Factsheet: Self Harm

This factsheet is available in a downloadable PDF here.

Table of Contents

Recognising Self Harm
Understanding why People Self Harm
How to Engage with Someone who Self Harms
If you are Someone who Self Harm
Relevant Books
Relevant Leaflets and Booklets

Recognising Self Harm

The definition of self harm is any behaviour that inflicts damage on the person’s body with the intent of gaining some sort of emotional release. Thus, nail biting, which often relieves anxiety, is a very mild and socially acceptable form of self harm.

Some common self harming behaviours:  

  • Cutting
  • Burning
  • Biting/ pulling hair out/ scratching
  • Head banging
  • Drinking bleach or other poisons
  • Swallowing damaging articles e.g. glass, razor blades
  • Overdosing

Many people who self harm may also iengage in other behaviours that are damaging to their health. Whether these are strictly deliberate self harm is debatable. However these behaviours often are motivated or triggered by factors, such as control, the need to escape from an emotional state they are unable to manage, and a disregard for personal safety prompted by feelings of worthlessness, despair or homelessness.

Some examples of harmful behaviours:

  • Controlling eating patterns
  • Abuse of drugs and alcohol
  • Indulging in risky behaviour

Ways to tell if someone is self harming: 

Look out for:

  • Spending more time in the bathroom
  • Unexplained cuts or bruises
  • Wearing long sleeves and trousers – especially if this is a change from normal behaviour
  • Razor blades, scissors , knives etc have disappeared
  • Unexplained smell of detol, tcp etc
  • Plasters disappearing
  • Low mood – seems depressed unhappy
  • ny mood changes – anger, sadness
  • Negative life events that could have prompted these feelings: bereavement, abuse, exam stress, parental divorce etc
  • Low self esteem
  • Feelings of worthlessness
  • changes in eating or sleeping pattens

Understanding why People Self Harm

Some reasons why people may self harm: 

  • To manage feelings
  • To regain a sense of control
  • Communication: to express emotional pain
  • To comfort & nurture oneself
  • To feel real & alive
  • As a method of suicide prevention
  • To release pressure

People do not self harm:

  • To seek attention
  • As a phase
  • As a horrific prank
  • As a group activity
  • For pleasure
  • As a form of manipulation
  • As a trend/copy cat behaviour
  • For the adrenaline rush

 

How to Engage with Someone who Self Harms

If you think that a member of your family or a close friend may be engaging in self-harming behaviour you may want to ask directly if sensitively. People who self harm often reports that they do not mind being asked if the person asking is sensitive and trying to understand. It is very difficult for anyone, but especially for parents to understand why a person inflicts harm on themselves. However, it is not attention seeking behaviour and the person is not mentally ill. The person is in great emotional pain. Therefore, it is crucial that you engage with the person in an open discussion on how you can help. They know best why they are self harming and what helps them to control it. Do not expect that the person will stop immediately as that is an unrealistic expectation. Instead work jointly on a plan to deal with the underlying issues and seek professional help if necessary.

Working with a person who you suspect self harms can be intimidating. Workers often feel that their skills are not specialised enough to deal with this area, and fear saying or doing something that will trigger an episode of self harm or a suicide attempt. The key thing to remember is that the self harm is just a symptom of what is going on for the person, and that as a worker you already have the relationship with that person, and thus the skills to work with them.

Try to see behind the self harm to the person in pain, ask them what they feel the problem is and how you can best support them. Be compassionate about wounds, be honest if you find them difficult to deal with, but explain to the person that you are aware that that is your issue and in no way reflects upon them. 

Show that you do not judge them for their way of coping, and discuss with them what they feel that they get from their self harm. If it is appropriate, discuss with them the issues underlying the self harm and try to help them feel safe enough to process these over time, or look at what they are getting from the self harm and explore other strategies that they could use to cope.

Emphasise to the person that you are not trying to take their self harm away from them; it may be the only thing keeping them here. Working with people who self harm can be frustrating; it is important to remember that even someone who has only been cutting for a few months may have a history of self damaging behaviours going back many years, and these cannot be changed overnight.

Give the person as much power in the situation as you can; the issues underlying self harm are often intensely personal and the person must feel safe to discuss these. Be firm about your boundaries; people who self harm have often developed a number of survival strategies to move within the world, and these can be difficult to deal with. 

If you are clear from the start about what you can and cannot offer in terms of time and support, and when you will have to break confidentiality, it prevents resentment building up and facilitates an effective working relationship. It is important to be open about discussing the self harm. It may be helpful to provide information on how to look after wounds and harm reduction techniques.

Try to

  • Be honest about the feelings and issues self harm raises for you and make sure you have good support to be able to off load the issues
  • Show concern for injuries
  • Be open and make time to listen
  • Empower person to make own decisions
  • Be calm and patient
  • Do not worry about saying the wrong thing-just letting them know that you are there for them to talk to is enough.
  • Listen to the person and try to understand their reasons for self-harming. Their reasons may seem trivial to you, however for them they are the source of an immense amount of emotional pain

Try not to

  • Show disappointment if person continues to self harm despite all your support
  • Give ultimatums
  • Shout
  • Force the person to talk
  • Confiscate self harm equipment
  • Make promises that might be difficult to fulfill

 

 
 

If you are Someone who Self Harm

Sometimes people who self harm do not understand themselves why they do it. To try to find out think about the following things

  • What was going on for you when you started
  • How do you feel when you are about self harm
  • Whether there things in your mind that you can’t tell to anyone
  • Are you always in the same situation or with the same people?

There are several things that you can do to control the self harm. When you feel the need you could:

  • Phone a friend
  • Take a hot bath
  • Write down your feelings in a diary or journal
  • Go for a walk, run or do some physical exercise
  • Punch a pillow
  • Focus your attention on something, a chair, a book. Observe what it looks like, how does it feel to touch etc, anything that will distract you from your thoughts
  • Breath slowly, in and out
  • Talk to someone you trust
  • This are only suggestions, explore what works for you

Stopping self harming can be difficult, you will need help, support and advice. It is important that you talk to someone about it. When you are ready try to seek help from professionals who will help you to identify what triggers your self harm and how to control it, at the same time working on the issues that are worrying you.

If you do not feel ready to stop, there are some things that you may want to take into account:

  • When cutting always use clean and if possible sterile utensils
  • Do not share cutting tools
  • Talk to someone about how you feel and your problems
  • Always clean your wounds
  • If you think that the wounds are too deep or may be infected (feeling tender, swollen and/or red) seek medical attention
  • Be honest about the feelings and issues self harm raises for you and make sure you have good support to be able to off load the issues

Relevant Books

No Harm in Listening

Eve Marie Haydock (2001). A report of Action Research with young people aged 16-21 in Edinburgh who self harm. Experiences and testimonies of young people-why, how, self harm and suicide, what they would like to see. Available from Penumbra

Life After Self Harm – A guide to the Future

Ulrike Schmidt and Kate Davidson (2004). Brunner- Routledge. A cognitive – behavioural approach to dealing with Self-harm.

Who’s Hurting Who?

Helen Spandler (1996). Young people, self –harm and suicide. Available from 42nd Street, 2nd floor, Swan Buildings, 20 Swan Street, Manchester M4 5JW. A very personal account of Self harm from young people’s perspectives.

Bodily Harm

Karen Conterio and Wendy Lader Ph.D. (1999), Little, Brown and Company. Describes a full-time residential programme but has some good examples of issues and topics to discuss.

Cutting – Understanding and Overcoming Self- Mutilation

Steven Levenkron (1998). Norton, New York/London. Provides a psychological understanding of self harm, focusing on the need to listen and understand those who self harm.

Relevant Leaflets and Booklets 

The ‘Hurt Yourself Less’ Workbook

E Dace et al. (1998). National Self Harm Network. Available from NSHN, PO Box 7264, NottinghamNG1 6WJ. Very good workbook that takes a person through different issues to consider.

What’s the Harm

Lois Arnold and Anne Magill (1997). The Basement Project. Good introduction to help young people understand self-harm.

Working with Self Injury

Lois Arnold and Anne Magill (1997). The Basement Project. Very good practical guide to working with self harm and exploring emotions.

Worried about Self Injury

Young Minds (2003). Available from Young Minds,102-108 Clerkenwell Rd, London EC1M5SA. Basic leaflet on the facts related to self harm. 

Related Services

Below are links to Services in the Edspace database that may be of interest:

External websites related to Self Harm

These web sites may be useful. Please note that we are not responsible for external sites; if you find any broken links or inappropriate content please report it to the site administrators using the feedback page.

  • Childline
    24 hours a day, 7 days a week A free, confidential helpline for children and young people to talk about any problem. The website is also full of information and links. Remember, asking for help doesn't make you weak or attention-seeking. You deserve to be taken seriously, and it might be the first step towards a solution!
  • Penumbra

    Penumbra is a leading Scottish voluntary organisation working in the field of mental health. 

    We provide an extensive range of person-centred and recovery focused support services for adults and young people.

    We also campaign to raise awareness of mental health issues and reduce the social stigma attached to them.

    The Penumbra Edinburgh Area has five support teams providing both supported accommodation and support in peoples own homes, a self harm project and the Edinburgh Crisis Centre.

  • Samaritans
    Samaritans provides confidential emotional support, 24 hours a day for people who are experiencing feelings of distress or despair, including those which may lead to suicide. You don't have to be suicidal to call us. We are here for you if you're worried about something, feel upset or confused, or you just want to talk to someone.
  • Breathing Space

    Breathing Space is a free, confidential phone-line aimed primarily at young men (aged 16-40) who are experiencing low mood or depression, and for those who are unusually worried and in need of someone to talk to.  Although Breathing Space targets young men it is open for anyone in Scotland to use.

  • Edinburgh Crisis Centre
    Edinburgh Crisis Centre supports people in crisis and their carers. Their free phone number is 08088010414
    Open 24 hours a day 7 days a week.
  • NHS Lothian Site
    NHS Lothian Website

Phonelines Related to Self Harm

  • Breathing Space

    0800 83 85 87

    A free, confidential phone line you can call when you're feeling down. They also have an excellent website which has loads of information and a self-help toolkit.

  • The Samaritans

    08457 90 90 90

    The Samaritans will not try to give you advice, judge you or tell you what to do, they will just listen and support you. They are there for anyone, especially those who are suicidal or in crisis.

  • Childline

    0800 1111

    24 hours a day, 7 days a week A free, confidential helpline for children and young people to talk about any problem. The website is also full of information and links. Remember, asking for help doesn't make you weak or attention-seeking. You deserve to be taken seriously, and it might be the first step towards a solution!

  • Edinburgh Crisis Centre

    0808 801 0414

    Edinburgh Crisis Centre supports people in crisis and their carers. Their free phone number is 08088010414
    Open 24 hours a day 7 days a week.

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