Self-harm

Self-harm is when someone hurts themselves on purpose rather than by accident. There are lots of different ways that people self-harm, for example:

• cutting, scratching, burning or hitting yourself
• poisoning yourself by eating or drinking things that you shouldn’t
• putting yourself in dangerous situations where you might be harmed

If you are doing something that damages your body or hurts you, this is self-harm.

It is important to get help if you are harming yourself, no matter how big or small the harm is. Unfortunately, self-harm can become more dangerous as time goes on. Asking for help as soon as possible can stop things from getting more serious.

Remember, you are not alone. Self-harm is very serious, but it is also very common. It is hard for us to know exactly how many young people self-harm, and estimates vary. Research suggests that between 1 in 10 and 1 in 4 young people have self-harmed.

You might not know exactly why you are self-harming, or you might be doing it for a very particular reason. For example:

• You are feeling sad, angry, scared, or overwhelmed, and want these feelings to stop.
• Things are happening in your life that feel overwhelming or unmanageable. You might feel as though self-harming helps you to feel in control.
• You have seen or heard about other people self-harming and want to see what it feels like.
• You have negative feelings about yourself and are looking for a way to punish yourself.
• You are feeling disconnected and are struggling to ‘feel’. Self-harm might be something you are doing so that you can ‘feel something’.
• Bad things are happening in your life or in your mind, and you are looking for a way to show people how you are feeling. You might feel conflicted, as though you both do and don’t want people to notice that you are self-harming.
• You feel like you don’t want to live anymore. Many people who self-harm do not want to die, but some do. If you have feelings of wanting to die or of not wanting to exist anymore, it’s important to speak to someone you trust as soon as possible. This could be a close friend, family member or teacher.

Whatever reason you have for self-harming, it is not your fault. It is also important that you don’t compare your self-harming to anyone else’s. All self-harm is serious and important, and everyone who self-harms deserves help.

What happens in my brain when I self-harm?

Before you self-harm, you might feel a build-up of emotions that become so strong that you feel completely overwhelmed. You might struggle to do or think about anything else.

Self-harming can create a temporary feeling of relief and distract you from the feelings you had before your self-harmed. Over time you may need to self-harm more or in more extreme ways to get the same feeling of relief. This creates a cycle that can make it hard to stop self-harming.

 

If you haven’t been self-harming for long, or you feel like your self-harming isn’t a big deal, you might be wondering why you need to stop.

Self-harm is something that often gets worse over time, and as it does the risks increase. Self-harm can lead to:

• scarring
• infections
• permanent nerve damage
• brain injury
• permanent damage to the heart, liver and kidneys from drug overdose
• accidental death.

While it can feel like self-harm is helping you to cope, it will negatively affect your mental health as time goes on. Over time you might find yourself becoming more isolated from friends and family. No matter how long you have been self-harming for or how ‘serious’ your self-harm is, it is important that you seek help and try to stop.

We know this can be incredibly difficult. You might want to stop but not know how, or be scared of how you will cope with difficult feelings if you can’t self-harm. However, it is important to remember that you are likely to start feeling better once you have stopped or reduced how much you self-harm.

Below we look at some things you can do to support yourself. This includes strategies that you can try yourself, and where to turn for further support.

Self-harming can be difficult to stop doing on your own. Over time it can become a habit and can start to feel like the only thing that will help. This can mean that when you want to stop you can’t.

There are lots of methods you can use to try to stop or reduce self-harming. There is no single approach that works for everyone, so you might need to spend some time finding what works for you. Be open to trying new coping strategies and throwing out ideas that don’t work, and congratulate yourself for trying them anyway.

Write a safety plan

Safety plans are forms that you can fill out with information that will help you when times get tough. The charity Charlie Waller has a wellbeing action plan that you can use. The medical professionals or service treating you might have an alternative one.

These plans should be filled in with the support of a healthcare professional and someone you trust. For example, a friend or family member. It is also best to write a safety plan when you are calm and can think clearly. It’s important that these are reviewed regularly and kept up to date. This is because the things you find hard and the things you find helpful might change over time.

Identify triggers

Identify triggers that lead to you feeling like you want to self-harm. These might be feelings, situations, people or even times of day. Work with someone you trust to come up with ways that you can respond to these triggers. For example, when you feel sad you might find it helpful to call a trusted friend. Or when you are feeling overwhelmed, you might find it helpful to go to a ‘safe space’. We look at different distraction techniques below.

“I think it’s important to identify triggers and have a list that says, when I’m feeling like this, this helps. It can be good to regularly update the list as well.” Emma

Speak to family and friends

Family and friends are an important support mechanism. Just reaching out to a trusted friend when you feel like you want to self-harm can distract you for long enough that this urge goes away. You might find it helpful to have a code word for when things are getting hard. This can help the people around you know when you need help, without you having to go into detail.

You might also want to tell people what things you don’t find helpful. If speaking feels too difficult, then consider other ways of letting someone know how you’re feeling. For example, sending a text message, or writing a letter.

Be careful with how you use social media

Social media can be a fantastic way to keep in touch with friends and family, and to make new connections. However, you might also find content online that isn’t helpful if you are trying to stop self-harming. Avoid websites or accounts that encourage self-harm. If you need to, you can also change your preference settings to avoid certain words or topics. Or you can restrict or block content that triggers your self-harm.

You could also try following accounts that make you feel good about yourself, or that offer positive messages about mental health and recovering from self-harm.

If you keep seeing upsetting or triggering content, try to avoid using those apps for the time being. This can be difficult if your friends are using them, but it’s important to prioritise your mental health.

Keep a journal

Write down or draw how you are feeling. This can help you to identify certain patterns or triggers, especially if you do this before and after you self-harm. This can help you to avoid these triggers or come up with techniques to distract yourself.

Distraction techniques

Sometimes the main thing you can do is distract yourself until the urge to self-harm goes away. What you find helpful will depend on your own likes and dislikes, and any methods you use should be unique to you. Some ideas include:

• Creating pain in a safer way by snapping a hairband on your wrist or holding an ice cube.
• Doing something creative like writing, painting, knitting or baking a cake.
• Going for a run or doing another exercise that makes you sweat and feel out of breath.
• Calling a friend or meeting up with someone in person.
• Watching a funny video or listening to a favourite song.
• Using the 5-4-3-2-1 mindfulness method. This is where you think of:
  • 5 things you can see
  • 4 things you can touch
  • 3 things you can hear
  • 2 things you can smell
  • 1 thing you can taste.
• Making a self-soothe box – These are small boxes (like a shoebox) full of things that soothe you. For example, fidget toys, nice smelling shower gel or comforting pieces of fabric.

You could share the distraction techniques you find helpful with the people you trust. That way, they can help you to do them when you are struggling.

For further help you can speak to your GP, your school nurse, a trusted teacher. You could also reach out to your local Child and Adolescent Mental Health Service (CAMHS), if you are already in touch with them.

Whoever you speak to, they should ask similar questions, and use the information you share to help them decide which services will be most helpful for you.

They should find out more about why you are self-harming and what might be going on in your life. They should also try to find out if there is anything else going on that might be causing your self-harm, such as:

• Mental health conditions like depression, anxiety or eating disorders. If you have a mental health condition, treating it might help you to stop self-harming
• Neurodevelopmental conditions like autism or ADHD. These conditions don’t cause self-harm. However, if you are not getting the support you need for these conditions, this could cause distress that might contribute to self-harm.
• If you are using drugs or alcohol
• If something is happening in your life that is causing you distress. For example,  difficulties at home or at school, bullying, or abuse.

They should help you think about:

• why you are self-harming
• what triggers there are to you self-harming
• the coping strategies you have
• the people in your life who support you
• the risks of self-harm.

They should also share details of support services local to you, and emergency mental health services so you know who to contact if you need help.

Every young person is different and there is no ‘one-size-fits-all’ treatment for self-harm. Healthcare professionals will work with you to find out what treatment or management plan will be the best fit for you.

Counselling and talking therapies

Healthcare professionals might recommend that you take part in supportive counselling or psychological therapies (also called talking therapies).

There are many different types of psychological therapies, and the kind you are offered for self-harm might include:

• cognitive behavioural therapy (CBT)
• dialectical behavioural therapy (DBT).

The type of therapy you are offered will depend on your needs, and if you have any mental health conditions.

Counselling or talking therapy can be given:

• Individually – This is where you meet with a therapist one on one.
• In a group – This is where you meet with a therapist and other young people who are experiencing similar challenges to you. This can help you to learn from other people and to be part of a community.
• With your family – This is where your family take part in your therapy. This can help you to understand how you can all work together to support each other.

The availability of counselling and talking therapies will depend on where you live. Unfortunately, you might need to wait some time before receiving talking therapy.

Support for underlying mental health conditions

If you have an existing mental health condition, treating it might help you to reduce or stop self-harming. For example, if you are experiencing depression, treating it will probably be an important part of treating your self-harm.

Other areas of support

There are lots of different services that can be helpful if you are a young person who is self-harming, including:

• your school
• your GP
• CAMHS
• social care services
• charities and non-profit organisations – these can offer you and your family specialist advice and support.

Remember, if you are not referred to CAMHS, this doesn’t mean that what is happening is not being taken seriously. Sometimes the support that is right for you may come from another service.

Sometimes, self-harm will need to be treated by medical professionals. If you think you have self-harmed in a way that is dangerous, speak to someone immediately.

You must go to A&E if you:

• Have taken an overdose of any kind. Many medications can do a huge amount of damage to your body, and you might not be able to tell that this has happened straight away.
• Have cut yourself and are unable to stop the bleeding.
• Have any concerns that you have harmed yourself badly in a way that cannot be treated at home.
• Feel that you can’t keep yourself safe.

If you can’t get yourself safely to A&E, you or someone else should call an ambulance.

What happens in A&E?

The young people’s charity The Mix have a page that looks at what happens when you go to A&E for self-harm. In A&E you will receive support for both your physical and mental health:

• doctors and nurses will help to treat any injuries you might have
• mental health professionals will speak to you about your mental health and your emotions.

Some young people can find a busy A&E department to be a very overwhelming place. Unfortunately, not everyone has positive experiences when seeking emergency care for self-harm. Remember that you have a right to seek help, and you should never feel shamed or judged for this. You have done the right thing in going to A&E.

“A big turning point in our relationship was when Emma self-harmed and I took her to A&E. I didn’t get dramatic and shout, I just dealt with it. I think Emma felt that I understood and was on her side, whereas before she felt like ‘I can’t do it when mum’s around because she’ll go mad’. I never thought that would have been a good moment.” Toni

Suicide is when someone ends their own life. The link between suicide and self-harm is complicated. Not everyone who self-harms wants to die, and not everyone who dies by suicide wanted to die. However, self-harm can be a sign that someone wants to die. Self-harm can also accidentally lead to someone dying when they didn’t want to, or weren’t sure if they wanted to die or not.

This is why self-harm is taken extremely seriously. If you self-harm, you might be asked by your family, friends or doctors whether you want to die. It is important to be honest about how you are feeling so you can get the support you need.

As a parent or carer, it can be incredibly hard to know that your child is self-harming. It is totally normal to feel angry, frightened or guilty. You might also feel like you want to pretend it isn’t happening, or you might not know what to do.

Stay calm

The most important thing for you to do is stay calm. This will help your child to know you can be trusted and relied upon in the future.

Take it seriously

It can be tempting to assume self-harm is caused by ‘peer pressure’, or to think that your child will ‘grow out of it’. However, self-harm is always a sign that something is wrong, and it must be taken seriously. Self-harm might start because of peer pressure, but continue because of other issues going on in your child’s life.

It can be helpful to think of self-harm as a way of communicating. Children and young people can struggle to express themselves when they are upset or overwhelmed. They can also find it hard to share when something bad is happening to them.

Don’t blame yourself

It can be easy to blame yourself, as a parent or carer, and worry that there is something you have missed or done wrong. However, there are often a number of reasons why your child is feeling the way they are. Focus on offering support and understanding, rather than on blaming yourself.

Don’t react negatively

If your child has harmed themselves, you will probably feel panicked and upset. Your first response might be to tell them how dangerous it is, or to tell them that they must stop. Unfortunately, this could cause them to hold back from sharing other information with you in the future. If they think they will get in trouble, they might try to hide their self-harming from you and others.

“As a parent you want to protect your child, and so you don’t see all the grey areas. All the nuances get lost because you just think about the potential end result.” Abi

Try to understand why they are doing it

Ask calm, simple questions. For example

• Do you know why you started self-harming?
• How do you feel when you self-harm?
• Did anyone show you how to self-harm?
• Is something happening that is making you feel this way?
• Is there a way that you would like me to help?

These kinds of questions can help you to understand why they are self-harming and if something has happened to lead to the self-harm. You might not get all the answers you need straight away. Be patient and reassure your child that they can always speak to you.

Writing a safety plan

When your child is feeling calmer, you might want to work together to create a safety plan. Or if they already have one, it might be helpful to review it together. You can use this plan to help you and your family know how your child wants to be supported when they are self-harming or thinking about self-harming.

Think about how your child will respond best

There isn’t one way to speak to your child about self-harming, or about anything for that matter. How you speak to your child will depend on

• them
• you
• your relationship
• your family dynamic
• your culture
• and lots of other factors.

Here are some ideas for how you might be able to make your child feel more comfortable when having these conversations:

• Speaking about it in the car – Some children find it easier to talk when no one is looking directly at them.
• Writing to each other – Some children struggle to speak openly, but are more comfortable writing things down.
• Talking about it at a particular time of day – Think about when your child is most open and feeling most calm. For example, at bedtime or on the way to school.
• Getting someone else to have the conversation – While you should be careful about maintaining confidentiality, your child might be more likely to speak to someone else. For example, they might have a favourite aunt or uncle or even a teacher who they are more open with.

Know when to stop talking

You might find it helpful to have a ‘safe word’ to start the conversation and to finish it. Speaking about self-harm can be difficult, and this can allow your child to have these conversations in a safe way, without feeling overwhelmed.

Maintain trust

Self-harm can be a very secretive thing, and your child might be carrying a lot of shame and fear. It is important that they can trust you not to share information of their self-harm more widely. It is also important that they don’t feel pressured into keeping it secret. Remember, you might need to tell other people that your child is self-harming if it becomes more serious. It is important not to promise to keep it secret.

Harm reduction

No matter how much support you give your child, they might still self-harm. There are things you can do to ensure that if they do self-harm it is as safe as possible:

• encouraging them to speak to you if they do self-harm
• having bandages and other medical equipment available
• making sure it isn’t easy for them to access large amounts of medication or sharp objects. Of course this won’t always be possible.

While these things won’t take away the risk of self-harm entirely, they can make it more difficult for your child to self-harm. Or it can mean that if they do they can seek help as quickly as possible.

The NHS has information and a video on how to help someone who self-harms that parents might find helpful.

Information for young people

Childline – Childline has a free and confidential telephone service for children.

The Samaritans - A 24-hour service offering confidential emotional support to anyone who is in crisis.

YoungMinds – A charity that provides information and support to children and young people struggling with their mental health.

Apps

Calm Harm app – Calm Harm is a free app that helps young people over the age of 13 manage the urge to self-harm. You can choose activities from different categories, such as comfort, distract, express yourself, release and random.

Kooth app – Free, safe and anonymous app to support people with their mental health. This app includes a magazine, discussion boards, goal tracker, journal, chat and messenger functions.

Information for friends

Tips for 11-18 year olds on supporting a friend or partner with self-harm, Mind – Information for young people from the charity Mind on supporting a friend or partner who self-harms.

Five Tips if Someone Tells You They Are Self-Harming, YoungMinds – YoungMinds have put together some tips for young people who know someone who is self-harming.

Information for teachers

Young people who self-harm: a guide for schools (PDF) – The College has worked with a number of organisations to produce guidance for schools on self-harming. This guide should be used alongside existing school safeguarding policies.

Guidance

Self-harm: assessment, management and preventing recurrence, information for the public, NICE guidelines NG225 – Information from the National Institute for Health and Care Excellence (NICE) on what you can expect from healthcare services if you have self-harmed.

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Lead author: Dr Emma Diggins

Experts by experience: Abiola Johnson, Emma Wakefield and Toni Wakefield

Full references available on request.