Acts of self-harm are carried out for a variety of reasons, most commonly to express and relieve bottled-up anger or tension, feel more in control of a seemingly desperate life situation, punish oneself for being a ‘bad person’, or combat feelings of numbness and deadness and feel more ‘connected’ and alive. Acts of self-harm reflect very deep distress, and are most often used as a desperate and reluctant last resort—a method of surviving rather than of ending one’s life, and sometimes also a method of attracting much-needed attention. For some people, the pain inflicted by self-harm is preferable to the numbness and emptiness that it replaces: it is something rather than nothing, and a salutatory reminder that one is still able to feel, that one is still alive. For others, the pain inflicted by self harm merely replaces a different kind of pain that they can neither understand nor control. Many people who self-harm feel that their behaviour is shameful, and such feelings may be reinforced by the stigma that they are unfairly made to feel.
Acts of self-harm are increasingly common in the UK where I practise, with approximately 170,000 cases presenting to hospitals each year. This is in itself a gross underestimate of the incidence of self-harm, as most cases are unlikely to present to hospital. The vast majority of cases that do present to hospital involve either a tablet overdose or self-cutting, although other forms of self-harm such as scratching or pulling out one’s hair are also seen. Teenage girls are at the highest risk of self-harm, perhaps because older people have learned to deal better with their emotions, because they are better at hiding their self-harming activity, or because they self-harm only indirectly, for example, by misusing alcohol or drugs. The problems most frequently cited at the time of self-harm are problems with relationships, alcohol, employment, finances, housing, social isolation, bereavement, and physical health. Of the cases that present to hospital, about 25% report high suicidal intent, and about 40% are deemed to suffer from a major psychiatric disorder excluding personality disorder and alcohol or drug misuse. This means that the majority of people who self-harm are not deemed to be suffering from a major psychiatric disorder. For some people, self-harm is a one-off response to a severe emotional crisis. For others it is a more long-term problem. Some people continue to self-harm because they continue to suffer from the same problems, or they may stop self-harming for a period—sometimes several years—only to return to it at the next major emotional crisis. Of the cases that present to hospital, about 20–25% self-harm at least one more time in the following year.
If you are plagued by thoughts of self-harm, try to take your mind off them by using one of several coping strategies or distraction techniques. A useful coping strategy is to find someone you trust, such as a friend, relative, or teacher, and to share your feelings with him or her. If no one is available or there is no one you feel comfortable with, there are a number of emergency telephone lines that you can ring at any time. Engaging in creative activities such as writing, drawing, or playing a musical instrument can also take your mind off thoughts of harming yourself, and also help you to express your feelings and understand them better. Other coping strategies include reading a good book, listening to classical music, watching a comedy or nature programme, or even just cooking a meal or going out to the shops. Relaxation techniques like deep breathing or yoga and meditation can also help. However, avoid alcohol and drugs as these can make your behaviour more impulsive and significantly increase your likelihood of harming yourself. In some cases the urge to harm yourself may be so great that all you can do is to minimize the risks involved. Methods for doing this include holding ice cubes in your palm and attempting to crush them, fitting an elastic band around your wrist and flicking it, or plucking the hairs on your arms and legs.
If you have harmed yourself and are in pain or unable to control the bleeding, or if you have taken an overdose of any kind or size, call emergency services immediately, or get a relative or friend to take you to the Emergency Room as soon as possible. Going to the Emergency Room not only enables you to get medical treatment, but also gives you an opportunity to spend time with someone and talk to him or her about your feelings.
Once things are more settled, consider getting yourself referred for a talking treatment such as counselling or cognitive-behavioural therapy. This can give you the opportunity to talk through your feelings in a safe and supportive environment, and to better understand why you sometimes feel the way you do. It can also help you to identify solutions to your problems as well as alternative strategies for coping with them. Joining a local support group enables you to meet other people with similar problems to yours, that is, people who are likely to accept you and understand you, and with whom you may feel better able to share your feelings. However, beware of joining unmonitored online forums and chat groups, which are open to all and sundry, and which can sometimes leave you feeling even worse than before.
See also my related article, Fighting Suicidal Thoughts
Neel Burton is the author of The Meaning of Madness and other books.