Understanding and managing self-harm

What is self-harm?

Self-harm is when you hurt yourself as a way of dealing with difficult feelings, memories, overwhelming situations or traumatic experiences. It usually occurs when an individual experiences worry, anger, fear, distress, depression or low self-esteem. It can be used as a way of regaining control over painful memories, and can be a mixture of tension relief as well as a punishment.

Self-harming might make you feel better, or more able to cope for a period of time, however, it can bring up difficult feelings and could make you feel worse. You may feel embarrassed, guilty or ashamed or worry people will judge you or pressurise you to stop. This can mean you keep your self-harm to yourself, which is a very common reaction, although not everyone does this.

Self-harm can be physical, such as cutting yourself, but can also be less obvious, such as placing yourself in dangerous situations or not looking after your own physical or emotional needs.

Self-harm can include:

  • cutting yourself

  • poisoning yourself

  • over or under eating

  • burning your skin

  • inserting objects into your body

  • hitting yourself, walls or other objects

  • exercising excessively

  • scratching your skin

  • hair pulling.

Why do people self-harm?

There are no fixed reasons behind why people self-harm. For some it can be linked with specific experiences either historically or currently, which have resulted in difficult and painful feelings. For others the reasons can be unclear, and it is important to remind yourself that you do not need to know why you are self-harming in order to ask for support or help.

Common causes include:

  • pressures at school or work

  • being bullied

  • worries over money or debt

  • sexual, physical or emotional abuse

  • bereavement

  • confusion about your sexuality

  • breakdown of a significant relationship

  • an illness or health problem

  • difficult feelings experienced as part of a mental health issue, such as depression or anxiety.

Self-harm can be viewed as a way to:

  • change emotional pain into physical pain

  • regain control

  • escape painful memories

  • reduce overwhelming feelings or thoughts

  • communicate to others your severe distress

  • express suicidal feelings without taking your own life

  • stop feeling numb or disconnected

  • make experiences or thoughts that feel visible

  • create a reason to physically care for yourself.

How to help yourself

There is no immediate solution for self-harm and making changes can take time and will involve difficulty. It’s common to make progress but slip back into old patterns. If this happens, it’s crucial to remember you are not failing; it is simply part of the process and may be a case of trying different things until you find something which works.

Understand patterns

Self-harm takes on different patterns for each person, you may become overwhelmed easily, find things escalate quickly or that it doesn’t take much for you to self-harm. Making notes or keeping a diary each time you self-harm can help you work out and recognise when the urge to self-harm is happening, and when done over a period of time, maybe a month, you can begin to see a pattern emerging.

Recognise triggers

This could be particular places, people or situations, or even times of the day, or physical sensations or sets of thoughts. In your diary note down what was happening before you self-harmed, maybe you had a particular reaction to a particular thought, or interaction with someone. Using a diary can be an intense experience, so ensure that after you do something which relaxes you afterwards.

Recognise urges

Urges for self-harm come in different forms, and learning to recognise them helps us manage when they happen.

  • physical sensations - increased heartbeat, feeling nauseous or having shallow breath

  • feeling heavy or foggy

  • a sense of disconnection, as if you are outside of your own body

  • strong emotions such as sadness, despair or rage

  • making decisions which aren’t good for you rather than expressing your feelings

  • thoughts specific to hurting yourself.


Distracting yourself from your urges to self-harm is a way of changing a cycle of behaviors. For example, hitting a cushion or writing a list will provide you with something else to focus on and give you alternative ways of expressing your feelings. Distracting yourself can be done whenever you find yourself having an urge to harm yourself or during harming yourself.

Once aware of what causes your self-harm you can create a list of distractions. It is important to note which distractions work for which situations, and which don’t. This helps you consider what you may need to do differently.

Treatment and support


Many people visit their GP for help with their emotional difficulties, and you can discuss your self-harm with them in confidence, and they will be able to work through different treatment options. They are also able to refer you on for further treatment if this is something you want or need.

Talking therapies

Psychotherapy and counselling can help you make sense of your self-harm, explore what is causing it and think of ways to manage and understand your urges, as well as find ways to work toward stopping or reducing your self-harm. Therapy aims to enable you to gain deeper knowledge of your experiences, and in a safe, confidential and non-judgmental space you can release and unpack your emotions.

Moving on

Self-harming can become addictive, and the release of pain and emotions can feel crucial to your ability to manage. It can seem hard to believe that things could get better. However, by understanding the patterns of your self-harm, recognising the urges and triggers, and by distracting yourself, you can take each day one day at a time and work toward making significant changes.

Just as it takes time for patterns of self-harm to occur, so it will take time for them to fade, but in time they will. Even if you can’t currently see a way of stopping at this moment in time, you can be certain that the way you are thinking and feeling at the moment will change.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London N6 & NW5
Written by Joshua Miles, BA, MSc, BPC, BACP Accredited Psychodynamic Psychotherapist
London N6 & NW5

Joshua's an experienced integrative psychotherapist who's worked with people at points in their lives where they've been very low & experiencing varying levels of self-harm. He's assisted people in exploring their feelings & experiences at depth & helped them gain understanding & clarity of their difficulties. He's based in Shoreditch, East London.

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