What is self-harm?

Self-harm is defined as the act of someone hurting themselves intentionally. Often people who self-harm won’t tell their family or friends and will harm themselves in places that they can cover up.

Most people who self-harm are not attempting suicide. Self-harm is also referred to as non-suicidal self-injury (NSSI). However self-harm can cause more damage to someone's health and safety than they may have intended and can also cause accidental suicide. Some people who self-harm may only do so once, whereas others self-harm frequently and for many years.

Self-harm includes behaviours such as:

• cutting, burning or hitting yourself
• binge eating or starvation
• putting yourself in a risky situation
• abuse of drugs or alcohol
• overdosing on prescription medications

Some people are more likely to self-harm than others. The chance of someone self-harming can increase if they have experienced or are experiencing physical, emotional or sexual abuse, or are living with a mental illness. Someone may also self-harm because of the death of a loved one, because they experience pain, such as bullying, or loss such as miscarriage, or because they experience extreme sadness or anger.

What signs suggest someone may be self-harming?

While every case is different, there are some common signs that suggest someone may be self-harming.

Behavioral signs:

• dressing inappropriately for the weather, such as wearing long-sleeved tops in the summer
• avoiding activities that expose the body, such as swimming
• washing clothes separately
• interacting less or performing activities less well at home, school or work
• having unexplained wounds or unlikely justifications for injuries
• hiding potentially dangerous objects, such as razor blades or cigarette lighters

Psychological signs:

• expressing feelings of anxiety
• expressing feelings of depression

Psychosocial signs:

• lack of interest in hobbies that were once enjoyed
• disengaging from social interactions
• having difficulties communicating with loved ones
• having drastic mood swings
• changes from their usual eating and sleeping schedule

Physical signs:

• complaining of headaches or stomach pains with no explanation
• overdosing on medicine and requiring medical attention
• physical signs of self-harm on the body such as open wounds or cuts

Why does someone self-harm?

Some people are motivated to self-harm in an attempt to show others that they are struggling. Some people also self-harm in an attempt to cope with upsetting feelings and thoughts. They may self-harm because they experience loneliness or to attempt to relieve feelings of guilt or shame. However, feeling relieved after self-harming is only short term, and can result in a desire to self-harm again.

A person who experiences a mental health condition is at a higher risk of self-harm or suicide. There is also evidence that suggests depression can be a precursor to self-harm. People living with personality disorders, may also be more likely to self-harm. Additionally, eating disorders such as anorexia and bulimia increase a person’s risk of self-harm.

How to get help if you or someone you care for self-harms

If you self-harm, it is important to see a counsellor, psychiatrist or doctor. These healthcare professionals can help you find what's causing your urge to self-harm and work through your difficult thoughts. Early intervention can minimise damage caused by self-harm and decrease your risk of future episodes. If you can, find supportive people who you feel comfortable with who you can talk to and will listen without judgement. If you have a friend or a family member you can trust, reach out to them to help you through this challenge.

If you think someone you care for is engaging in self-harm, it is important that you offer them support and show them that you care about their wellbeing. Encourage them to get professional help and continue the conversation about their mental health by checking in with them to see how they are going. If you are concerned for your loved one’s welfare and want to tell a healthcare professional, tell your loved one you are planning to share your concerns before you do.

If you need support, call Lifeline on 13 11 14. If you think you or another person's safety is at risk, call triple zero (000) immediately. If you're self-harming, it’s important you speak to a doctor about possible causes and any treatment or therapy.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is someone who self-harms diagnosed?

Someone self-harms and seeks medical assistance will be referred by their doctor to a psychologist who specialises in self-harm. A psychologist or mental health professional can help you to find the cause or trigger for your self-harm behaviour. They can also provide management tools to help you cope with any challenging thoughts and difficult feelings.

In many cases, people who self-harm also live with a mental health disorder. A psychologist can assess whether there are any underlying mental health conditions. Psychologists can provide management strategies and treatments that can help you feel better.

How can a psychologist help someone who is self-harming?

There are different approaches to manage self-harm and mental illness. They include the following:

• Cognitive behavioural therapy — This is a type of ‘talking therapy’ that is based on the principle that how you think and act affects the way you feel.
• Medicine — In some cases, the best treatment for an underlying condition that triggers self-harm is medicine, such as an antidepressant or anxiety medicine. Your psychologist may recommend a treatment, but only a doctor (GP or psychiatrist) can prescribe medicines.
• Psychotherapy — Counselling helps to stabilise thoughts and feelings by identifying the cause of the emotional stress and teaches skills to help address distress.

You may need treatment from a doctor for physical injuries after a self-harm episode. In severe cases, you may be required to go to the emergency department.

What techniques can I use as distractions from self-harming?

Techniques that work as distractions from self-harm help replace a very dangerous activity with a constructive or unharmful activity. Some of these techniques may feel uncomfortable or hurt, but they are not harmful or dangerous.

Examples of distraction techniques include:

• holding ice cubes in your hands
• keeping a rubber band on your wrist — you can snap it against your wrist whenever you feel you need to
• drawing red lines in pen on your body, where you would otherwise cut yourself
• using exercise to release pressure and stress
• writing, drawing or scribbling on paper with a red pen
• doing meditation, such as practising relaxation or breathing techniques
• focusing your attention on something simple for some time — this may help your negative thoughts pass
• talking with someone you trust

You may want to copy this list of distraction techniques onto a piece of paper or keep it on your phone, so you have it when you need it.

Does self-harming behaviour have complications?

Self-harming behaviour has very serious complications, such as an increased risk of serious physical harm or accidental suicide. These complications can occur when a person causes more damage than they intended.

Sometimes people who self-harm become suicidal or feel confined to a cycle of hopelessness, as self-harm is not a helpful way to deal with distressing emotions.

Other potential complications of self-harm include long-term scarring, infection, brain injury or organ damage.

Other questions you might have

When should I tell a professional if someone I care about is self-harming?

While it is very important to be there for your loved one, it is a lot to manage on your own. It is important to share this information with a mental health professional as soon as possible. Reassure your loved one that you have their best interests in mind, you care about them and your intentions are to keep them safe.

How can I bring up the topic of my self-harm to a loved one?

Some suggestions of conversation starters are:

• “I am feeling annoyed/upset/frustrated/shameful about…”
• “Recently I've been struggling and I feel…”
• “It began when...”

Resources and support

If you or someone you know are in immediate danger call triple zero (000) immediately or go to the hospital emergency department.

You can access support and more information via the following websites and helplines. It is important you reach out if you need to talk to someone:

• SANE Australia — 1800 18 7263
• Lifeline — 13 11 14
• Suicide Call Back Service —1300 659 467
• ReachOut Australia Kids Helpline — 1800 55 1800
• Beyond Blue — 1300 22 4636
• MensLine — 1300 789 978
• Head to Health mental health resources

If you would like to learn how to support people struggling with the challenges of self-harm and mental illness, consider doing a Mental Health First Aid course.

Prefer to read in languages other than English? The Transcultural Mental Health Centre has mental health resources in other languages.