What is self-harm?

Self-harm, also known as self-injury, can be defined as the deliberate injury of one's body, causing damage to tissue or leaving marks which last for more than a few minutes. This includes behaviours such as:

•  Scratching, cutting or burning the skin.
• Deliberately banging your head against a wall or punching a hard surface.
• Taking a drug overdose, or swallowing a poisonous substance.
• Pulling out hair on the head and body.
• Jumping from high objects or 'falling' down stairs.
• Breaking bones.

Self-harm may also take less obvious forms, including taking unnecessary risks, staying in an abusive relationship, developing an eating problem, such as anorexia or bulimia, or simply not looking after one's emotional or physical needs.

Why do people self-harm?

Self-harm is a way of expressing a deep distress and is used by some as a means of coping with painful emotions. These emotions are released in a physical way which the individual finds easier to deal with. It is a means of communicating something which cannot be put into words, or even into thoughts, something akin to an 'inner scream'.

The direction of such communication is often unclear as most people who harm themselves go to great lengths to cover their behaviour up. However, those who are more open have described it as '...curiously comforting to show a bleeding arm to friends and say: 'This is how I'm feeling.'' For many, a mark on the skin is testimony to the fact that although outwardly they appear okay, they do not feel so on the inside.

It is important to remember that, even though it may not be apparent, self-harm is serving a function for the person who does it. Figuring out what functions it serves and helping someone learn other ways to meet those needs is an essential part of helping people who self-harm. Some of the reasons people have given for their acts include:

• 'Affect modulation' - distraction from emotional pain, a way to combat feelings of numbness, calming overwhelming or intense feelings.
• A way of maintaining control and distracting the self from painful thoughts or memories.
• A way of punishing oneself - either because they believe they deserve such punishment or because they hope that self-punishment will avert worse punishment from some outside source.
• Expression of something that cannot be put into words.
• Expression of feelings for which they have no label - this phenomenon, called 'alexithymia', is common in people who self-harm.

People who self-harm often never developed healthy ways to feel and express emotion or to tolerate distress.

A person who self-harms is likely to have gone through difficult and painful experiences during which they probably had no one they felt they could confide in, so didn't receive the support and the emotional outlet they needed to deal with it.

The experiences that lead someone to self-harm are varied. They might have been neglected by their family, separated from someone they loved, been bullied, harassed, assaulted, isolated, put under intolerable pressure or have been made homeless. Whether or not they harm themselves in response to these experiences is dependent upon the person, what may seem minor to one person can have a profound and lasting affect on another. Whatever the event, the amount of pain it has caused the individual should never be trivialised.

How common is it?

Hospital records show that some 142,000 young people are treated at accident and emergency departments each year as a result of their self-harm. However, this is only part of a bigger picture. The majority of people who self-harm will either not harm themselves in a way that needs medical treatment or they will deal with it themselves, so their numbers go unrecorded. The research available shows that between 1 in 12 and 1 in 15 young people self-harm in the UK. It is not unlikely you know someone who self-harms or has done in the past.

Who is most likely to self-harm?

According to research, the majority of people who self-harm are young women, although the percentage of men is on the increase. Self-harming behaviour is significant among minority groups who are discriminated against by society. People who have mental health problems, such as depression, are more likely to self-harm. So are those who are dependent on drugs or alcohol, or who are faced with a number of major life problems, such as being homeless, a single parent, in financial difficulty or otherwise living in stressful circumstances. One important common factor is a feeling of helplessness or powerlessness.

Young people are often under great pressure within their families, from school and among their peers. Student life is prone to such pressures making this a vulnerable time for those at risk.

The research suggests that people who self-harm are more likely to have low self-esteem, to be depressed and anxious. They are less able to deal with the problems life throws at them and often retreat into themselves, feeling angry, blaming themselves for their failure. Of course, these traits are not found in everyone who self-harms.

Dispelling common myths

Self-harm is usually a failed suicide attempt.
This is perhaps the most common myth, despite research proving otherwise. Those who self-harm are at a higher risk of suicide but this is due to the other problems they are experiencing for which self-harming is a symptom. Self-harm is inflicted with the intention to cause damage but not to end one's life. Many, if not most people who make a suicide attempt use means that are completely different to their preferred methods of self-harm.

People who self-harm are just trying to get attention.
We all seek attention sometimes, talking to the cashier at the supermarket or wearing loud clothes; wanting attention is not bad or sick. If someone is in so much distress that the only way they fell they can express their pain, or ask for help, is by hurting their body, something is definitely wrong in their life and this isn't the time to be making moral judgments about behaviour. That said, most people who self-harm go to great lengths to hide their scars. Many consider their self-harm to be a deeply shameful secret.

Self-harm is just an attempt to manipulate others.
A small minority of people use self-inflicted injuries as an attempt to cause others to behave in certain ways. Most do not. If you feel someone is trying to manipulate you with such behaviour, it is more important to focus on what it is they want to tell you and how you can communicate about it while maintaining appropriate boundaries.

If the wounds aren't "bad enough," self-harm isn't serious.
The severity of the wounds has very little to do with the level of emotional distress felt. Different people have different methods of harm and different pain tolerances. It is dangerous to treat 'a few scratches' with the assumption they are not a serious problem.

Self-harm is a trend...people do it to be "cool".
A small number of people do self-harm because it is "cool" and the in thing in their group of friends. This may be a small phase in their life which will pass but regardless it should be treated as the genuine article.

'Someone who self-harms can just stop what they're doing, if they really want to…'
Self-harm is an addiction. It can induce a rush similar to taking drugs. Some people can stop and never self-harm again. Other people cannot and need this as a coping mechanism to survive. Even if they don't want to self-harm they need to because it as become an addiction.

People who self-harm have been abused.
Some people who self-harm have been abused but this does not apply to everyone. The reason for self-harm are unique to the individual.

Once you stop self-harm the problem will go away.
The act of self-harm is not the problem. It is only a response to an underlying issues. Self-harm is a symptom not a cause.

When you feel the need to hurt yourself, what can you do instead?

There are various ways to cope with the urge to self-harm. Everyone has their own method and there is no standard method that helps everyone. Below are some ideas which people report to be helpful when combating the urge.

• Snap your wrist with a rubber band or a hair band.
• Use washable, non-toxic markers to draw on your skin, you can draw in red pen to emulate the cuts or marks you would make.
• Allow yourself cry and do not stop until you feel calmer.
• Write a letter to the person or problem that is upsetting you, but do not mail it.
• Scream at the top of your lungs, you can scream into a basin of water or a pillow if you don't want to be overheard.
• Throw things (such as ice cubes or pillows, NOT objects like glass which are dangerous).
• Chat to a friend about what is upsetting you, even if you don't know what the problem is, just express how you feel.
• Punch a soft object like your pillow.
• Shred a phonebook or a newspaper.
• Hold an ice cube or something cold against your skin.

There are other methods of distraction such as drawing a picture, making a journal entry, exercising, listening to your favourite 'angry' music and cooking which help some individuals. It is also useful to give yourself five minutes where you are not allowed to hurt yourself. When those five minutes are up try and take another five minutes. Repeat this until the urge passes. It may take some time to find something that works for you.

How to tell someone you self-harm and seek help
Self-harm is a difficult issue. Despite its long history and increased media attention, it remains largely misunderstood. As self-harm is very secretive you may have been harming yourself for many months or even years before you feel able to tell someone.

Revealing you self-harm can invoke a wide and varied range of feelings and emotions, in yourself and in your confidant. You could choose to speak directly to whoever you decide to confide in, or write them a letter/email or even, show them your scars. However you choose to disclose the fact it is important to set aside some time to discuss it with the person and it may be useful to provide some literature to help them understand. During the disclosure you may find that initially you provide the sympathetic listening ear while they deal with the revelation.

Telling someone shows strength and courage and can often be a relief to be able to let go of such a secret. Consider why you feel the need to tell somebody and explain these reasons to them as this to help clear up any misunderstandings. It will also show them that you are not in any way telling them this to punish them. You should aim to remain calm during your disclosure. If you are worried about telling someone about your self-harm, you may find that if reassuring to have a friend who knows about your self-harm present.

If you have decided to tell someone remember it is your choice how little or how much you decide to say. There are a number of web based and national organisations that can help you talk through your decision to tell someone and can help you to understand your self-harm better. These can be contacted in the details at the end.

How can friends and family help?

If someone you care about is self-harming, it can be very difficult to cope with your own feelings of shock, anger, guilt, grief and helplessness. You may be very afraid of what might happen to this person. It is important to remember your own needs and feelings and not become overwhelmed. You are not responsible for someone else's actions contrary to what you may think or feel. It is okay to admit that their self-harm confuses and scares you and to talk through your feelings as well. If at any point you feel it is too much for you then you should gently step back and help them find someone else, such as a counsellor or GP, to talk to.

Although you may feel helpless, what you do or do not do can make a lot of difference. By simply listening and paying attention you affirm that you care and that they are worth caring about.

It is important not to panic, if you need it then ask for time to digest the information and decide how you feel about it. It is also important to be uncritical, even if you do not agree with their actions, as this will only add to the problem. Do not panic, blame them, treat them as if they are crazy, or make them feel guilty. It is unhelpful to take a judgemental approach and stereotype the person. Banning their self-harm, forming contracts, punishing their behaviour and giving ultimatums is also counter productive. Avoid asking the person to stop harming themselves for you, they need to stop for themselves and if they are unable to stop they will feel guilt in letting you down, only adding to the problem.

Don't expect change to happen quickly. It takes a while for people to change the strategies they use for coping and to learn that it is acceptable to feel and express their emotions in other ways. In the end, each individual has to find their own solution and you cannot do it for them. Ideally, you should set boundaries to keep yourself feeling safe while respecting the person's right to make his or her own decisions about how to deal with stress.

How to seek help (advice from MIND)

Although you may doubt your abilities to deal with your problems in any other way than harming yourself, with plenty of support you can learn to cope with the emotions that need to surface. The important thing is to find ways to start talking to someone you trust. It could be to a friend, a family member, a professional counsellor, a psychologist or a psychotherapist.

A good first contact is your GP, you need not go alone if you are uncomfortable doing so. NICE (National Institute of Clinical Excellence) recommends that you should be offered a full assessment of your physical, psychological and social needs, by a professional who has been trained in the treatment of people who harm themselves, in an atmosphere of respect and understanding. If your GP is dismissive or unhelpful, you can contact the Patient Advice and Liaison Services (PALS), listed in your phone book under the local NHS Trust. You have a right to change your GP, if you feel the need.

Your GP may offer you a number of treatment choices, including various forms of counselling or therapy. If your self-harming is severe, you may be referred to psychiatric services for further assessment, treatment and support. In an emergency, you may be taken into hospital. People's experience of these services is very variable. When time and resources are limited, it may be easier for staff to make snap judgements, use diagnostic labels and offer medication, than to spend time looking for the underlying causes of distress. If you find that this is the case, you may need an advocate, who can speak for you and ensure you are properly treated. This could be a friend, relative or a professional. The new NICE guidelines are designed to counteract this kind of response and to ensure that people receive the best possible care. The can be found at the following web address:

http://www.nice.org.uk/download.aspx?o=cg016publicinfo

If you are a student you may wish to seek help from your personal tutor or the counselling services at your University.

Contact the University Of York's counselling service by visiting http://www.york.ac.uk/admin/scs/

York also offers 'NightLine' which is a student service run by students which offers advice and information and is reachable between 8pm-8am.

Telephone: 01904 433721/433735
Email: nightline@york.ac.uk
Webpage: http://www.york.ac.uk/student/nightline/

Further literature

The Basement Project
PO Box 5, Abergavenny, Wales NP7 5XW
tel: 01873 856 524
Publications, groups and workshops for people who self-harm

British Association for Counselling and Psychotherapy (BACP)
BACP House, 35-37 Albert Street, Rugby CV21 2SG
tel: 0870 443 5252
web: www.bacp.co.uk
For details of practitioners in your area

British Red Cross UK Office
44 Moorfields, London EC2Y 9AL
tel: 020 7877 7000
For information about their scar camouflaging service

Mind (National Association for Mental Health)
Granta House, 15-19 Broadway, Stratford, London, E15 4BQ
tel: 020 8519 2122.
MindinfoLine: 0845 766 0163.
email: contact@mind.org.uk
web: http://www.mind.org.uk
A leading mental health charity in England and Wales, providing a wide range of services and with a large number of local groups.

National Self-harm Network (NHSN)
PO Box 7264, Nottingham NG1 6WJ
web: www.nshn.co.uk
Survivor-led organisation supporting those who self-harm

Samaritans
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF
tel: 09457 90 90 90
web: www.samaritans.org.uk
24-hour emergency helpline

YoungMinds
102-108 Clerkenwell Road, London EC1M 5SA
parents information service: 0800 018 2138
web: www.youngminds.org.uk
For anyone concerned about a child's mental health

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behaviour in a way that protects the patient as well as the practitioner. If you need to seek medical assistance for your injury it is advisable to have read this or to take a copy with you.

http://www.palace.net/%7Ellama/psych/brights.html

'The Bill Of Rights For Those Who Self-harm'