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Self-harm

Published by Bupa's health information team, May 2009.

This factsheet is for people who self-harm, or who would like to know more about it.

Self-harm is a term used to describe a behaviour where a person deliberately and often repeatedly injures themselves. It's most common in girls and young women, although anyone can self-harm at any age.

• About self-harm
• Symptoms of self-harm
• Complications of self-harm
• Causes of self-harm
• Diagnosis of self-harm
• Treatment of self-harm
• Questions and answers
• Related topics
• Further information
• Sources

About self-harm

Some people self-harm as they feel it helps them deal with distressing or overwhelming thoughts and emotions. It can act as a temporary release from negative feelings and can help take your mind off things that make you feel low.

If you self-harm you may injure yourself by:

• cutting your skin
• scratching or picking your skin
• burning your skin
• hitting and punching yourself
• pulling out your hair or eyelashes
• swallowing poison
• taking an overdose of tablets or medicines
• breaking bones
• banging yourself against objects

Other, less obvious ways such as drinking too much alcohol, taking recreational drugs, smoking, working long hours in the day, starving yourself or binge eating are also forms of self-harm.

Self-harm is most common in adolescents aged between 11 and 25 but it can occur at any age. Young women are more likely to self-harm than young men, although the number of young men who self-harm is increasing. It's difficult to know the exact number of people who self-harm as many people do it secretly and never seek medical help.

Symptoms of self-harm

It can be very difficult to tell if someone is self-harming. People who self-harm often go to great lengths to keep it a secret from friends and family.

If you self-harm you may cover your injuries with clothing and avoid activities that expose your body such as swimming and sunbathing. You may be depressed, or become socially withdrawn and isolated.

Complications of self-harm

Most people who self-harm aren't trying to attempt suicide. People usually self-harm to deal with overwhelming feelings and thoughts. Occasionally self-harm can be a failed genuine suicide attempt. Many people who commit suicide have self-harmed in the past.

Cutting your skin can cause permanent scarring and numbness.

Causes of self-harm

People self-harm for a number of reasons. Often people have low self-esteem and feel hopeless. You may self-harm as a way to manage the problems and pressures of everyday life. It can help you gain control of a difficult situation or can be used as self-punishment if you feel guilty. If you're unhappy or feel helpless, you may self-harm to release your negative emotions. Occasionally people are pressurised by friends to self-harm.

Certain painful and difficult experiences can lead to self-harm, these include:

• losing someone close to you such as a parent, friend or relative
• being neglected
• physical or sexual abuse
• relationship problems
• poor health
• alcohol misuse
• being bullied

People with mental health problems such as schizophrenia and bipolar disorder are more likely to self-harm.

Around a third of people who self-harm will do it again within one year.

Diagnosis of self-harm

Telling someone about your self-harm can be difficult. You may feel embarrassed or guilty about harming yourself. You may fear that no one will understand you and you will lose control over your problem. You may also be worried that you won't be taken seriously. It's important that you talk to someone who you trust such as a relative, a friend or your GP.

Treatment of self-harm

There are a number of treatments available for self-harm.

Self-help

Keeping a diary of your feelings and making a note of when you feel the need to harm yourself may be helpful. Lifestyle changes such as eating a healthy diet, making sure you get plenty of sleep and doing some physical activity can help to build your self-esteem and make you feel better about yourself. Even listening to music or reading a book can help to take your mind off feeling anxious or upset.

Support groups may also be helpful. As well as offering support, it's often comforting to know that someone else feels the same as you.

When you feel the need to self-harm there are a number of things you can do to distract yourself:

• Call a friend or relative
• Be creative - draw or paint how you're feeling

Getting help

Visit your GP and he or she can give you advice on how to care for your injuries. He or she can also provide you with information about support groups and advise you about the treatments that can help you. If your self-harming is severe, your GP may refer you to local psychiatric services for further assessment and treatment.

Talking treatments

Your GP may refer you for cognitive behavioural therapy (CBT). This type of therapy will help you change the way you think, feel and behave. It will help you identify the thoughts and feelings that act as triggers for self-harm. CBT can make you feel more able to deal with the challenges in your life. For more information about CBT, please see related topics.

Other forms of therapy such as cognitive analytical therapy and psychodynamic therapy aim to identify what past experiences may have caused you to self-harm.

If you've been diagnosed with borderline personality disorder, you may be referred to a therapist for dialectical behaviour therapy.

Medicines

Research into medicines for self-harm is very limited. If you're depressed your GP may prescribe you an antidepressant.

Hospital treatment

If you're at risk of suicide or seriously harming yourself, you may have to stay in hospital.

You may be admitted to hospital if you have taken an over-dose or if your injuries are very severe. Most Accident and Emergency departments have a psychiatric liaison nurse or a social worker who will talk to you about why you have hurt yourself. He or she will assess your physical, mental and social needs so you can get the best treatment available to you.

Related topics

• Depression
• Cognitive behavioural therapy
• Bereavement

Further information

• National Association for Mental Health (Mind)
  0845 766 0163
  www.mind.org.uk
• Mental Health Foundation
  020 7803 1101
  www.mentalhealth.org.uk
• Rethink
  0845 456 0455
  www.rethink.org

Sources

• Self-harm. The royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 21 October 2008
• Understanding self-harm. National Association for Mental Health (Mind). www.mind.org.uk, accessed 21 October 2008
• Information on self-harm. What is self-harm? National Children's Bureau. www.selfharm.org.uk, accessed 22 October 2008
• The truth about self-harm. Mental Health Foundation, 2006. www.mentalhealth.org.uk
• Deliberate self-harm. Epidemiology. GP Notebook. www.gpnotebook.co.uk, accessed 22 October 2008
• Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. New York: Oxford University Press, 2007:980 - 981
• Deliberate self-harm. Aetiology. GP Notebook. www.gpnotebook.co.uk, accessed 22 October 2008
• About self-harm. Rethink. www.rethink.org, accessed 24 October 2008
• National Institute for Clinical Excellence (NICE). Self-harm: short-term treatment and management. www.nice.org.uk
• Cognitive Behavioural Therapy (CBT). The royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 21 October 2008
• A guide to understanding cognitive behavioural therapies. BABCP. www.babcp.com, accessed 12 January 2009
• Psychotherapy. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 9 January 2009
• Help for self-harm. Rethink. www.rethink.org, accessed 24 October 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009