Article updated by the author on 4 November 2015.
Acts of self-harm such as self-cutting or overdosing may be 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, or punish oneself for being a ‘bad’ person, or combat feelings of numbness and deadness and feel more 'connected' and alive.
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 of self-harm merely replaces a different kind of pain that they can neither understand nor control.
Acts of self-harm reflect deep distress, and are most often used as a desperate and reluctant last resort—a means of surviving rather than dying, and sometimes also a means of attracting much-needed attention. 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.
In general, it appears that teenagers, particularly teenage girls, are at the highest risk of self-harm. Perhaps this is because older people are more adept at dealing with their emotions; or because they are better at hiding their self-harming activity; or else because they self-harm only indirectly, for instance, by misusing alcohol or drugs.
Self-harm is reaching epidemic proportions in the UK, where I practise. In a speech delivered to the Mental Health Conference in January 2015, the then Deputy Prime Minister Nick Clegg claimed that emergency departments see 300,000 cases of self-harm each year. This in itself is a gross underestimate of the true incidence of self-harm, as the vast majority of cases never present to hospital.
For some people, self-harm is a one-off response to a severe emotional crisis. For others, it is a more long-term problem. People may keep on self-harming because they keep on suffering from the same problems, or they may stop self-harming for a time, sometimes several years, only to return to self-harm at the next major emotional crisis.
If you are plagued by thoughts of self-harm, try to take your mind off them by using one of several coping strategies and distraction techniques. An effective 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 you can’t find anyone, or there is no one you feel comfortable sharing your feelings with, there are a number of phone lines you can ring at any time.
Engaging in creative activities such as writing, drawing, or playing a musical instrument can provide distraction, and also enable you to express and understand your feelings. Other coping strategies include reading a good book, listening to classical or jazz music, watching a comedy or nature programme, or even just cooking a simple meal or going out to the shops. Relaxation techniques like deep breathing can also help, as can yoga and meditation. However, avoid alcohol and drugs as these can make your behaviour more impulsive and uncontrollable.
In some cases, the urge to self-harm may be so great that all you can do is minimize the risks involved. Try 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 whatever type or size, call emergency services immediately or get someone to take you to the Emergency Room as soon as possible.
Once things are more settled, consider asking for a talking treatment such as counselling or cognitive-behavioural therapy. Joining a local support group enables you to meet other people with similar problems, that is, people who are likely to accept and understand you, and with whom you may feel more comfortable sharing 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