Self Harm

This guide is for people who deliberately harm themselves and are unhappy about it. It is also for family and friends who may have difficulty understanding this behaviour. 

People who have experience of harming themselves have contributed to the writing of this guide. 

It offers self help advice. However, anyone who self-harms should also see their GP (family doctor).

“I need to feel something, to know that I exist. Burning myself allows me to be in control of my body. It sometimes seems as though it is the only way I can feel alive or in control of anything… it is something I carefully plan when things get bad…” 

“Tension builds inside me and I get to the point when I feel I will explode. When I cut myself it all disappears, it seems like the badness goes out of me, my anger dissolves… for a while…” 

“I hurt myself when I want to hurt others… it is better to hurt myself than them” 

“It’s a downward spiral… small cuts lead to bigger cuts”

“I self-harm to 'punish' myself. But I feel guilty doing it, it’s my only coping mechanism, it works for me. It plays into my 'self-hatred'. I am not doing it to spite my family but they think I am punishing them”

These are the thoughts of people who have self-harmed. You may have had similar experiences yourself or you may have a friend or family member who self-harms. Although people don’t often talk about self-harm, it is relatively common, little understood and very distressing. 

This guide aims to help you to begin to:

• Understand self-harm, what can cause it and keep it going.
• Explore ways of controlling self-harm.
• Discover other ways of getting help. 

There is a lot of information in this guide and it may be helpful to read it several times, or to read it a bit at a time, to get the most from it.

More than half of people who die by suicide have a history of self-harm. 

The following are some things to look for that may mean you are at risk:

• Do you think that you want to die or to kill yourself?
• Have you planned a way to kill yourself?
• Do you feel hopeless about the future and can think of no reason to live?
• Have you had a suicide attempt in the past?

What is self-harm?

Many people harm themselves in some way, by smoking, drinking, working too hard or exercising too much. But for some people this self-harm is more apparent and can be quite severe.

Self-harm is sometimes known as self-injury and is where someone harms their body without wanting to die. Many people who harm themselves also have suicidal thoughts. But most feel that there is a difference between suicidal acts and acts of self-harm. They may say “I didn’t want to die, I just needed to get rid of terrible feelings”.

Some people may harm themselves many times each day. It may involve a lot of ritual. Some people may feel addicted to the self-harm behaviour. Others may only harm themselves occasionally when under emotional stress.

Who self-harms?

People who self-harm may feel distressed a lot of the time. They may be stressed and very sensitive to rejection.

Self-harm is not determined by a person’s race, age, education, or social group. Research has suggested that more women than men harm themselves (men may show their feelings in other ways). It tends to begin in adolescence and may decrease or disappear in the thirties, although not always, and can begin later in life. Sometimes people begin to self-harm following difficult life events including debt, bereavement, bullying and relationship breakdown.

Some people who harm themselves have been sexually, emotionally or physically abused in their early life. It may be useful to seek help such as a talking therapy if you have experienced abuse. Some mental health problems are linked with self-harm, including emotionally unstable personality disorder, depression, bipolar disorder, schizophrenia, and drug and alcohol-use disorders. Some people harm themselves in response to hearing voices. This is especially true when hearing voices that speak negatively about the person’s thoughts and actions.  Help is available through your GP practice for these conditions.

People often don’t know why they harm themselves at the time. But through talking to a lot of people who harm themselves, research has allowed us to begin to understand what may be happening. You may recognise some of the following reasons. Tick any that apply to you.

To manage moods or feelings

• To escape from feelings of emptiness, depression or shame.
• To stop feeling spaced out, disconnected or unreal, sometimes called dissociation.
• To relieve pent up tensions, pressure or anger.
• To feel something – to know you still exist.
• To feel in control.
• To express or stop sexual feelings.
• To forget something.
• As an alternative to killing yourself.
• To get a thrill or an adrenalin rush.

To fit in with beliefs or thoughts

• To punish yourself because you feel you are ‘bad’.
• To maintain negative belief “I’m flawed, worthless, weird”.
• To escape from feelings of guilt.
• To cope with the expectations of others for example regarding your sexuality or regarding arranged marriage.

To communicate

• To let people know how bad things are.
• To make your body show your pain.
• To express anger towards others and yourself, but on your own body.
• To obtain and maintain a response from others that you feel you wouldn’t otherwise get.
• To punish others via your own body.
• To get people to listen to you.
• To feel part of a group and have an identity.

Many people who self-harm regard their behaviour as a way of surviving. It may be a means of coping with unbearable emotional pain. Their reasons for self-harm tend to be complex and may include many of those listed above. Self-harm can be very addictive and can be a difficult pattern to change. Sadly some people do kill themselves whilst self-harming. This is most common in those who take overdoses of tablets or medicines.

People who self-harm may cut or burn themselves. They may pull out their hair, punch themselves, bite themselves, poison themselves, pluck at or scratch their skin. They may generally put themselves at risk. There are endless different ways of self-harming. It may be dramatic, hidden, or ritualistic. It may be permanently mutilating, and may seriously disfigure their body before they are able to gain control of it.

Carers, friends, relatives or workers may react to self-harm in various ways. Some responses may be helpful, others less so.

Typical reactions some helpful, many unhelpful include:

Later on we will offer advice on how friends, family and workers can offer a more helpful response.

Many people who self-harm want to stop. These are some of the reasons that they give.

• “It hurts sometimes”.
• “When my wounds become infected they are really painful”.
• “Trying to escape things by giving yourself scars only reminds you of the things you are trying to escape”.
• “Every time you see where you self-harmed it reminds you of when you did it and makes you down again”.
• “People treat you funny if you have the scars”.
• “It upsets the people you are close to…”
• “I can’t wear short sleeved t-shirts in the summer”.
• “I can’t go on holiday to hot countries…”
• “I’m thinking about the future and what my children would think of the scars…”

If you self-harm you may have your own reasons to stop.

Ask yourself the following questions.

• Do I need to change my life circumstances?

If you are living in a situation that is emotionally or physically unsafe it will be difficult for you to stop self-harming. If you are in a violent or abusive atmosphere ask yourself why you are staying. Try to plan how you might change your situation. It may help to talk this over with someone else such as a friend, your GP, healthcare professional or a counsellor.

• What leads me to self-harm?

Keep a diary of your self-harm to help you understand it better. It may look something like this.

People often find there is a clear pattern of events that leads them to harm themselves. If you know this you can begin to try and change. Think back to the last time you self-harmed and fill in the diary below.

Try and keep a regular diary like this. This can be difficult and painful – it may be hard to capture your thoughts. But once you have discovered the pattern to your self-harm you can begin to try out methods to alter that pattern. Many people find that they self-harm following conflict or pain in a relationship.

This is a crisis list. These are immediate short-term solutions. Please tick those that you feel you might try …

• Try less destructive ways of doing it. For example, pinching yourself or holding an ice-cube in your hand, instead of cutting.
• Do not share razors or implements with other people because of the risk of HIV and hepatitis. Use clean implements.
• If you are cutting yourself think of the scarring that will be left in the future. Avoid deep cuts.
• Aim to reduce the number of times you self-harm and the amount of time spent.
• Try not to feel too angry with yourself for having done it. Try to make some longer term plans (see the next page) to avoid doing it in the future. Recognise that it is a difficult pattern to break.
• Learn to clean and dress cuts to avoid infection.
• Remember that if you overdose you are no longer in control of what happens. Even small overdoses can kill.

Some people feel they need to keep using self-harm until they have progressed with other issues.

• Do I really want to stop harming myself? Use this to list the pros and cons of self-harming, the good things and the bad. Make sure to list all the negatives – the scars, the waste of time and energy, the risk of permanent injury and even death, etc. (look back at the reasons other people have given).

If you feel that self-harm is a way that you communicate emotional pain, then it may be helpful to work on communicating in other ways.

The following are important questions to ask yourself:

• What do I feel like when I harm myself?
• Have I ever tried to express in words how bad I feel?
• If not, could I think of words to describe what I feel like?
• Could I share this with anyone? (A friend, family member, therapist)
• Might it help to write it down first of all?
• What do I fear might be the response of those people to what I have to say?

Try to learn to describe how you feel. Try to learn to say no when you would like to. Courses and books on learning to be assertive are widely available. Try assertiveness training. Ask a friend to go with you if your confidence is very low.

If you feel that your self-harm is often in reaction to others around you, it may help to try to increase your understanding of yourself and others. Give yourself some calm time to think in detail about the feelings, thoughts, motives, intentions, beliefs, desires and needs of yourself and others. Slowing things down and trying to see both positions can be really helpful. Try to be kind and empathic in your understanding of yourself and others. This is sometimes called ‘mentalising’ or ‘thinking about thinking’. You can learn to do this better through a therapy called Mentalisation Based Therapy. This is usually done in a group, and may be available through your local mental health services. You can find out more through the suggestions made in the Useful Books and Information section at the end of this guide.

Many people who harm themselves have experienced some physical, sexual or emotional abuse in their past. Unfortunately they often feel they must take the blame for what has happened to them even if they were very young when this abuse occurred. It can help to reconsider this self-blame. Try this approach. Imagine a friend told you a story almost identical to your own – would you blame him or her because someone else abused them? If not, then why do you continue to blame yourself for what happened to you? Try to be compassionate towards and understanding of yourself, try not to be critical of yourself. Some therapies will help you to learn to be more self-compassionate.

Take good care of yourself; allow yourself relaxation, pleasures, time for yourself, luxury. Don’t allow yourself to feel guilty about this. It is what you need and deserve. Are there issues from your childhood that you need to understand? If there are, try and talk them over with someone. Find a therapist who may be able to help you review this area of your life. Ask your GP or healthcare professional about this.

Try self-calming techniques. Try relaxation of the body (see the guide in this series about managing anxiety). Or ask your GP or healthcare professional about medication. Use the senses to calm yourself. Try to stay in the ‘here and now’ in your mind.

Touch – Massage yourself, especially your face and shoulders. Touch some soft fabric, such as silk or velvet. Concentrate on the feelings and learn to enjoy them.

Hearing – Listen to some soothing music. Concentrate on the sounds around you. Learn to enjoy sounds.

Vision – Look at a beautiful picture, film or object. Concentrate on it and try to enjoy the pleasure of it.

Smell – Try perfume, flower scent, or the smell of coffee. Spend some time concentrating on this.

Taste – Taste and slowly appreciate something you really enjoy.

Use your imagination – Picture pleasant scenes and feelings. Give yourself time and space to try out these things.

Make a list of things you might enjoy and build these into your day. Here are some examples:

• Listening to music.
• Looking round the shops.
• Eating chocolate.
• Going to see, or streaming, a film.
• Watching sport.
• Going out on a trip.
• Reading a good book.
• Being creative: painting, writing, cooking.
• Doing nothing.
• Reading the paper in peace.
• Going out with friends.
• Doing some sport.
• Try mindfulness.
• Try relaxation.

Mindfulness and relaxation classes are becoming very popular, and you may find there are classes you can attend locally. Examples of where you can download free mindfulness and relaxation exercises can be found at the end of this guide.

Mindfulness can be helpful in managing self-harm.

Make sure there are some good things happening each day and each week. Plan ahead. Build these moments into your life.

Look at the relationships you have. Nurture the good ones and end those that might be destructive. If similar destructive relationships are happening to you again and again then try to think what goes wrong. Talk it over with someone. Try to think how you can break the cycle.

There are addresses at the end of this guide for contacts for self-help groups and organisations. The Internet can also be a good source of advice but some websites may be distressing. Some good websites are also listed at the back of this guide.

It may help to:

• Recognise how distressed the person is even if they don’t seem to be. Encourage their attempts to control self-harm and don’t despair or become angry if they fail to control it.
• Keep an accepting attitude towards it. Try to discuss it and try to help him or her to think of ways to control it.
• Get medical help if the injuries are serious.
• Discuss with them the idea of seeing a therapist. The GP or healthcare professional is a good first port of call for this.
• Be there for them.
• Encourage the person to stay in company, where they will be less likely to harm themselves.
• Seek support yourself if the problem continues.
• Offer practical help (e.g. look after children, go shopping with the person etc.).
• Give them time and talk on their terms.

We hope the information in this guide will be useful to you in beginning to understand self-harm. There are other guide in this series which may be helpful, including advice on coping with anxiety, depression, abuse and other mental health issues.

It may also be helpful for you to seek further support, particularly if you are feeling anxious and/ or depressed. Your GP or healthcare professional may be the best person to talk to first. They may refer you on to local mental health services, where you should be offered a talking therapy.

Talking therapies recommended by National Institute for Health and Care Excellence (NICE) include therapy tailored to each individual which includes cognitive-behavioural, psychodynamic or problem-solving approaches. Other approaches that have been shown to be useful include dialectical behaviour therapy and compassion focussed therapy.

It is important to remember that if you seek NHS help for self-harm, the National Institute for Health and Care Excellence states that you can expect to be treated with compassion, respect and dignity. Please do not hesitate to get help if needed.

• British Association for Behavioural and Cognitive Psychotherapies
  Email: babcp@babcp.com ​​​​​
  ​​www.babcp.com
  Information and advice for people about behavioural and cognitive psychotherapy (CBT).

• British Association for Counselling and Psychotherapy
  Tel: 01455 883 300
  Email: bacp@bacp.co.uk
  www.bacp.co.uk
  Information and advice about counselling and psychotherapy.

• Staying Safe from suicidal thoughts
  www.stayingsafe.net/
  Information written by a group of professionals to support anyone in distress and feeling suicidal.

• Healthwatch
  www.healthwatch.co.uk
  If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, we want to hear about your experiences. As an independent statutory body, we have the power to make sure NHS leaders and other decision makers listen to your feedback and improve standards of care.

• LifeSIGNS
  Email: hello@lifesigns.org.uk
  www.lifesigns.org.uk
  LifeSIGNS is a user-led small charity providing information, guidance and support for people who self-harm and their family, friends and loved ones.

• Mental Health Matters
  Tel: 0191 516 3500
  Email: info@mhm.org.uk
  www.mhm.org.uk
  A national organisation which provides support and information on employment, housing, community support and psychological services.

• Mind Infoline
  Tel: 0300 123 3393, Mon - Fri, 9am - 6pm
  Email: info@mind.org.uk
  www.mind.org.uk
  Provides information on a range of topics including types of mental distress, where to get help, drug and alternative treatments and advocacy. Also provides details of help and support for people in their own area.

• National Debtline
  Tel: 0808 808 4000
  www.nationaldebtline.org
  Help for anyone in debt or concerned they may fall into debt.
• National Self Harm Network
  www.nshn.co.uk
  An online support forum providing crisis support, information and resources, advice, discussions and distractions.
• ​​​​​​​​​​​​​​​​​​​​​The NHS website
  www.nhs.uk
  Information about conditions, treatments, local services and healthy lives.
• Rethink
  Advice service: 0808 810 0525
  Email: advice@rethink.org
  www.rethink.org
  Provides information and a helpline for anyone affected by mental health problems.
• Samaritans
  Tel: 116 123
  www.samaritans.org
  Email: jo@samaritans.org
  Post: Freepost SAMARITANS LETTERS
  Provides confidential support for anyone in a crisis.
• Self Injury Support
  www.selfinjurysupport.org.uk
  A national organisation that supports girls and women in emotional distress who harm themselves. Support Service available Monday to Friday 7pm-9pm.

• The Mental Health Foundation
  www.mentalhealth.org.uk
  Provides mental health related resources, information and campaigns. Does not run a helpline.

• For friends and family: a guide for supporters of women and girls who self-injure 
  Lois Arnold
  Bristol Crisis Service for Women 1998
  The aim of this booklet is to help those who want to understand and support a woman or young person who struggles with self-injury.
  www.selfinjurysupport.org.uk/understanding-self-injury-publications

• Freedom from Self-Harm: Overcoming Self-Injury with Skills from DBT and Other Treatments
  Kim L. Gratz and Alexander L. Chapman
  New Harbinger Publications 2009
  Guide to stopping self-injury gives you the facts about self-harm, corrects common myths about this behaviour, and provides self-soothing techniques you can begin using right away for regulating difficult or overwhelming emotions.

• Healing the hurt within: understand self-injury and self-harm and heal the emotional wounds (3rd revised edition)
  J Sutton
  How to Books Ltd. 2007
  Offers solace, hope, and direction to those who self-injure; guidance to family and friends supporting a loved one who self-injures; and guidelines to professionals and voluntary caregivers on how to respond to clients that self-injure.

• Overcoming low self-esteem: a self-help guide using cognitive behavioural techniques (2nd edition)
  Melanie Fennell
  Little Brown 2016
  This is a guide which is full of real-life examples, intended for people who suffer from low self-esteem and for those who help them.

• Self-injury support and self help groups
  Karin Parker and Hilary Lindsay
  Bristol Crisis Service for Women 1998
  This booklet is for anyone interested in setting up or being involved in a self-help group.​​​​​​​
  www.selfinjurysupport.org.uk/publications-about-self-injury

• The scarred soul: understanding and ending self-inflicted violence
  Tracy Alderman
  New Harbinger 2002
  Written for the victims of this addiction, and for mental health professionals, The Scarred Soul explores the reasons behind this behaviour and shows how to overcome the psychological traps that lead to self-destructive acts.

• Women who hurt themselves (10th edition)
  ​​​​​​​D. Miller
  Basic Books 2005
  A book that provides help for the thousands of women who secretly inflict violence on themselves.

For young people:

• Mind your head
  Juno Dawson
  Hot Key 2016
  Covers topics from anxiety and depression to addiction, self-harm and personality disorders with added information and support from clinical psychologist Dr Olivia Hewitt.  Juno and Olivia talk clearly and supportively about a range of issues facing young people's mental health - whether fleeting or long-term - and how to manage them.

www.franticworld.com – Mindfulness: Finding Peace in a Frantic World – Free meditations and mindfulness resources.

www.headspace.com – A free taster of mindfulness, with an opt-in to buy further sessions

www.freemindfulness.org – A collection of free to download meditations

www.cntw.nhs.uk/relaxation

www.wellbeing-glasgow.org.uk/relaxation

A full list of references is available on request by emailing pic@cntw.nhs.uk

Share your thoughts with other people and let them know what you think of this guide.

Written by Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists.

Many thanks to Dr David Rawlinson, Consultant Psychological Therapist, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, who has contributed to the review of this guide.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS healthcare staff, service users and local voluntary sector groups.

Published by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

2024 Copyright PIC/105/0324 March 2024 V5

Review date 2027