Self-harm management and recovery

Trigger warning: this article discusses self-harm and harm minimisation in detail. 

Self-harm is the act of intentionally injuring or harming oneself. For people who have never engaged in self-harm, it can sometimes be difficult to comprehend why someone would purposely cause themselves physical pain, or what they could possibly gain from this. There is sometimes the misconception that self-harm is an attention-seeking behaviour, however, most individuals who harm themselves go to great lengths to hide any physical injuries or scars.  

There are many reasons a person will self-harm, however, some of the common reasons are: 

• To relieve intense feelings of tension, frustration, or anger.
• To express feelings that can’t be put into words.
• To ‘feel something’ by replacing numbness with physical pain.
• To distract from emotional pain.
• To punish the self if feeling guilt or self-loathing.
• To feel in control if everything else feels uncontrollable.
• Eventually, self-harm can become addictive. 

Although self-harm can appear to help short term, long term it can increase feelings of guilt, self-loathing, lack of control, and fear of being ‘found out’. It can be a lonely, and isolating experience, and reaching out can be difficult for fear of being judged or upsetting loved ones. 

How to support someone who is, (or you suspect is), self-harming

Encourage them to open up and express their feelings and needs. Show empathy for their experience and don’t judge. You may feel upset, angry or frustrated but it’s so important to make every effort not to make the person feel worse.

You don’t have to agree with the behaviour, but you can express understanding that it is difficult to ‘give up’ self-harm without learning alternative ways of coping.

How to overcome or reduce self-harming

Postpone when you get the urge to harm. Like any urge or addiction, the need to self-harm can feel overwhelming, however, this urge can reduce if given time. Perhaps use this time to practice some breathing exercises, relaxation or meditation. If this doesn’t work, and you still feel the need to act, perhaps you could try some of the following self-harm alternatives:

• Flick an elastic band against your wrist (if you do this with a sharp snap it will hurt and can replicate the pain of self-harming).
• Hold ice cubes (wet them a little first to make sure they don’t stick or burn). Holding ice for a period of time can hurt without causing physical harm. If you need the ‘visual’ aspect, you can add red food colouring to your ice cubes and let them melt over the area you would usually harm. 
• To release tension, frustration or anger, punch a pillow or mattress, scream into a pillow, rip up wads of paper, squeeze a stress ball or throw something soft like playdough or plasticine.
• Write a letter explaining how you feel or start a private blog where you can add photos, quotes or posts expressing your innermost feelings and thoughts.
• Do some high-intensity exercise, running on the spot, skipping, anything to release the adrenaline and get rid of pent-up feelings. Energetically sing and dance to loud music.
• Write on your skin with a (safe) red marker pen. You can just draw lines or write words. You may want to be more artistic and design patterns. 
• Take a cold bath or shower. Put your face in cold water or hold a cold pack over your eyes and cheeks (this simulates the ‘diving reflex’ and can rapidly reduce strong emotions).

Harm minimisation

If you have postponed, tried alternatives, and you still need to self-harm: 

• Try to use the least damaging method. 
• Give yourself rules (method used, where you will inflict the damage and how many times).
• Have a first aid kit to care for any wounds immediately, making sure they are clean and if possible kept uncovered (if you have to cover them make sure this is with a suitable dressing which is changed regularly).
• Monitor regularly for any signs of infection (redness, weeping, an unpleasant smell).
• If you cause more harm than intended and feel you are in any physical danger, or you notice signs of infection seek medical support immediately (depending on severity, either from your pharmacy, GP, minor injuries unit or emergency department). 

Longer-term

Work on developing self-compassion. If you had a friend or loved one who was struggling, would you hurt them physically? Would you want to see them in pain? Or would you treat them with kindness and understanding? 

When you feel the urge to hurt yourself, stop, put your hand on your heart and focus on your breath. Notice yourself for what you are. You are a human, deserving of the same love, understanding and compassion you would show others. 

Focus on the part of your body you would usually harm and instead, gently hold that part of your body. Perhaps take some soft body cream and gently rub it into your skin. Tell yourself you are sorry for being unkind to yourself and notice how it feels to be affectionate towards yourself.

Getting support 

• Seek support for any symptoms of poor mental or emotional health (anxiety, low mood, trauma, low self-esteem, or stress) that may be exacerbating self-harm. You can access support via your GP, local primary care mental health teams (usually via GP but can vary by area), or private counselling/therapy.
• You can speak in confidence to the Samaritans (UK) 116123 or the CALL Helpline (Wales) Freephone 0800 132 737 or text help to 81066.
• For more immediate support, especially if you are experiencing any suicidal thoughts, contact your local crisis team. If you are unable to contact the crisis team ring 999 in an emergency.