Self-harm

Self-harm is when someone deliberately damages or injures their own body.

It has been described as a "physical expression of emotional distress". When a person is carrying painful emotions, hurting themselves physically can sometimes make them feel better.

If you self-harm, help is available for you. It's there for your family and friends too.

• harming yourself
• having thoughts about harming yourself
• worried about minor injuries like small cuts or burns, because without treatment they might become infected

Some people who self-harm are at a higher risk of suicide. So get support as soon as you can, as this can help prevent suicidal thoughts.

Find out how to get urgent help for your mental health.

Phone 999 or go to the hospital emergency department if you or someone else:

• has taken an overdose of drugs, alcohol or prescription medicine
• is in a lot of pain
• is having difficulty breathing
• is losing a lot of blood from a cut or wound
• is in shock after a serious cut or burn

You should also phone 999 if someone else is unconscious.

Self-harm takes many different forms, and it isn't always easy to notice. It may include:

• cutting
• burning
• punching
• poisoning
• misusing alcohol or drugs
• starving or bingeing

People often keep self-harm a secret because they feel ashamed or fear being found out.

If you think a friend or relative is self-harming, look out for signs like these:

• unexplained cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
• keeping themselves covered at all times, even in hot weather
• unusual eating behaviour
• blaming themselves unreasonably
• pulling out their hair

Someone who is self-harming may feel deep shame and guilt. They might also feel confused and worried by their own behaviour. It's important to approach them with care and understanding.

They may not want to talk about it with you. You could suggest that they speak to an anonymous helpline or see their doctor.

People self-harm for different reasons, and the reasons can differ from one person to the next. Some of the reasons include:

• to express or cope with emotional distress
• to express deep emotional feelings like low self esteem
• to try to feel in control
• to cope with a traumatic event like the loss of a loved one
• as a way of punishing themselves
• as a cry for help
• as a response to intrusive thoughts

Self-harm is a way of showing personal distress, and it is not an illness in itself. It can be linked to other mental health conditions like depression.

The distress that follows a traumatic experience or an unhappy situation can lead to feelings of low self-esteem or self-hatred.

Emotional distress can have many causes. Sometimes it's a build-up of several smaller things that leads people to think about self-harm.

Some examples include:

• difficult relationships with friends or partners
• problems or pressures at school or work
• being bullied
• money worries
• alcohol or drug misuse
• coming to terms with your sexuality
• coping with cultural expectations, for example, an arranged marriage
• sexual, physical or emotional abuse, including domestic abuse and rape
• the death of a close family member or friend
• having a miscarriage
• low self esteem
• struggling with stress, anxiety or depression

Anyone who self-harms should see a doctor. The doctor will try to treat the emotional cause behind it as well as any physical injury.

Expect the doctor to ask you about your feelings in some detail. They'll want to understand why you self-harm, what triggers it and how you feel afterwards. They may also ask a few questions to find out whether there's an underlying condition.

You may have your height, weight and blood pressure checked too. And you may be asked about any drinking or drug-taking habits.

Be honest with your doctor. If you don't know why you self-harm, say so.

You might be able to stop self harming by learning to manage your feelings in healthier ways, for example by talking to others.

Your doctor may refer you to a mental health professional. This could be:

• a counsellor, somebody who is trained in talking therapies
• a psychiatrist, a doctor with further training in treating mental health conditions
• a psychologist, a health professional who specialises in managing mental health conditions

If you have another condition that's linked to your self-harming, you may be referred to a specialist who can help treat that condition. For example, if you have anorexia nervosa, you might see a specialist in eating disorders and a dietitian or nutritionist (somebody who specialises in nutrition).

You might also be advised to attend a self-help group. For example, you might attend Alcoholics Anonymous if you're misusing alcohol, or Narcotics Anonymous if you're misusing drugs. These groups can offer support as you try to stop your self-harming behaviour.

You may be offered a psychosocial assessment. It looks into all the factors that contribute to your self-harm, including:

• social factors, for example your relationships with others
• psychological factors, meaning your feelings and emotions
• motivational factors, meaning what made you want to do it

You'll be asked how you're feeling at the moment, for example whether you feel hopeless or are thinking about suicide. If you have any other symptoms, you'll be asked about those too.

If possible, you and your mental health professional will decide together on any further treatment. It will be a programme made for you, based on your needs and on what's likely to work. You'll be asked for your consent before any treatment begins.

Don't include personal information, such as your name, your location or any personal health conditions.