to change; that they are not accepted or understood and this may in turn lead to them feeling even more isolated and distressed.
Self harm is very often an individual's way of coping and staying alive. People who self harm are more likely to commit suicide than the general public but their harm may be the one thing that keeps them going; to take this away from them, encourage them to hide it, or stop for the wrong reasons may lead to them feeling so overwhelmed with their feelings and experiences and may lead to suicidal feelings or actions.
It is really important to remember that self harm is VERY different to suicidal intent, but at times the two may be close. Someone who is suicidal feels as if they can't take anymore and their only option is to end their life, whereas someone who self harms feels that they can't take anymore (of whatever they're feeling) and their only option is to harm themselves in order to stay alive.
If you tell them to STOP when they're not ready, imagine what they could feel their only option is.
The most constructive way to deal with self harm is to stay calm, try not to be alarmed or show your fears. There are many things that can help: it may be that the individual needs structured therapy from a mental health professional, or that the compassionate support of family and friends is enough to aid their recovery.
The most helpful treatment for people who self harm is any talking therapy that usually takes place over a number of months or years.
Medical Treatment for Self Harm
There may be sometimes when the individual requires medical treatment for their self harm. If this is the case the individual should expect to be treated sensitively and with the same level of care and attention as any other patient. (There are a set of guidelines produced for NHS staff to advise them how they should treat people who self harm.)
Unfortunately this is not always the case, and it will help if you are prepared and able to advocate for the person who has harmed themselves. Be aware that going to a GP or A & E for treatment of self harm is most likely going to be a very difficult experience for someone who self harms as this is a very public arena for a very private act.
Try to ensure the individual is given a private area to speak to the health care professional and that they are given a choice in their treatment - even if their choice is one you disagree with.
Any individual who has self harmed has the right to pain relief and thorough treatment for their harm, and should not be exposed to judgment or crititcism by the healthcare professional.
If the person is bleeding heavily, has taken an overdose or ingested a substance, take the person to A & E as this could be life threatening. We are not healthcare professionals and cannot give advice on first aid.
A majority of cases of self harm are not serious enough to warrant medical intervention so individuals may never come into contact with healthcare services for their self harm. In these cases it is often beneficial for the individual to manage their own first aid by dressing their wounds and keeping them clean and dry.
Self Harm Minimisation
It is essential that wounds are kept clean, and perhaps you could encourage this by providing the individual with a first aid kit or making an agreement with them that they look after themselves, for example, by using clean blades to avoid infections, or by not cutting too deeply to avoid damage to tendons and muscles.
This might be the first step to recovery but must be mutually agreed and not imposed. We know this may feel very difficult for you, but this method of patience and care may be very influential in promoting health and recovery, and may be enough to help the person feel back in control, accepted and less isolated.