About this leaflet
This leaflet
provides information about self-harm and is for anyone who is
harming themselves, or feels that they might. We hope it will also
be helpful for their friends and families.
What is self-harm?
Self-harm happens when someone hurts or harms themselves. They
may:
- take too many tablets;
- cut themselves;
- burn their body;
- bang their head;
- throw their body against something hard;
- punch themselves;
- stick things in their body;
- swallow inappropriate objects.
It can feel to other people that these things are done coolly
and deliberately – almost cynically. But someone who self-harms
will usually do it in a state of high emotion, distress and
unbearable inner turmoil. Some people plan it in advance, others do
it suddenly. Some people self-harm only once or twice, but others
do it regularly - it can become almost like an addiction.
Some of us harm ourselves in less obvious - but still serious -
ways. We may behave in ways that suggest we don't care
whether we live or die – we may take drugs recklessly, have unsafe
sex, or binge drink. Some people simply starve themselves.
Other words that are used to describe
self-harm
These terms are inaccurate and going out of use:
- Deliberate self-harm (DSH) - the word
'deliberate' unhelpfully blamed self-harm as a reaction to painful
feelings.
- Suicide/Parasuicide - most people who
self-harm do not want to kill themselves, so these terms are
misleading.
Who self-harms?
- About 1 in 10 young people will self-harm at some point, but it
can occur at any age.
- It is more common in young women than men.
- Gay and bisexual people seem to be more likely to
self-harm.
- Sometimes groups of young people self-harm together - having a
friend who self-harms may increase your chances of doing it as
well.
- Self-harm is more common in some sub-cultures – "goths" seem to
be particularly vulnerable.
- People who self-harm are more likely to have experienced
physical, emotional or sexual abuse during childhood.
Research probably under estimates how common self-harm is, and
surveys find higher rates in communities and schools than in
hospitals. Some types of self-harm, like cutting, may be more
secret and so less likely to be noticed by other people. In a
recent study of over 4000 self-harming adults in hospital, 80% had
overdosed and around 15% had cut themselves. In the community,
these statistics would probably be reversed.
What makes people self-harm?
Emotional distress – people often struggle with difficulties for
some time before they self-harm:
- physical or sexual abuse;
- feeling depressed;
- feeling bad about yourself;
- relationship problems with partners, friends, and family.
If you feel:
- that people don't listen to you;
- hopeless;
- isolated, alone;
- out of control;
- powerless – it feels as though there's nothing you can do to
change anything.
- Using alcohol or drugs – it may feel that these are as out of
control as the rest of your life.
- If you want to show someone else how distressed you are or to
get back at them or to punish them. This is not common – most
people suffer in silence and self-harm in private.
How does it make you feel?
Self-harm can help you to feel in control, and reduce
uncomfortable feelings of tension and distress. If you feel guilty,
it can be a way of punishing yourself and relieving your guilt.
Either way, it can become a 'quick fix' for feeling bad.
Are people who self-harm mentally ill?
Most people who self-harm are not mentally ill. However, some
may be depressed, or have severe personality difficulties, or be
addicted to alcohol and drugs. But they all still need help - the
risk of killing yourself increases after self-harm. Everyone who
self-harms should be taken seriously and offered help.
Getting help
A lot of people who self-harm don't ask for help. Many young
people who self-harm know that they have serious problems, but
don't feel that they can tell anyone – so they don't talk to
friends, family, or professionals. Other young people don't feel
that they have serious problems - they use self-harm as a way of
coping, but their situation stays the same.
What's more, less than half of those who go to hospital after
self-harming are seen by a specialist in this area. You are less
likely to be seen by a specialist if you are young, if you cut
yourself, or if you have taken an overdose.
Danger signs
Those who are most likely to harm themselves badly:
- use a dangerous or violent method;
- self-harm regularly;
- are socially isolated;
- have a psychiatric disorder.
They should be assessed by someone with experience of self-harm
and mental health problems.
What help is there?
Talking with a non-professional
Many people find that it's helpful just to talk anonymously to
someone else about what is happening to them. Knowing that someone
else knows what you are going through can help you to feel less
alone with your problems. It can also help you to think about your
difficulties more clearly – maybe even see ways of solving them
that you wouldn't think of on your own. You can do this on
the internet or by telephone (see contacts section at the end of
this leaflet).
Self-help groups
A group of people who all self-harm meet regularly to give each
other emotional support and practical advice. Just sharing your
problems in a group can help you to feel less alone - others in the
group will almost certainly have had similar experiences.
Help with relationships
Self-harm is often the result of a crisis in a close
relationship. If this is the case, help with the relationship will
be needed rather than help with self-harm.
Talking with a professional
For people who use self-harm to cope with other problems,
one-to-one treatments can help. These include:
- Problem solving therapy;
- Cognitive psychotherapy;
- Psychodynamic psychotherapy;
- Cognitive behavioural therapy.
Family meetings
Where this is appropriate, family meetings with a therapist can
help to relieve the tiring, daily stress for everyone in the
family.
Group therapy
This is different from a self-help group. A professional will
lead (or facilitate) the group in a way that helps the members to
deal with problems in getting on with other people.
What works best?
There is little evidence to say that any one of these therapies
is better than any of the others for self-harm, although what
evidence there is supports problem-solving therapy.
What if I don't get help?
- About 1 in 3 people who self-harm for the first time will do it
again during the following year.
- About 3 in 100 people who self-harm over 15 years will actually
kill themselves. This is more than 50 times the rate for people who
don't self-harm. The risk increases with age and is much greater
for men.
- Cutting can give you permanent scarring, numbness, or
weakness/paralysis of fingers.
How can I help myself ?
When you want to harm yourself
The feelings of self-harm go away after a while. If you can cope
with your upset without self-harming for a time, it will get easier
over the next few hours. You can:
- Talk to someone – if you are on your own perhaps phone a
friend.
- If the person you are with is making you feel worse, go
out.
- Distract yourself by going out, singing or listening to music,
or by doing anything (harmless) that interests you.
- Relax and focus your mind on something pleasant – your very own
personal comforting place.
- Find another way to express your feelings such as squeezing ice
cubes (which you can make with red juice to mimic blood if the
sight of blood is important), or just drawing red lines on your
skin.
- Give yourself some 'harmless pain' - eat a hot chilli, or have
a cold shower.
- Focus in your mind 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 you don't feel like harming yourself
When the urge has gone, and you feel safe, think about the times
that you have self-harmed and what (if anything) has been
helpful.
- 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.
- How did other people react?
- What did you do about the feeling?
- Could you have done anything else?
- Make a tape or MP3 recording. Talk about your good points and
why you don't want to self-harm. Or, ask someone you trust to do
this. When you start to feel bad, you can play this back to remind
yourself of the parts of you that are good and worthwhile.
- Make a 'crisis plan' so you can talk to someone instead of
self-harming. Being able to get in touch with someone quickly can
help you control your urge to self-harm. While you are talking,
your wish to harm yourself may start to go away.
What if you don't want to stop
self-harming?
If you decide that you don't want to stop self-harming, you can
still:
- reduce the damage to your body (for example, use clean
blades);
- keep thinking about possible answers to the things that make
you harm yourself;
- every so often, re-visit your decision not to stop.
Self-harm can be very damaging physically and psychologically –
in the end, you'll do better by stopping.
There are a number of questions to ask yourself to see if you
are ready to stop. If you can honestly say YES to half of the
questions below, or more, then why not try stopping?
- Are there at least two people who are willing to help me
stop?
- Do I have friends that know about my self-harm, who I can go to
if I get desperate?
- Have I found at least two alternative safe ways that reduce the
feelings that lead me to self-harm?
- Am I able to tell myself, and to believe it, that I want to
stop hurting myself?
- Can I tell myself that I WILL tolerate feelings of frustration,
desperation, and fear?
- If necessary, is there a professional who will also give me
support 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 Accident and Emergency departments now have either a
psychiatric liaison nurse, or a social worker, who will be able to
talk with you about how you are feeling, and to see if there are
any further ways of helping. They should be able to consider all
your needs, whatever they may be, and to write an assessment of
them. You should be able to go through this with them and, if you
disagree with their assessment, to write this in the notes. 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?
It can be very upsetting to be close to someone who self-harms -
but there are things you can do. The most important is to listen to
them without judging them or being critical. This can be very hard
if you are upset - and perhaps angry - about what they are doing.
Try to concentrate on them rather than your own feelings – although
this can be hard.
Do
- Talk to them when they feel like self-harming. Try to
understand their feelings, and then move the conversation to other
things.
- Take some of the mystery out of self-harm by helping them find
out about self-harm perhaps on the internet at the local
library.
- Find out about getting help - maybe go with them to see
someone.
- Help them to think about their self-harm not as a shameful
secret, but as a problem to be sorted out.
Don't
- Try to be their therapist – therapy is complicated and you have
enough to deal with as their friend, partner or relative.
- Expect them to stop overnight – it's difficult. and takes time
and effort.
- React strongly, with anger, hurt, or upset - this is likely to
make them feel worse. Talk honestly about the effect it has on you,
but do this calmly - 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
with them the basis for an agreement for stopping.
- Make yourself responsible for their self-harm or become the
person who is supposed to stop them. You must get on with your own
life as well. Make sure you talk to someone close to you, so you
get some support.
Click here for
further information on other organisations which might be able to
help you.
Telephone Help
ChildLine - Free
national helpline for young people, free confidential advice on all
sorts of problems; 0800 1111.
Samaritans - Telephone
and email support for anyone who is worried, upset, or suicidal;
08457 90 90 90; ROI 1850 60 90 90; email: jo@samaritans.org.
NHS Direct – A helpline
with health advice provided by NHS nurses; 0845 4647.
Further Reading
The Scarred Soul: Understanding and Ending Self-inflicted
Violence by Tracy Alderman: New Harbinger Publications.
Healing the Hurt Within: understand self-injury and
self-harm, and heal the emotional wounds by Jan Sutton: How To
Books Ltd.
References
Understanding resolution of deliberate self-harm:
qualitative study of patients' experiences (2005). Sinclair,
J. & Green, J. BMJ, 330, p.1112 – 1115.
Prevalence of deliberate self harm and attempted suicide
within contemporary Goth youth subculture: longitudinal cohort
study (2006). Young, R., Sweeting, H., & West, P., BMJ,
332, p909.
In what ways are adolescents who engage in self harm, or
experience thoughts of self harm, different in terms of
help-seeking, communication and coping strategies? (2005).
Evans, E., Hawton, K. & Rodham, K., Journal of Adolescence, 28,
p.573-587.
The epidemiology and management of self-harm amongst adults
in England (2005).
Gunnell, D. & Bennewith, O., Journal of Public Health; 27,
p.1.
The efficacy of problem-solving treatments after deliberate
self-harm: meta-analysis of randomized controlled trials with
respect to depression, hopelessness and improvement in
problems. (2001). Townsend E., Hawton K., Altman D.G., et al.,
Psychogical Med, 31, p.979–88.
Suicide and deliberate self harm in young people(2005).
Hawton, K. & James, A., BMJ, 330, p.891-894.
Suicide following deliberate self-harm: long-term follow-up
of patients who presented to a general hospital(2003) Hawton,
K., Zahl, D. & Weatherall, R., British Journal of Psychiatry,
182, p.537 - 542.
NICE Clinical Guideline 16. Self-harm - The
short-term physical and psychological management and secondary
prevention of self-harm in primary and secondary care
(2004) National Institute of Clinical Excellence: London
http://www.nice.org.uk/page.aspx?o=cg016niceguideline
The Royal College of Psychiatrists produces:
- a wide range of mental health information for patients, carers
and professionals;
- factsheets on treatments in psychiatry such as antidepressants
and Cognitive Behavioural Therapy.
These can be downloaded from our website: www.rcpsych.ac.uk/info
A range of materials for carers of people with mental health
problems has also been produced by the Partners in Care campaign.
These can be downloaded from www.partnersincare.co.uk/.
For a catalogue of public education materials or copies of our
leaflets contact:
Leaflets Department
The Royal College of Psychiatrists,
17 Belgrave Square,
London SW1X 8PG. Tel: 020 7235 2351 x 259
Charity registration number (England and Wales) 228636 and in
Scotland SC038369.
The leaflet was produced by the Royal College of Psychiatrists'
Public Education Editorial Board.
Series
Editor:
Dr Philip Timms
Expert
Review:
Dr Anthony Bateman
Editorial
Board: Dr
Ros Ramsay, Dr Martin Briscoe, Deborah Hart
User and carer input: Royal
College of Psychiatrists' Special Committee of Patients and
Carers
Updated: Jan 2007
This leaflet recieved a commendation in the BMA 2007
book awards.
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