Self-harm is the act of intentional damage or injury to an individual’s own body. It is understood to be a physical response used in an attempt to cope with difficult feelings, memories or overwhelming experiences. Self-harm can be very addictive.
- There are different ways people can harm themselves: physically or emotionally.
- According to the self-harm support charity, Self Harm UK, it is thought that around 13 per cent of young people may attempt self-harm, though the actual figure may be higher.
- Studies suggest a 70 per cent rise in 10 to 14 year olds admitted to hospital for self-harm related incidents.
This fact-sheet will look at the reasons why people turn to self-harm. We will explore the long-term effects, the signs of self-harm and learn how a counsellor/psychotherapist may help.
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What is self-harming?
Self-harm is defined as a deliberate injury to one’s self. The most common form of self-harm is to cut or scratch the skin with a sharp object. However it can take a variety of forms such as hair pulling, overdosing or lack of care to own physical or emotional needs.
Other common ways of self-harming include:
- overeating or undereating
- burning the skin
- substance abuse
- excessive exercise
- scratching the skin
- hitting objects.
The act of self-harming can often occur when the individual is experiencing times of anger, worry, fear, distress, depression or low self-esteem. They will turn to self-harm to regain control over the negative feelings. It can also be used as an act of punishment. For example, if the individual believes they have done wrong or feel guilty for something they have done. The act of self-harm may be a mixture of tension relief and punishment.
Sometimes when people self-harm, they believe that on some level they intend to die. According to the NHS, more than 50 per cent of people who commit suicide have a history of self-harm.
Why do people self-harm?
People can be affected by self-harm at any age, from any walk of life. While it is a common misconception that people who are from certain areas, a problem family or a different cultural background are more likely to self-harm, it can affect anyone. For some, it can be a direct response to a traumatic event, for others the cause can be less clear.
Any experience can cause an individual to self-harm. The most common causes include:
- school or work pressure
- financial worries
- sexual, physical or emotional abuse
- identity confusion
- health problems
- the loss of a loved one
- symptoms related to mental health, such as depression, anxiety or anger.
According to Mind, many people who self-harm have described it as a way to express a situation or feeling that they cannot put into words. It offers a sense of being in control and the chance to escape traumatic memories. It has also been described as a way to communicate with others that they are experiencing distress.
There may be long-term or short-term psychological factors that lead to self-harm. If an individual has suffered abuse either in childhood or later relationships, it is common for emotions to be suppressed. Self-harm is often then regarded as a way for these emotions to be released. Short-term psychological issues have also been considered risk factors. Short-term factors include bereavement, a relationship breakdown, unemployment or poverty.
While people find that self-harm brings immediate relief, it can be quickly replaced by greater feelings of distress.
As with many mental illnesses, the person suffering needs to recognise that their behaviour is not healthy. It is important to accept that they may need extra support.
Self-harming is a cyclical pattern of behaviour. For a person to stop self-harming, they need to break the cycle. When the person is ready to make a change, there are many methods they can practise to help themselves. For those who know someone close to him/her who is self-harming, it can be very difficult to understand. As much as they want to help the individual, they need to realise that the person cannot change their behaviour until they are ready.
Understand that the person self-harming is not doing so to punish, anger or annoy anyone else. Confiding in someone is the first step on the road to recovery. It doesn’t matter who the person is, but making the change will be much easier with a friend for support.
Sometimes it can be more helpful to focus on how the person is feeling, rather than what harm they are causing themselves. Acknowledging the issue, understanding and talking about it is where the recovery process can start.
It is important to contact a GP or medical professional if you self-harm or know somebody who does. There they can get any physical injury treated before seeking further professional help. Prescribed medication such as antidepressants may also be recommended by a GP. These will be prescribed to regulate the emotions that trigger the self-harming. This is an option particularly if self-harm is linked to a wider state of depression.
How does counselling work for self-harm?
There are many methods that can be used to help break the behavioural pattern of self-harming. These can include distraction, channelling the emotions into another activity and identifying the triggers.
A qualified medical professional will be able to suggest methods of prevention. They will help the individual cope with the stresses that cause them to self-harm. The most common self-harm treatment is counselling. Here the individual can talk through their concerns, emotions and explore the reasons why they self-harm. Counselling allows the individual to experience a calm, completely confidential and non-judgemental atmosphere.
There are different distraction methods that can be used, depending on what emotion triggers the self-harming. For example, if an individual is sad or unhappy, doing a soothing activity such as reading a book or taking a bath can help release the tension. For those who self-harm to feel pain, there are methods of distraction that can be practised that do not cause physical or lasting damage. Squeezing ice or biting hot chillies for example can be a harmless release technique.
Many people find channelling their emotions into something creative can help. This can often include writing, painting, listening to music or exercising.
When visiting a professional, an individual should expect a series of questions. The questions and answers will be assessed, collecting information about the self-harming behaviour. After the assessment, the counsellor will devise a suitable treatment plan. During these consultations, an individual may be asked topics surrounding:
- physical and emotional health
- personal relationships
- how often they self-harm
- the forms of self-harm they turn to
- feelings that occur before and during self-harming
- what the triggers may be.
The counsellor or psychotherapist will take each factor into consideration. They will work with the individual to create a tailored treatment programme that they believe will be most effective.
Talking therapy, such as cognitive behavioural therapy (CBT) is a common treatment for people who self-harm. This involves discussing the feelings and emotional state of the individual, observing how their behaviour and well-being is affected. According to the NHS, evidence suggests this can be an effective, long-term form of treatment for those who self-harm.
According to Young Minds, the concern around the number of young people who self-harm continues to grow. Recent figures have shown that one in 12 young people are self-harming. Last year saw 38,000 young people admitted to hospital as a result of self-harm.
- Out of a list including binge drinking, bullying and drug use, self-harm came out as the top concern for young people.
- A report found that self-harm is the issue that young people, parents and professionals find most difficult to discuss.
- Many parents associate their child self-harming with failure.
- Over a third of parents would not think to seek professional support.
For some people, the act of self-harming can become addictive. Causing harm to the body produces endorphins, similar to that of an adrenaline rush. This release of endorphins can decrease over time. The individual may feel the need to harm again to feel the same rush, only this time it may be more damaging.
Despite this, not all of those of self-harm find it addictive physically. Over time, they may begin to rely on it emotionally. Instead of self-harming to combat intense feelings of emotion, a habit may develop where the individual tries to reduce the risk of feeling bad as part of their daily routine.
A survey found that cutting was the most common method of self-harm, with 81 per cent of respondents admitting to cutting. It is important to remember that cutting often leaves permanent scarring. As well as scars, cutting can lead to more serious consequences. Cutting the skin of the wrist is close to several nerves and muscles. People who cut may also injure nerves, tendons and muscles. While some of these can heal, others cannot and may result in permanent numbness or weakness in the hand.
If a person is concerned about self-harming and the long-term effects it may have, consulting a qualified professional is the first step toward recovery.
The link between eating disorders and self-harm
In the broadest sense, an eating disorder can be perceived as a form of self-harm as it is harmful to your health and body. While the behaviours of both affect many young people and share similar traits (anxiety, low self-esteem, experience of trauma), every person is different and the two do not always coincide.
It is thought that of those who suffer an eating disorder, 25 per cent will also self-harm. This is particularly high among those who are living with bulimia nervosa. Some people may find self-harm and eating disorders co-exist. Others find self-harm develops as a replacement for an eating disorder, or vice versa. For example, if a person attempts to recover from self-harm before they are psychologically ready, it is easy for another symptom to develop.
For others, it is possible for an eating disorder to develop as a form of punishment for expressing self-hate towards the body. If an individual is suffering with low self-esteem and poor self-image, feelings of self-loathing can lead to a lack of respect for the body. These feelings in turn can lead to wanting a sense of relief or control, such as self-harming.
What should I be looking for in a counsellor or psychotherapist?
Currently there are no laws that stipulate what level of training or qualifications a counsellor dealing with self-harm needs. However, the National Institute for Health and Care Excellence (NICE) have developed a set of guidelines that provide advice about the recommended treatments, including the following:
- If you have harmed yourself, you should be offered a full assessment of your needs. This may be by a specialist mental health professional, for example, a psychiatrist or psychiatric nurse.
- After the first full assessment, you may be offered a further assessment or further treatment.
- Psychological treatment has the best evidence for helping people who have self-harmed in the longer term.
Read the full NICE guidelines:
The NHS recommends psychological treatments such as cognitive behavioural therapy (CBT).
What our experts say
- Self-harm - what is it?
Anna Honeysett- MBACP, Adv.Dip.Hum.Couns, BA.Hons20th July, 2016
- Therapy can be a lifesaver for men
Noel Bell MA, PG Dip Psych, UKCP13th June, 2016
- Self-harm: The secret battle
Katie Evans BA(hons), Dip., MBACP Registered2nd March, 2016
- Self-injury awareness: There is another way
Lyn Reed, MBACP (Registered), Ad.Prof Dip.PC, Dip.PC, B.A., M.A., Adv.Dip.CQSW26th February, 2016
- Self-harm from a relationship perspective
Sheila Lauchlan MSc Relationship Psychotherapy, UKCP, AFT, SCPI24th February, 2016
- Understanding and managing self-harm
Joshua Miles MBACP Integrative Psychotherapist & Bereavement Counsellor9th February, 2016
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