Self-harm

8-minute read

Someone who is self-harming can seriously hurt themselves, so it’s important that they speak to a doctor about the underlying issue and about any treatment or therapy that might help them. If you have feelings of wanting to harm or kill yourself, call Lifeline on 13 11 14. If you think someone’s safety is at risk, call triple zero (000).

What is self-harm?

Self-harm is when somebody intentionally damages or injures their body. It is a response to deep emotional feelings such as low self-esteem, or a way of coping with traumatic events, such as the death of a loved one.

Self-harm may provide short-term relief from painful feelings, but they usually come back and the urge to self-harm returns. It can become compulsive and the cycle can be hard to break. People who self-harm are usually not trying to commit suicide, but they are at risk of accidentally killing themselves. Repeated self-harm can also lead to people feeling suicidal and hopeless.

Some ways people self-harm include:

cutting or slashing the skin
burning the skin
punching, biting or using blunt force on the body
hanging, strangulation, suffocation or self-poisoning
misusing alcohol or drugs
refusing food or water or eating disorders, such as anorexia nervosa, binge eating or bulimia

When should I call an ambulance?

Call triple zero (000) for an ambulance if:

you or somebody else have taken an overdose of drugs, alcohol or prescription medication
somebody is unconscious
you or somebody else are in a lot of pain
you or somebody else are having difficulty breathing
you or somebody else are losing a lot of blood from a cut or wound
you or somebody else are in shock after a serious cut or burn

You cannot stop someone from self-harming. The best you can do is to encourage them to get help. You can suggest they see a doctor or contact other support services (listed below).

What are the warning signs/symptoms of self-harm?

It is common for people to hide self-harm. They may cover up their skin and avoid discussing the problem. They may be ashamed and react in an angry or upset way if you try to talk about it.

Some signs of self-harm may include:

unexplained injuries like cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
hiding parts of the body, keeping themselves fully covered at all times, even in hot weather
avoiding situations where they know parts of the body will be shown
depression (low mood, tearfulness or a lack of motivation or interest in anything)
low self-esteem (as blaming themselves for any problems or thinking they are not good enough for something)
sadness
anger
anxiety
mood swings
losing interest in things they used to enjoy
problems at school or work
withdrawing from friends and family
signs they have been pulling out their hair
signs of alcohol or drug misuse

What causes self-harm?

There are many reasons why people self-harm, but the causes usually stem from unhappy emotions. These may include low self-esteem or self-hatred. You may feel angry, sad, guilty, anxious, lonely, numb or unconnected to the world. Someone who has been abused may feel unclean, unworthy, trapped or silenced.

These emotions can gradually build up inside you, and you may not know who to turn to for help. Self-harm may be a way of releasing these pent-up feelings and finding a way to cope with your problems. It is not usually an attempt to seek attention, but a sign of emotional distress.

Some research has suggested that people who self-harm may have difficulty managing or 'regulating' their emotions. They use self-harm as a way of managing tension and anger. Research has also shown that people who self-harm are poorer at problem-solving.

Self-harm is linked to anxiety and depression. These mental health conditions can affect people of any age. Self-harm can also occur alongside antisocial behaviour, such as misbehaving at school or getting into trouble with the police.

Social causes

Research has shown that social factors commonly cause emotional distress in people who self-harm. These include:

difficult relationships with friends or partners
difficulties at school, such as not doing well academically
difficulties at work
being bullied, either at home, school or work
worries about money
alcohol or drug misuse
coming to terms with your sexuality if you think you might be gay or bisexual
coping with cultural expectations, for example, an arranged marriage

Trauma

Self-harm could also sometimes be a way of coping with a traumatic experience. For example:

sexual, physical or emotional abuse, including domestic abuse and rape
the death of a close family member or friend
having a miscarriage

Psychological causes

In some cases, there may be a psychological reason for the self-harming (where the cause is related to an issue with your mind). For example:

you may hear voices telling you to self-harm
you may have repeated thoughts about self-harming and feel like you have to do it
you may disassociate (lose touch with yourself and your surroundings) and self-harm without realising you are doing it
it can be a symptom of borderline personality disorder (a condition that causes instability in how a person thinks, feels and behaves)

How is self-harm diagnosed?

If you are self-harming, it’s often a sign that you need help for a mental health condition. It’s important for you to see a doctor or another health professional like a counsellor or psychologist. They will talk to you and work out what is triggering these thoughts and feelings. Your doctor is likely to ask you about your feelings in some detail. They will want to establish why you self-harm, what triggers it and how you feel afterwards.

They may ask you some questions to see if you have an underlying condition such as depression, anxiety or borderline personality disorder. If the way you self-harm follows a particular pattern of behaviour, such as an eating disorder, you may be asked additional questions about this. Your height, weight and blood pressure may also be checked, and you may be asked about any drinking or drug-taking habits.

It is important that you are honest with your doctor about your symptoms and your feelings. If you don't know why you self-harm, tell your doctor that.

If you’re worried someone you know is self-harming, let them know you have noticed. Tell them you’re worried and that you care about them.

Have an open, honest conversation and don’t judge them. Recognise they are in pain and let them know you are there for them and will support them.

Beyond Blue has some useful tips on having a conversation with someone you’re worried about.

How is self-harm treated?

Treatment involves addressing the underlying emotional cause as well as any physical injury.

Some teenagers who self-harm are able to give up this behaviour as they learn to manage feelings in healthier ways, for example, by talking to others.

However, some young people who self-harm continue to do so into adulthood and if you fall into this category, 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 qualified medical doctor with further training in treating mental health conditions
a psychologist — a health professional who specialises in the assessment and treatment of mental health conditions

For example, if you have lost a close relative, you may be referred to a specialist grief counsellor for help coping with bereavement. If you are self-harming after an incident of rape or physical or mental abuse, you may be referred to someone who is trained in dealing with victims of sexual assault or domestic abuse.

If you have another condition that is linked to your self-harming, such as anorexia nervosa or bulimia, you may be referred to a specialist in eating disorders and a dietitian or nutritionist (somebody who specialises in nutrition).

It might also be recommended that you attend a self-help group, for example, Alcoholics Anonymous if you are misusing alcohol, or Narcotics Anonymous if you are misusing drugs. These groups can offer support as you try to stop your self-harming behaviour.

Can self-harm be prevented?

It is possible to replace the self-harm with something that doesn’t hurt you. for example, you could:

hold an ice cube in your hand
wear a rubber band on your wrist and snap it
use a red pen to draw on the areas you might normally cut, or scribble with a red pen on a piece of paper
do some exercise
relax and breathe deeply
try to distract yourself by focusing on something around you, until the thoughts go away. Having a shower, reading a book or having something to eat or drink can help
write down how you feel in a diary
talk to someone