What is self-harm?
Self-harming behaviour describes someone deliberately inflicting injury, pain or damage to their body There are a number of ways people generally hurt themselves, including cutting, burning, taking small quantities of medications or illegal drugs, scratching, biting and pinching oneself. Self-harm is usually neither a suicide attempt nor intended to be fatal but sometimes the outcome result in serious bodily injury or accidental death.
Self harm is often used as a means of coping with, or feeling relief from strong and sustained negative emotions such as guilt, depression, anxiety or self-hatred and in a number of cases is associated with experience of earlier trauma. People who self harm often report that they experience some relief from these emotions when they harm themselves.
Self-harm may be a one-off incident (when someone is in acute distress) or it may be that the person is using self-harm on a regular basis as their main way of coping. When someone regularly self-harms as a means of coping over a period of time, it can become difficult to change that behaviour. Self-harming behaviour is a complex combination of emotions, actions and reactions to the external world and requires expert assistance to manage and resolve.
Why do people self-harm?
People who use self-harm have often experienced difficult times in their lives. Some situations that have led people to hurt themselves include:
- Being persistently bullied or abused (emotional, physical, and/or sexual abuse)
- Losing someone close to you, like a parent or sibling
- Relationship break ups and intense emotional pain or loss
- Living with mental illness (e.g., anxiety and depression)
Self-harm is usually a response to the powerful distress associated with these situations. These emotions can range from hopelessness, anxiety, rejection, anger, and despair through to guilt. People who self harm may find it difficult to express strongly negative feelings or may feel helpless and powerless in the face of overwhelming difficulty. People self-harm as a means of relieving, controlling or expressing the distress and emotional pain of these intense emotions.
How can I help someone who self-harms?
Self-harm can be a very confronting experience, particularly if you witness the event. It is important to take incidents of self-harm seriously and assist the person get professional help.
If you are with the person during an incident there are some things you can do to help them:
- Try to control your emotional reaction and respond as calmly as possible.
- Help the person to administer first-aid to their injuries. If the injuries are severe, call an ambulance or take the person to the hospital. If the person is ambivalent about seeking help it is still important to have them talk with a professional experienced in managing self-harming behaviour.
- Ask the person if they are suicidal, it is important to either rule this out or get appropriate mental health support if they are suicidal. For tips about how to start a conversation about suicide, see How can I talk to them about it. If they do disclose suicidal thinking, see Emergency information.
Supporting someone who self-harms
It is helpful for the person to start to move through a process of exploring and understanding the reasons for their self-harm and at the same time learn other ways of coping with the thoughts and feelings that precipitate the self-harm. Stopping self-harm is something a person needs to make a conscious decision to do, and this decision can not be made for them. However there are a number of ways you can help someone who self harms.
Some ways you can support someone who is self-harming include:
- Encouraging the person to seek professional help (see Supporting someone to get help). It is essential that the person receives appropriate health care that is sensitive, skilful and non-judgmental. Ongoing support delivered in this manner could reduce the person's self-harming behaviour and therefore reduce the likelihood of accidental death.
- Assisting the person to access professional support. Suggest options for support and offer to accompany the person to an appointment. Your local GP can advise about specialist mental health professionals who can help.
- Remaining calm and supportive. A person who self-harms needs the support of family, friends and professionals.
- Keeping an open attitude. It is likely that the person will feel ashamed by their behaviour and worried that others will judge them. Aim to create a caring space where the person feels safe enough to discuss their feelings if they wish.
- Listening to the person so they feel heard and supported and taken seriously.
- Encouraging the person to talk about their feelings, rather than self-harming. Explore with the person what other strategies he/she could use to cope, as an alternative to self harm.
- Finding ways to enhance the person's self-esteem and acknowledge their positive qualities.
Things to avoid when caring for someone who self-harms:
- Do not condone self-injury. At the same time, try to be non-judgmental and let the person know you will support him or her to find alternatives to self-harm.
- Do not give ultimatums. This could increase feelings of rejection for the person and decrease trust between you, as the person may feel unheard. The motivation for change must come from within the person.
- Do not pressure the person into undertaking any treatment they feel uncomfortable with, but at the same time make your feelings about the importance of proper professional care known to the person.
Looking after yourself
Caring for someone who self-harms can be emotionally demanding and stressful, so it is important to look after yourself and use extra support when you need it. See Looking after yourself for suggestions on relieving stress.