What is self-harm?
Self-harming often begins when a person feels overwhelmed with upsetting thoughts and feelings. Harming themselves physically can feel like a release, almost giving them a sense of relief from the emotional pain they’re feeling.
This relief is only temporary, though, and is often followed by feelings of guilt and even shame. As the emotional pain is still present, the person may continue to rely on self-harming in an attempt to cope, continuing the cycle.
In this video, integrative counsellor Mike Swift explains how counselling can help people struggling with self-harm, including what self-harm can mean for different people.
Why do people self-harm?
There are no simple answers as to why someone might hurt themselves, as every individual is different. According to the NHS, many people who report having self-harmed did so to relieve unpleasant feelings. 83% said they had self-harmed to relieve unpleasant feelings of anger, tension, anxiety, or depression.
Many people who self-harm say it is a way for them to express something they can’t put into words. This may be emotional pain, loneliness or low self-esteem. For some, there is a particular event or experience that triggers them to start self-harming. This could include:
- being bullied;
- feeling overwhelmed with school/work;
- losing a loved one;
- the end of a relationship;
- losing a job;
- having an illness (mental or physical);
- feeling stressed;
- having a poor sense of self-worth;
- dealing with discrimination;
- experiencing abuse (sexual, physical or emotional);
- having difficulties at home.
For others, there may not seem to be a direct cause. If you self-harm but don’t know why, you are not alone, and you can still reach out for support.
Some situations or times of day may make the urge to self-harm feel stronger. For example, some people find their urges increase after drinking alcohol or during the evening or at night-time. Everyone experiences self-harm differently, and what triggers one person may not affect another.
Is self-harm 'attention seeking'?
Some people might talk about self-harming being an ‘attention-seeking’ act. The truth is, many people keep their self-harming private and feel alienated and upset to hear people misunderstanding their behaviour in this way.
For some, there is an element of wanting, or needing, attention. They may want people to see how upset they are and offer help. Either way, self-harming shouldn't be brushed off.
Deliberate self-harm is most often carried out in secret, so the stigma of it being ‘attention-seeking’ or that it’s ‘the behaviour of a drama queen’ seldom applies.
- Lukas Dressler, (MSc.) Counselling Psychologist, HCPC registered, MBACP, How to help someone who's self-harming
Types of self-harm and self-harming behaviours
There are many different ways someone may self-harm. While cutting is one of the more commonly recognised forms, it isn't the only one.
Self-harm can involve any behaviour where someone intentionally harms themselves as a way of coping with difficult thoughts or feelings. This may include under- or over-eating, overdosing or self-poisoning, or getting into fights knowing you may be hurt. For some people, self-harm can also involve emotional behaviours, such as deliberately doing things that make them feel upset.
Who can be affected by self-harm?
Self-harm can affect anyone, of any gender and any social background, at any age. According to NHS findings, the prevalence of self-harm has increased. 10% of people will self-harm at some point over their lifetime. Research found that younger people, those of White British or Mixed ethnicity, and those who are in problem debt, unemployed, or economically inactive were most likely to report self-harm. Those who had a physical health condition that limited their activities were also more likely to have self-harmed.
Statistics can help us understand patterns, but they don't define individuals. If you're experiencing self-harm, your feelings are valid, whatever your age, background or circumstances. Support is available whenever you're ready to reach out.
How to get help for self-harm
Once you get into a cycle of self-harming, it can be difficult to stop. Getting professional support can help you make changes. There are different ways to get help, and for many, a combination of self-help techniques and professional support is key.
It is OK to feel nervous about asking for help. It takes a lot of bravery to speak up, but remember you are worthy of support and have the right to receive help.
When asking for help, try to be as honest as you can. It may be tempting to downplay the extent of your self-harm, but speaking honestly about how you’re feeling is the best way to get the right support.
Below we look at some of the different options for getting help:
Speak to your doctor
Visiting your doctor and telling them you want help is a great first step. They can talk through treatment options and, if appropriate, offer medication for related conditions that may be impacting you.
Join a support group
Talking to other people who self-harm in a supportive setting can be comforting. Understanding that you are not alone and sharing your experience with others who ‘get it’ can help you feel lighter.
If you're not ready to attend a support group, online support communities can offer a way to connect with others who have had similar experiences. When looking for support online, choose trusted, moderated communities, as some websites and social media content may be unhelpful or triggering.
Try talking therapies
Counselling and psychotherapy have been shown to be very helpful for people who self-harm. Counselling offers you space and time to talk about your feelings in a safe, non-judgmental and confidential setting.
Cognitive behavioural therapy (CBT) and psychodynamic therapy are two talking therapies that are recommended for those who self-harm.
How to cope with urges to self-harm
The urge to self-harm can be intense, making it difficult to know what to do instead. If you’re struggling with this, there are a few things you can try to help yourself.
Recognise your triggers
Try to keep a diary of when you self-harm. Note down what you were doing, how you were feeling and/or what you were thinking before you self-harm to see if you can spot any patterns. Recognising what triggers you and how you feel before you self-harm can help you anticipate the urge and distract yourself.
Distracting yourself
Distracting yourself when you feel the urge to self-harm can help you change your behaviour. Everyone is different. Try different distraction techniques to see what works best for you. You could try:
- hitting cushions
- going for a walk
- exercising
- talking to someone
- tidying your room
- listening to music
- writing about how you feel
- drawing
- trying relaxation techniques.
If distraction doesn't help, you could try delaying. Rather than acting on the urge straight away, see if you can wait for five or 10 minutes while trying another coping strategy, such as listening to music or going for a walk. You may find the urge becomes less intense with time. If you can, gradually increase the amount of time you wait.
These techniques won't work for everyone, and it's OK if they don't. If urges to self-harm feel difficult to manage, speaking to a GP or mental health professional can help you find longer-term support.
These self-help techniques are useful for the short term, but in order to recover for the long term, you may need professional support. A professional can help you learn to understand and accept your feelings and help you build self-esteem.
Worried about a friend? How you can help a friend who's self-harming.
Can you recover from self-harm?
Recovering from self-harm is totally possible with the right support. This will involve you gaining a better understanding of why you self-harm, recognising your triggers and developing new ways of coping. You may experience relapses when you fall back into old habits, but don’t be discouraged by this if it happens. You are stronger than you know.
The longer you leave getting help, the harder it can be to stop self-harming. You are not alone in this, and everyone deserves happiness. Remember that – and when you’re ready, support is available.
After you've found a way to explain your 'why' – you're halfway there – because at last, you've externalised your feelings and the story surrounding it all. It's like suddenly there's a handle on the door.
- Counsellor Fiona Austin explains more in Unwrapping self-harm
What should I be looking for in a counsellor or psychotherapist?
Currently, there are no laws that stipulate what level of training or qualifications a counsellor dealing with self-harm needs. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- If you have harmed yourself, you should be offered a full assessment of your needs. This may be by a specialist mental health professional, for example, a psychiatrist or psychiatric nurse.
- After the first full assessment, you may be offered a further assessment or further treatment.
- Psychological treatment has the best evidence for helping people who have self-harmed in the longer term.
The NHS recommends psychological treatments such as cognitive behavioural therapy (CBT).
