Self-harm

Self-harm happens when you injure or harm yourself on purpose. You may overdose; hit, cut or burn yourself; pull your hair or pick your skin; or try to strangle yourself. Or you just take too many drugs or drink too much alcohol. Such actions may be a sign that something is seriously wrong

Causes

It's a way of dealing with very difficult feelings that build up inside. You may:

• Feel desperate about a problem and don't know where to turn for help. You feel trapped and helpless. When you self-harm, you feel more in control.
• Your feelings of anger or tension get bottled up inside until you feel like exploding. Self-harm relieves this tension.
• Have feelings of guilt or shame that become unbearable - self-harm can be a way to punish yourself.
• You feel detached from the world and your body. This can be a way of coping with distressing experiences, such as trauma or abuse - by convincing yourself that it didn't happen, you avoid the pain of the memory but feel emotionally numb or dead. Self-harm is a way of feeling more connected and alive.

Symptoms

If you're harming yourself, it's a struggle to cope. You often keep your self-harm secret - even from friends or family. You feel so ashamed, guilty or bad that you can't face talking about it. You may:

• Take too many tablets
• Cut yourself
• Burn your body
• Bang your head
• Throw your body against something hard
• Punch yourself
• Stick things into your body
• Swallow objects

Treatment

Talking to someone can help you feel less alone, to see your problems more clearly. The following treatments may help:

• Self-help groups help people with similar problems to give each other support and practical advice – believe it or not, sharing problems in a group does help.
• Group therapy can often help you sort out difficulties in getting on with other people. Talking therapies - including problem solving, cognitive behavioural therapy or psychodynamic psychotherapy - can all help. Some evidence suggests that problem-solving therapy may be beneficial too.

One in three people who self-harm will do it again within a year if they don’t get help. People who self-harm are 50 times more likely to kill themselves. It gets more likely with age and is most common in men. Cutting can cause scarring, numbness or paralysis.

Support

When you want to harm yourself, if you can ride out how you feel without self-harming, the feelings will usually go after a few hours. You can talk to someone, distract yourself by going out, sing or listen to music, or do anything (harmless) that interests you. Try to relax and focus your mind on something pleasant.

Find another way to express your feelings such as squeezing ice cubes (make them with red juice to mimic blood if that helps), or draw red lines on your skin. Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower.

Focus on positives. Be kind to yourself – get a massage. Write a diary or a letter, to explain what is happening to you – no one else needs to see it.

When the urge has gone, think about the times that you’ve self-harmed and what (if anything) has helped. Go back in your mind to the last time you didn’t want to self-harm, and move forward in your memory from there. Where were you, who were you with, and what were you feeling? Try to work out why you began feeling like you did.

Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you. Make a recording by talking about your good points and why you don't want to self-harm. When you feel bad, play this back to remind yourself of the parts of you that are worthwhile. Make a 'crisis plan' of what to do when you feel bad. If you don't want to stop, try to reduce the damage. If you cut, use clean blades. Find ways of hurting yourself that don't damage your body.

What can I do if I know someone who self-harms?

• Listen to them without being critical. This can be very hard if you're upset or angry, but try to focus on them rather than your feelings.
• Try to understand their feelings, and then move the conversation to other things.
• Take the mystery out of self-harm by helping them find out more on the internet or at the library.
• Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.