self-harm

by Sally Burningham

Self-harm, sometimes referred to as 'self-injury', includes deliberately cutting, bruising or burning oneself, damaging skin, pulling out hair or taking an overdose.

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Although incidents of self-harm are not fatal in themselves, they should be taken very seriously as they are usually a sign that the person is deeply distressed and needs a great deal of understanding and support. People who self-harm are at much greater risk of eventually committing suicide if they cannot find help to deal with their problems and very painful feelings.

Self-harm is not only very upsetting for those who injure themselves. It is worrying for friends and family and for any professionals concerned. But the more information we have on why self-harm may occur and what appropriate steps we can take, the easier it may be for everyone to cope.

who self-harms?

Self-harm is far more common than generally supposed. This may be because many of those who self-harm are ashamed and try to keep it secret. However, hospital figures suggest that it is three to four times more common among women than men and more common among young adults.

It is estimated that 2-3% of girls will make a serious attempt at self-harm at some time during their teenage years. The rate for men appears to be rising: between 1980 and 1998, self-harm among those aged 15-24 almost doubled and the rate for those aged 25-35 rose by 15%. During the same period, the rate in women has risen considerably less.

A small survey among women who had self-injured found that 90% had cut themselves and about 30% had inflicted blows or scalded themselves. The majority had begun to injure themselves during childhood or adolescence. Another survey suggests that self-harm among young people is often missed by adults who may simply think they are 'accident-prone'.

People vary considerably in the number of times they may self-harm and the gaps between instances. Some people may have months or years between bouts and then self-harm frequently over a short period when under considerable stress. Others may self-harm from time to time or on a more regular basis.

myths about self-harm

self-harm is usually attention-seeking behaviour Untrue. Most people who self-harm do so in private and try to keep it from friends and family. They tend to have very low self-esteem and so are likely to need more care and attention, not less.

self-harm is rather like being naughty. People who do it can simply stop if they choose Untrue. People who self-harm often do so because they can see no other way of dealing with unbearable feelings. They may need to find appropriate support and more positive ways of coping with distress before they are able to stop.

the extent of the problem can be measured by the seriousness of the self-harm Untrue. People who harm themselves only slightly may be as deeply distressed as those who inflict much greater damage. Any case of self-harm should be regarded as a serious warning sign that a person is struggling with problems that seem almost overwhelming.

people who self-harm won't actually commit suicide Untrue. The link between self-harm and suicide is a strong one. The Samaritans have estimated that the risk of dying from suicide is 100 times greater for people who self-harm than for the general population.

why people self-harm

Some people self-harm as a way of dealing with very difficult feelings that build up inside to a point when they seem unbearable. They see it as a coping strategy – a way of exercising some sort of control over their own bodies when everything else in their lives seems out of control, and a way of relieving painful feelings.

Others, particularly those who overdose, may see self-harm as a way of escaping from feelings that have become too painful. However, some see it as a way of being able to feel. For example, people who cut themselves rarely feel pain at the time of cutting (a phenomenon called 'dissociation'), but feel relieved at the sight of blood.

People self-harm for a great variety of reasons. Sometimes there may be mixed reasons or the people themselves may not be clear as to why they are doing it. Some also have other difficulties such as alcohol or drug dependency or mental health problems, which may contribute to their self-harming behaviour.

In one survey, people described some of the feelings that had led them to self-harm. These included:

• misery, grief, desperation, hopelessness
• guilt, 'dirtiness', shame, badness
• anger, anxiety, frustration, panic
• a sense that no one was there for them
• a sense of unreality or numbness.

There are frequently underlying causes that are triggered by particular stresses such as an argument or pressure at work. Some experts feel that one or more adverse childhood experiences have contributed to their self-harm, including:

• sexual, physical or emotional abuse
• neglect or lack of communication within the family
• loss or separation from a parent or a parental illness
• bullying, rejection by peers, racism or anxieties about sexual orientation
• being subject to excessively high expectations.

Others consider that adverse experiences in later life – such as rape or an abusive relationship – or difficulties in communicating with others and having their own needs heard may have influenced them to self-harm.

what professional help is available?

It is important that self-harm is taken seriously and that appropriate help and support is offered. People who self-harm are unlikely to be able to sort out their problems on their own.

Ways of helping people who self-harm may include:

individual counselling This can help people look at the underlying reasons for their self-harm and find more appropriate ways to express their feelings.

a therapy or support group Groups enable people to share their thoughts and feelings with others who have had similar experiences and to support each other to find new ways of coping. Groups can also be very helpful in overcoming people's feelings of shame and isolation.

creative arts therapies These often provide a good way of expressing feelings that are too difficult or painful to talk about. For more information see our feature on art therapies.

practical help over matters such as benefits, accommodation, training or employment. This can be important to help people find a way out of a damaging situation (such as a relationship with an abusive partner) or get back on their feet.

supportive discussions on finding alternative ways to cope with stresses that can trigger self-harm.

crisis support Many people need some sort of outside support in a crisis, whether it is somewhere to go where they will feel safe and cared for or a telephone number to ring.

Unfortunately, many of these resources are scarce on the National Health Service and may not be immediately available.

how you can help yourself

You may want to understand why you have been self-harming. You may also want to consider what triggers your self-harm episodes and find alternative ways to cope.

talk to someone If you have kept your self-harm a secret, your first step might be to talk to someone on a helpline (see help and info).

You should not feel embarrassed or ashamed. Although you may feel that you are the only person who behaves this way, it is far more common than you think. You will probably find it a relief to talk to someone who understands.

confide in family and friends You are also likely to find that it helps to confide in a few people you trust. Let them know how they can best help. Caring friends or family are often the best support.

explore with a counsellor or group When you are ready, you may want to explore the reasons for your self-harm with a trained counsellor or with a group who have had similar experiences. Although this can sometimes be a painful process, it can help you come to terms with what has happened and enable you to move on and make new choices about how you live your life. Again, unfortunately, there are not enough counsellors or groups to go around and you may have a long wait – up to two years.

The feature am I losing my mind? has detailed information about how to find help.

find ways of coping You will find it easier to reduce your self-harming behaviour or give it up completely if you can find alternative – and positive – ways of dealing with painful feelings and stress. These may include:

• Phoning a supportive friend for a chat.
• Writing a diary or doing something creative such as painting.
• Doing calming activities such as yoga or relaxation exercises or having a scented bath.
• Channelling your energy into regular exercise such as a daily walk or run.
• Carefully structuring your day so that you do not spend long periods on your own.
• Making time for activities that you enjoy and make you feel good about yourself, such as spending time with friends, listening to music or having a nice meal.

It may take you a long time before you are ready to give up self-harm completely. You may even find that your need for it increases as you explore distressing experiences in your past that may underlie your self-harm or make changes in the way you live your life.

Try not to get discouraged. The more progress you can make in sorting out other areas of your life, the easier giving up self-harm will eventually become.

how friends and family can help

Friends and family often provide the most valuable support. People who self-harm often feel very isolated and despairing. Knowing that others are there for them and care about them, despite what they are doing to themselves, can make all the difference.

• Make time to listen and to try and understand. This is one of the most important things anyone can do. There is no need to find solutions. Simply accept the person as they are, even though you find the self-harm upsetting.
• Try not to criticise the person, attempt to control their behaviour or show just how anxious you are, however hard this may seem. They are unlikely to be able to stop self-harming just like that and your actions may drive them to self-harm in secret.
• Do not show anger or disgust if they show you evidence of their self-harm. Behave in a caring way as you would with anyone who is ill or injured.
• Find out all you can about self-harm and about sources of help (see help and info) so that you can offer suggestions if appropriate.
• Ask if there is anything you can do to help.
• Try to support the person while they find their own ways of coping. Encourage any positive steps they take, even if they are continuing to self-harm.
• Try to persuade the person to see their GP for help. If they are unwilling to do so, or the GP is not particularly helpful, you might suggest contacting one of the helplines listed at the end of this feature or contacting one on their behalf.
• Try to be very patient. Self-harm may take months or even years to overcome.

Of course, if the person has seriously harmed themselves or their life is in danger you must get help as soon as possible, even if they have asked you to respect their secrecy. If you accompany someone to a hospital accident and emergency department, try to make sure that the professionals involved take the incident seriously. Some follow-up care should always be offered. If not, you should ask about it.

help and info

Channel 4 is not responsible for the content of third party sites.

You will find lots of useful advice and information in two other articles in this section: self-help strategies and family and friends. If you think a complementary therapy might help you cope, check with your GP. For more information see the therapies section of the complementary medicine site.

organisation

Bristol Crisis Service for Women
P0 Box 654
Bristol BS99 1XH
National Helpline: 0117 925 1119 (Fri and Sat 9pm-12.30am, Sun 6pm-9pm)
E-mail: bcsw@btconnect.com
Website: www.users.zetnet.co.uk/BCSW
Telephone support for any woman in distress, with particular focus on self-injury. The confidential helpline is available to women anywhere in the UK, and offers support, information, details of local self-injury groups and publications available.

National Self-Harm Network
PO Box 7264
Nottingham NG1 6WJ
E-mail: info@nshn.co.uk
Website: www.nshn.co.uk
Contact NSHN if you are worried because you self-harm or you are close to someone who does. Campaigns for a better understanding of self-harm and provides a free information pack.

Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org.uk
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website).

SANE
1st Floor
Cityside House
40 Adler Street
London E1 1EE
SANELINE: 0845 767 8000 (every day 12pm-2am)
E-mail: london@sane.org.uk (admin queries only)
Website: www.sane.org.uk
SANELINE is a national mental health helpline providing information and support for people with mental health problems, and those who support them. They can provide information on illnesses and symptoms, local and national mental health services, medication, treatments and therapies.

websites

Warning: Some of these websites may contain "triggering" material; please make yourself safe before visiting them.

Deliberate Self-harm in Young People
www.rcpsych.ac.uk/.../self-harminyoungpeople.aspx
Factsheet for parents and teachers produced by The Royal College of Psychiatrists which discusses what you can do to help, and lists sources of further information.

Harmless
www.harmless.org.uk
A user led organisation that provides support, information, training and consultancy to people who self harm, their friends and families and professionals.

Lifelink
www.lifelink.org.uk
Lifelink is a crisis intervention project based in Glasgow for people over the age of 12 who are in crisis, self-harming or at risk of suicide. Their website includes a comprehensive information section on harm minimisation/wound dressing, combating suicidal impulses, self-harm/suicide forum and a detailed links page.

Self-Harm: Look beyond the scars
www.nch.org.uk/selfharm
Frequently asked questions, information and resources about self-harm, especially for children and young people who are self-harming, or for their families and friends.

Self-Injury, Abuse & Trauma Resource Directory
www.self-injury-abuse-trauma-directory.info
Lists self-injury, abuse, and trauma resources on the web.

Self-injury: You are NOT the only one
http://crystal.palace.net/~llama/psych/injury.html
Aims to educate, inform and help those who hurt themselves. Has extensive information about self-harming, including a self help section and interactive resources such as web boards.

SIARI
www.siari.co.uk
Extensive UK resource offering information and support to people who self-harm and their carers. Features self-injury research and references, book lists, poems, artwork, stories, message boards, access to an online support group for helpers and a section for counsellors.

Young People and Self-Harm
www.selfharm.org.uk
Aims to provide information about initiatives in this area, provide resources to those who are affected by the issue of deliberate self-harm amongst young people, and to provide support to policy-makers and professionals.

reading

A Bright Red Scream: Self mutilation and the language of pain by Marilee Strong (Virago Press, 2000)
Looks into why so many people deliberately hurt themselves and what can be done to help them begin a process of healing. Features powerful first-person stories from those who self harm.
Get this book

The Scarred Soul: Understanding and Ending Self-inflicted Violence by Tracy Alderman (New Harbinger Publications, 1997)
Alderman's hope is that The Scarred Soul will help educate people on the topic of self-inflicted violence. There are numerous activities designed to help sufferers and their friends and families better understand and cope with this difficult issue. The book is also designed to be of benefit to therapists. Alderman says she wrote this book because the topic is so misunderstood and largely ignored.
Get this book

Women and Self-harm by Gerrilyn Smith, Dee Cox and Jacqui Saradjian (The Women's Press, 1998)
The authors look at the reasons why women self-harm and describe the experiences of those who do so. Offer strategies for recovery and healing, and a range of resources for help and advice.
Get this book

Women Living With Self-Injury by Jane Wegscheider Hyman (Temple University Press, 1999)
Discusses this misunderstood condition, and contains the personal accounts from women who battle with self-injury. Aimed at those who self-injure, their loved ones, and mental care professionals, this book offers compassion as well as encouragement for recovery.
Get this book

(July 2001, resources updated December 2004)


                                                                  Self harmers