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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Self-harm: key facts

self-harm

Introduction

1 in 10 of us self-harms by taking tablets, cutting, burning, piercing or swallowing objects. It is more common in young people, women, gay and bisexual people and in some sub-cultures. Some people self-harm regularly - it can become almost an addiction.

What makes people self-harm?

It usually happens when you feel very distressed. This can be caused by abuse, feeling depressed, feeling bad about yourself or relationship problems. You may do it because you feel:

  • not listened to
  • hopeless
  • isolated
  • alone
  • out of control
  • powerless.

You are more likely to self-harm if you were abused in childhood.

How does it make you feel?

Self-harming can help you to feel in control and less tense. So, it can be a 'quick fix' for feeling bad.

What help is there?

  • Talking: Talking can help you to feel less alone, to see your problems more clearly and think about them differently.
  • Self-help groups: People with similar problems can provide support and practical advice – and, believe it or not, sharing your problems in a group does help.
  • Help with relationships: Group therapy can often help you to sort out difficulties in getting on with other people.
  • Talking Therapy: Problem-solving, Cognitive Behavioural, Psychodynamic psychotherapy or Dialectical Behaviour therapy are all types of therapy that can help.

What works best?

All these treatments help. Some evidence suggests that problem-solving/Dialectical Behaviour therapy may be best.

What if I don't get help?

1 in 3 people who self-harm will do it again within a year. People who self-harm are 50 times more likely to kill themselves. The more time you self-harm, the greater the risk. Cutting can cause scarring, numbness or paralysis.

How can I help myself ?

When you want to harm yourself:  See if you can ride out how you feel without self-harming, the feelings will usually go after a few hours. You can talk to someone, distract yourself by going out, sing or listen to music, or do anything (harmless) that interests you. Try to relax and focus your mind on something pleasant. Find another way to express your feelings such as squeezing ice cubes (make them with red juice to mimic blood if that helps), or draw red lines on your skin. Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower. Focus on positives. Be kind to yourself – get a massage. Write a diary or a letter, to explain what is happening to you – no one else needs to see it.

When the urge has gone: Think about the times that you have self-harmed and what (if anything) has helped. Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there. Where were you, who were you with, and what you were feeling? Try to work out why you began feeling like you did. Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you. Make a recording by talking about your good points and why you don't want to self-harm. When you feel bad, play this back to remind you of the parts of you that are worthwhile.  Make a 'crisis plan' of what to do when you feel bad.

What can I do if I don't want to stop?

If this is the case, try to reduce the damage you may cause yourself. If you cut, use clean blades. Find ways of hurting yourself that don't damage your body (see above).

If you can say YES to at least 3 of the questions below, it's worth trying to stop.

  • Are there at least two people who are willing to help me stop?
  • Do I have friends that I can go to if I get desperate?
  • Have I found at least two safe ways that reduce the feelings that make me self-harm?
  • Can I really say to myself that I want to stop hurting myself?
  • Can I tell myself that I WILL tolerate feelings that make me want to self harm?
  • Is there a professional who will support me and help in a crisis?

If I harm myself and need treatment?

You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many departments have a psychiatric liaison nurse, or a social worker, who can talk with you. You can ask to be treated by a male or a female member of staff if you have a preference. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.

What can I do if I know someone who self-harms?

  • Listen to them without being critical. This can be very hard if you are upset or angry. Try to focus on them rather than your feelings – this can be hard.
  • Try to understand their feelings, and then move the conversation to other things.
  • Take the mystery out of self-harm by helping them find out about self-harm on the internet or at the library.
  • Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
  • If you are caring for someone who self-harms, and you would like some emotional support, you can request this from your GP or the mental health services if they are involved.

Don't

  • Try to be their therapist – you have enough to deal with as their friend.
  • Expect them to stop overnight – it's difficult and takes time.
  • Get angry - this may make them feel worse. Talk calmly about the effect it has on you - in a way that shows how much you care for them.
  • Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
  • Make them promise not to do it again or make your involvement conditional on them stopping.

For more in-depth information see our main leaflet: Self-harm

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Amy Green

© January 2014. Due for review: January 2016. Royal College of Psychiatrists.This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 3701 2552.

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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