Let’s talk. Raising awareness about self-injury and self-harm
In line with the theme of Self-Injury Awareness Day, I would like to share my reflections on working with people who have struggled with self-injury and self-harm to raise awareness and challenge stigma.
I appreciate that this may be a difficult topic for many people and I hope that any readers will find value in this post. I believe wholeheartedly that it is important to raise awareness of mental health difficulties. Although self-injury and self-harm are not viewed among professionals as a mental health condition itself, this behaviour is often associated with psychological distress and has strong links with low self-esteem, low mood and anxiety. I have found it incredibly important to have open discussions about self-harm with my clients in terms of understanding their experiences, managing triggers and assessing their levels of risk.
I intend to raise awareness by reaching out to people who self-injure or self-harm and offer support for their loved ones, as well as having this space to educate, talk about and reflect upon our existing knowledge of this difficulty.
Why is self-injury and self-harm important to talk about?
Self-injury and self-harm is more prevalent than one might think. With data from research studies covering 41 countries across the world, research has found an estimated 17% of people will self-harm in their lives, and the average age for the first instance of self-harm is 13 years old (Gillies et al., 2018). More than this, the data currently reported may not be entirely accurate because of the shame and stigma that surrounds this concern, with professionals suspecting that the rates, in reality, are likely to be higher than what is reported.
The Mental Health Foundation reports that anyone of any age group can self-injure, and I have found this to be the case. however, it may be more common in vulnerable groups such as:
Females
Young people
People with an existing mental health problem
LGBTQIA+
Prisoners
Asylum seeks
Veterans
People who have experienced child abuse
People bereaved by suicide
What do we mean by self-injury and self-harm?
Self-injury is when a person injures or hurts themselves on purpose. There are lots of different ways that people can hurt themselves, with some harmful acts towards the body understood as more obvious than others.
Examples include:
cutting skin using sharp objects
excessive picking and/or scratching skin until drawing blood
burning skin
inserting objects through skin openings
head banging against objects and/or punching objects
punching or hitting themselves
pulling out hair
self-poisoning by ingesting harmful chemicals
purposefully breaking bones
However, self-harm encapsulates a wider range of behaviours which many people may not necessarily think of as self-harm. This includes eating problems associated with eating disorders, such as restricting food, binge eating and self-induced vomiting, as well as over-exercising and risk-taking behaviours such as substance misuse, getting into fights, and unsafe sex.
Why would someone purposefully hurt themselves?
There is no simple answer to this question as one size does not fit all and there are different motivators for this behaviour. It is understood that there are many different reasons why people may harm themselves, often they have difficulty coping and managing their feelings. They may harm themselves by:
Release strong emotions that feel overwhelming
Express emotional pain through physical pain
Express something difficult to put into words
Make themselves feel something (due to numbing)
Block or escape upsetting (often traumatic) memories
Punish themselves
Reach out for help
Feel a sense of control
Express suicidal feelings and thoughts, without taking their life
Importantly, there can be a link between suicidal thoughts and self-injury, however, not all people who hurt themselves experience suicidality. For many people, self-injury is used to stay alive and manage their emotional distress. It can bring a temporary sense of relief, but without adequate support, the underlying issues which have led to this style of coping will not disappear, and as distress intensifies it is likely that people feel urges to hurt themselves again making it very difficult to break the cycle.
What are the signs that a loved one may be self-harming?
Changes in a loved one's behaviour may raise concerns about their wellbeing. Specific changes that may indicate self-harm or self-injury include
Frequent injuries, including cuts & bruises
Making excuses about injuries
Wearing long-sleeved tops and trousers or tights, even in hot weather
Refusing to get changed in front of others, for children & adolescents this could be for PE
Hair missing on scalp, eyelashes, and eyebrows
How can I help myself?
If you aim to stop or reduce your self-harm, there are recommendations that you may try to help you with this process.
Start noticing your mood and when you experience urges to self-harm.
Consider the common situations, or environment that you are in when you are harming yourself. Ask yourself “What runs through my mind?”, is it a feeling, a memory, a person or place? What sort of sensations do you feel in your body? Getting to know yourself and recognise urges can help you make sense of your experiences and start steps to reduce or stop them.
Trial the waiting method
You can start this by noticing the urge to self-harm and then challenging yourself to wait before engaging in the behaviour. Can you wait for 5 minutes before self-harming? If you manage this, can you manage another 5 minutes? Keep trying this method and see if the urge to self-harm passes.
Meaningful distraction
When you recognise that you are experiencing an urge you have the power to choose a distraction which works for you. This could be exercising, going for a walk, listening to music, journaling your feelings, having a bath or stroking a pet. The options are endless.
Talk to a trusted person
You may have a person, or people, in your life that you feel comfortable talking to about how you are feeling. One way to reduce or stop self-harming is by reaching out to others when you are feeling most isolated. This could be a friend, a relation or a professional.
Harm reduction
If you are not ready to stop entirely, there are ways to reduce the risks that are associated with self-harm.
You could try alternatives such as holding ice cubes in your hands, snapping rubber bands on your wrist, pinching yourself, squeezing a stress ball, punching a pillow or screaming into it, or even drawing red lines on your skin.
Without condoning or encouraging this behaviour. You can start to educate yourself to minimise the risk of infection and further physical harm. This may include disinfecting instruments used in self-harm, having first aid materials nearby, trying to slow down and have more control during the process, and considering the wound care you might need afterwards. Try to keep within limits that are safe to self-manage, and if you have gone outside of these limits get the required medical care. Whether you are seen by a doctor or a mental health practitioner they should be able to speak with you in a sensitive and non-judgmental manner.
How can I help a loved one?
If you would like to support a loved one who self-harms the first step is to try your best to be non-judgmental. It can be scary, shocking or even upsetting to find out that a family member or close friend is self-harming. However, try your best to stay calm and let them know that you would like to help. By avoiding upset, then the loved one may feel more able to open up to you about this again in the future.
If the person is under 16, encourage them to talk to a trusted adult and seek support for yourself. For people over 16, encourage them to seek support and speak to a medical professional about their difficulties. To be supportive try your best to listen to them and approach the conversation in a non-judgmental manner.
Do not ask to see their injuries if they do not wish to show you.
Do not attempt to force them from self-harming if they are not ready to stop.
Please remember that they have autonomy and deserve respect.
What can mental health professionals do to help?
In my experience, people who are seeking therapy and looking to let go of self-harming behaviours may be experiencing several worries. They may fear being judged or not understood, perhaps they are worried about how they will manage without self-harm. Through gaining an understanding of why you harm yourself and how the cycle perpetuates you can look to new ways of coping. We can help you in this process by improving problem-solving skills and regulating difficult emotions. We can also explore relationship difficulties and strengthen self-esteem, letting go of the self-harm cycle which has become so familiar.
I have supported many individuals who struggle with self-injury and have assisted them in reducing their levels of self-harm. It has struck me through having open conversations and listening to their stories that one of the most painful aspects of self-harming is how isolated people feel. Many who self-injure suffer in silence and feel fearful about judgements made by others through misconceptions about self-harm. Yet, from talking with individuals about their support systems loved ones often express a tremendous amount of worry and concern about their wellbeing. One of the most important things we can do is work together to widen the support system of the person who is struggling.
If you are experiencing problems with self-injury, or are concerned about a loved one who self-injures, please consider arranging a free consultation with my colleagues at MAPP Psychology to find out more about therapy options and putting support in place.
If you have hurt yourself badly, or have concerns that you might act on suicidal thoughts please contact for crisis support (for people living in the UK):
SAMARITANS: 116 123
BREATHING SPACE: 0800 83 85 87
CALM: 0800 58 58 58
SHOUT: 85258
NHS24: 111 OR IN AN EMERGENCY: 999