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Self-harm is a coping mechanism. An individual harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation. Self-harm is any deliberate, non-suicidal behaviour that inflicts physical harm on the body and is aimed at relieving emotional distress. Physical pain is often easier to deal with than emotional pain, because it causes 'real' feelings. Injuries can prove to an individual that their emotional pain is real and valid. Self-harming behaviour may calm or awaken a person. Yet self-harm only provides temporary relief, it does not deal with the underlying issues. Self-harm can become a natural response to the stresses of day-to-day life and can escalate in frequency and severity.

People who self-harm usually make a great effort to hide their injuries and scars, and are often uncomfortable about discussing their emotional inner or physical outer pain. It can be difficult for young people to seek help from the NHS or from those in positions of authority, perhaps due to the stigma associated with seeking help for mental health issues. Self-injury is usually private and personal, and it is often hidden from family and friends. People who do show their scars may do so as a reaction to the incredible secrecy of their emotions and feelings which they are unable to share, and one should not assume that they are attention seeking, although attention may well be needed. Accurate assessment, early detection and early intervention are essential to the successful treatment of self-harm.

Self Harming Behaviours

Factors that motivate people to self-harm include a desire to escape an unbearable situation or intolerable emotional pain, to reduce tension, to express hostility, to induce guilt or to increase caring from others. Even if the initial intent is not to kill oneself, self-harming may express a powerful sense of despair and needs to be taken seriously. Moreover, some people who do not intend to kill themselves may do so because they do not realise the seriousness of the method they have chosen or because they do not get help in time following an incident. Examples of Self-harming behaviour include:

  • Cutting
  • Taking an overdose of tablets
  • Swallowing hazardous materials or substances
  • Burning, either physically or chemically
  • Over/under medicating, e.g. misuse of insulin
  • Punching/hitting/bruising
  • Hair-pulling/skin-picking/head-banging
  • Episodes of alcohol/drug abuse or over/ under eating may be deliberate acts of self-harm
  • Risky sexual behaviour

Why do children harm themselves?

There can be lots of different reasons why a child or young person may self-harm. The reasons may not be obvious or easy to work out. A child or young person might not know themselves why they do it.

There are links between depression and self-harming. It may be because of bullying or feeling too much pressure at school. A child who self-harms may also be emotionally abused, grieving or have relationship problems. Children who self-harm often have low self-esteem. They may experience feelings of loneliness, sadness, anger or numbness. They might feel that they have little control over their life and the act of self-harming restores at least some of that control. Self-harm can also occur alongside antisocial behaviour, such as misbehaving at school or getting into trouble with the police.

Although some people who self-harm are at a high risk of suicide, many people who self-harm don't want to end their lives. In fact, the self-harm may help them cope with emotional distress so they don't feel the need to kill themselves.

The following risk factors, particularly in combination, may make a young person vulnerable to self-harm:

Individual factors:

  • Poor communication skills
  • Low self-esteem
  • Poor problem-solving skills
  • Hopelessness
  • Impulsivity
  • Substance misuse
  • Bereavement
  • Perfectionism
  • Exam pressure

Family factors:

  • Unreasonable expectations
  • Neglect or abuse (physical, sexual or emotional)
  • Child being Looked After
  • Poor parental relationships and arguments
  • Parental separation and / or loss
  • Depression, deliberate self-harm or suicide in the family.

Social Factors:

  • Difficulty in making relationships/loneliness
  • Persistent bullying or peer rejection
  • Easy access to drugs, medication or other methods of self-harm.
  • Copied self-harm behaviour (contagion effect)
  • Difficult times of year e.g. anniversaries (bereavement; miscarriage; relationship breakdown)
  • Criminal behaviour
  • Accessing or difficulties within school

Psychological Factors:

  • Depression
  • Anxiety
  • Repeated thoughts or voices telling a person to self-harm
  • disassociating (losing touch with who they are and with their surroundings)
  • borderline personality disorder

Warning Signs

A child or young person may go to great lengths to hide physical signs of self-harm. There may however be a change in the behaviour of the young person that is associated with self-harm, or other serious emotional difficulties, that are not immediately visible. Signs to be aware of may include:

  • Low self-esteem or an increase in negative self-talk.
  • Difficulty handling emotions or easily overwhelmed.
  • Difficulty functioning at school, work or home.
  • Relationship problems
  • Increased isolation from friends/family
  • Withdrawing from activities once enjoyed.
  • Changes in eating/sleeping habits
  • Extremely sensitive to rejection.
  • Extreme emotional ups and downs (due to the cycle of self-injury).
  • Changes in activity and mood, e.g. more aggressive than usual or more withdrawn
  • Increased time alone.
  • Increased time with peers who self-injure.
  • Talking about self-harming or suicide
  • Wearing trousers and long sleeves in warm weather (to cover injuries).
  • Wearing bangles, bracelets and wristbands (to cover injuries).
  • Avoiding sports or other activities that would require showing more of one’s body.
  • Rubbing of arms, especially wrist, through sleeves (cuts often itch while they are healing).
  • Discovery of tools used for self-injury (broken disposable razors, lighters, un-bent paper clips).
  • Bloodied wads of tissue or toilet paper, blood on clothing.
  • First aid supplies being used quickly.
  • Frequent injuries (i.e., cuts, bruises, burns) with suspicious explanations.
  • The presence of behaviours that often accompany self-injury: eating disorders, drugs/alcohol misuse, excessive risk-taking.

What perpetuates self-harm

Once self-harm, particularly cutting, is established, it may be difficult to stop. Self-harm can have a number of functions reinforcing itself as a way of coping, for example:

  • Reduction in tension
  • Distraction from problems
  • Outlet for anger and rage
  • Way of punishing self
  • Way of taking control
  • To not feel numb
  • To relieve emotional pain through physical pain
  • Care-eliciting behaviour
  • Means of getting identity with a peer group

When a person inflicts pain upon themselves, the body responds by producing endorphins, a natural pain-reliever that gives temporary relief or a feeling of peace. The addictive nature of this feeling can make the stopping of self-harm difficult. Young people who self-harm still feel pain, but some say the physical pain is easier to stand than the emotional/mental pain that led to the self-harm initially.

How to help someone who is self-harming

Provide opportunities for children and young people to talk, but don’t focus on the self-harming straight away. If they don’t want to talk about their situation suggesting that they write you a note, a text or an email about how they feel can be less intimidating. Ask them if they would rather talk to someone else – a family member, friend or other professional.  The NHS recommend consultation with a GP, which may lead to referral to specialist services such as CAMHS.

Coping with self-harm is a guide for parents and carers about how to cope when a young person is self-harming. It includes information on the nature and causes of self-harm, how to support a young person when facing this problem and what help is available. Parents can also contact Young Minds Parents Helpline for advice (0808 802 5544 - 9.30am to 4pm on weekdays). MindEd provide some E-learning resources on the subject of self-harm which may be of interest to parents, carers and professionals.

Harmless is a user led organisation that provides a range of services about self-harm and suicide prevention including support, information, training and consultancy to people who self harm, their friends and families and professionals and those at risk of suicide.

Childline offer self-harm support for young people including self-harm coping techniques and getting help. Young people aged under 19 can confidentially call 0800 1111 (available 24 hours a day) or email or chat online with a trained counsellor through the website.

For local support it’s a good idea to talk to the child or young person’s school / college, which is likely to have a counsellor or trained member of staff that they can go to during the day if they feel like they are on the verge of harming themselves.

Talk to your family doctor, who can also speak to your child (if they wish) as well as treat any injuries if necessary. GPs can also refer to local child and adolescent mental health services.

Further Reading and Resources

The Plymouth Safeguarding Children Partnership has today posted key publications which focus upon children’s mental health.  These publications focus upon and will support practitioners working with children with current and emerging mental ill-health.  

Local Services registered with the

Mind (2019) Understanding Self-Harm

NSPCC (2019) Keeping Children Safe: Self – Harm

NICE (2019) Self-Harm in over 8s: Short term management and prevention of recurrence