What is self-harm?
||Who is at risk?
Self-harm is a term used when someone injures
or harms themselves on purpose rather than by accident. Common
examples include `overdosing' (self-poisoning), hitting, cutting or
burning oneself, pulling hair or picking skin, or
self-strangulation. Self -harm is always a sign of something being
Why do young people harm
Unfortunately some young people use self-harm
as a way of trying to deal with very difficult feelings that build
up inside. This is clearly very serious and can be life
threatening. People say different things about why they do it.
- Some say that they have been feeling desperate about a problem
and don't know where to turn for help. They feel trapped and
helpless. Self-injury helps them to feel more in
- Some people talk of feelings of anger or tension that get
bottled up inside, until they feel like exploding. Self-injury
helps to relieve the tension that they feel.
- Feelings of guilt or shame may also become unbearable.
Self-harm is way of punishing oneself.
- Some people try to cope with very upsetting experiences, such
as trauma or abuse, by convincing themselves that the upsetting
event(s) never happened. These people sometimes feel 'numb' or
'dead'. They say that they feel detached from the world and their
bodies, and that self-injury is a way of feeling more
connected and alive.
- A proportion of young people who self-harm do so because they
feel so upset and overwhelmed that they wish to end their lives by
committing suicide. At the time, many people just
want their problems to disappear, and have no idea how to get help.
They feel as if the only way out is to kill themselves.
An episode of self-harm is most commonly
triggered by an argument with a parent or close friend. When family
life involves a lot of abuse, neglect or rejection, people are more
likely to harm themselves. Young people who are depressed, or have
an eating disorder, or another serious mental health problem, are
more likely to self-harm. So are people who take illegal drugs or
drink too much alcohol.
Many young people who self-harm with a wish to
commit suicide also have mental health or personality difficulties;
often the suicide attempt follows a stressful event in the young
person’s life, but in other cases, the young person may not have
shown any previous signs of difficulty.
Sometimes the young person is known to have
long standing difficulties at school, home or with the police. Some
will already be seeing a counsellor, psychiatrist, or social
worker. There has been an increase in the suicide rate in young men
over recent years.
The risk of suicide is higher if the young
- is depressed, or has a serious mental illness
- is using drugs or alcohol when they are upset
- has previously tried to kill themselves, or has planned for a
while about how to die without being saved
- has a relative or friend who tried to kill themselves.
How can I help?
Where do I get speicalist help?
- Notice when the young person seems upset, withdrawn or
irritable. Self-injury is often kept secret but there may be clues,
such as refusing to wear short sleeves or to take off clothing for
- Encourage them to talk about their worries and take them
seriously. Show them you care by listening, offer sympathy and
understanding, and help them to solve any problems.
- Buy blister packs of medicine in small amounts. This helps
prevent impulsive overdoses. Getting pills out of a blister pack
takes longer than swallowing them straight from a bottle. It may be
long enough to make someone stop and think about what they are
- Keep medicines locked away.
- Get help if family problems or arguments keep upsetting you or
the young person.
- If a young person has injured themselves, you can help
practically by checking to see if injuries (cuts or burns for
example) need hospital treatment and if not, by providing them with
clean dressings to cover their wounds.
As a parent, it's really hard to cope with a
child/young person with self-harming behaviour or who attempts
suicide. It's natural to feel angry, frightened or guilty. It may
also be difficult to take it seriously or know what to do for the
best. Try to keep calm and caring, even if you feel cross or
frightened; this will help your child/young person know you can
manage their distress and they can come to you for help and
This may be difficult if there are a lot of
problems or arguments at home. Or, you may simply feel too upset,
angry or overwhelmed to effectively help your child/young person.
If so, you should seek advice from your GP.
If you are a teacher, it is important to
encourage students to let you know if one of their friends is in
trouble, upset, or shows signs of harming themselves. Friends often
worry about betraying a confidence and you may need to explain that
self-harm is very serious and can be life threatening. For this
reason, it should never be kept secret.
Everyone who has taken an overdose, or tried to kill
themselves, needs an urgent assessment by a doctor
as soon as possible even if they look OK.
Usually, this means an examination at the
nearest Emergency Department (also known as A&E). If you are
unsure whether the young person was suicidal or not, it is best to
act cautiously and take them to hospital. With overdose, the
harmful effects can sometimes be delayed, and treatment with
medication may be needed. Paracetamol is the most common medicine
taken as an overdose in Britain. It can cause serious liver damage,
and each year this leads to many deaths. Even small overdoses can
sometimes be fatal.
If the young person is self harming by cutting
themselves or other ways, it is still important that they have
help. Do speak to your GP who can refer you to your local child and
adolescent mental health services (CAMHS).
How is it treated?
Michelle’s story, aged 16
All young people who attend hospital following
attempting suicide or harming themselves should also have a
specialist mental health assessment before leaving.
It is often difficult to work out what
prompted the young person to self-harm or whether they actually
wished to commit suicide or not; mental health professionals have
the expertise to make sense of these complicated situations.
It is usual for parents or carers to be
involved in the assessment and any treatment. This makes it easier
to understand the background to what has happened, and to work out
together whether more help is needed.
Assessments in Emergency Departments (also
known as A&E) which include a short ‘talking therapy’
session have been shown to help young people come back for ongoing
help and support. A lot of young people self-harm or make
another suicide attempt if they do not receive the help they
Usually, treatment for self-harm and attempted
suicide, other than any immediate physical treatment, will involve
individual or family 'talking therapy' work for a small number of
sessions. They will need help with how to cope with the very
difficult feelings that cause self-harm.
Clear plans on how to help and how to keep the
young person safe will also be made. Some people who find it very
difficult to stop self-harming behaviour in the short term will
need help to think of less harmful ways of managing their
Families often need help in working out how to
make sure that the dangerous behaviour doesn't happen again, and
how to give the support that is needed This is something your local CAMHS
should have on offer.
If depression or another serious mental health
problem is part of the problem, it will need treatment. Some young
people who self-harm may have suffered particularly damaging and
traumatic experiences in their past. A very small number of young
people who try to kill themselves really do still want to die.
These two groups may need specialist help over a longer period of
"I’ve always been the tallest girl in my class
and my so-called friends regularly bitch about me behind my back
and bully me. I hate being different, but the harder I try to fit
in, the more they reject me.
My parents are divorced and I lived for many
years with my mother but it was my grandmother who really looked
after me. My mother was always busy at work or with her friends or
boyfriend; she travelled a lot. I never felt that she was really
there for me. My father remarried to a much younger woman who hated
me and I hated her – I still do.
A couple of years ago, I was changing for PE
and noticed that one of my friends has bright red lines all the way
down her arms; she usually wore long sleeved tops, even in the
summer, so I had never noticed them before. I was shocked and she
confided in me that she regularly cut herself. I couldn’t
understand why – she had everything, rich parents and wonderful
holidays all over the world. She told me that her parents were
never around and that she spent a lot of her time by herself. She
felt that when she cut herself, she got rid of the pain and the
I am now sixteen and have been regularly
cutting myself for more than a year. I hide the knife or the
scissors under the mattress and when my mother goes to bed, I cut
my arms and the top of my thighs. Some days are worse than others,
particularly when I get upset.
My mother noticed the marks on my body and
took me to the GP who put me on antidepressants, but I never took
them. I am now seeing a psychotherapist. I go every week, but I
still have a lot of things to sort out and it’s taking time. I’m
not doing it so often, only when I feel very stressed. I know it’s
dangerous, but it’s a very difficult thing to stop doing."
Provides a free and confidential telephone service for children.
Helpline: 0800 1111.
An online, user-lead voluntary organisation to raise awareness
about self-injury and provide information and support to people of
all ages affected by self-injury.
Network - UK charity offering support, advice and
advocacy services to people affected by self harm directly or in a
Direct - Health advice and
information service. Tel: 0845 4647
Samaritans - Provide a 24-hour service offering
confidential emotional support to anyone who is in crisis. Helpline
08457 909090 (UK), 1850 609090 (ROI); e-mail: email@example.com
Provides information and advice on child mental health issue and a
Parents'Helpline:0800 802 5544.
Understanding NICE guidance: They are versions of all
guidance for patients, carers and the public and summarises, in
plain English, the recommendations that the National Institute for
Health and Clinical Excellence makes to health and other
A CD-ROM designed for 13-17 year-olds on
mental health, which looks at health, which looks at depression,
and self-harm: 'Changing
Minds' A Multimedia CD-ROM about Mental Health'.
- National Institute for Health and Clinical Excellence: CG16 Self Harm: NICE Guideline
- National Institute for Health and Clinical
Self-harm: Longer term management): of Self Harm: NICE Guideline
- Hawton K, Harriss L. Deliberate self harm in
young people: characteristics and subsequent mortality in a 20 year
cohort of patients presenting to hospital. Journal of Clinical
Psychiatry 2007 68:1574-83
- Ougrin D et al. Trial of therapeutic
assessment in London: randomised controlled trial of Therapeutic
Assessment versus standard psychosocial assessment in adolescents
presenting with self-harm. Archives of disease in
childhood 2011 96 148-153
Revised by the Royal College of Psychiatrists’ Child and Family
Public Education Editorial Board.
Series Editor: Dr Vasu Balaguru
With grateful thanks to Dr Vasu Balaguru and Dr Mona
reflects the best possible evidence at the time of writing.
© March 2012. Due for review March 2014. Royal
College of Psychiatrists.