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Self Harm A Help Guide

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How is Self Harm Defined? Self harm can be defined as the intentional, direct injuring of one’s self. Many behaviours fall under this

term, including: cutting, scratching, picking of skin, burning, overdosing, poisoning, substance abuse,

banging or hitting body parts, along with other harmful behaviours. The term ‘self injury’ is often

associated with the harming of skin tissue specifically.

Self harm is consensually and more recently understood as a coping mechanism which is used to

deal with negative mind states.

What are the Signs and Symptoms of Self Harm? The signs of self harm will often be visible to the eye,

for example in the form of a cut, scar or burn. However, many individuals who self harm may

choose to cover any evidence of this behaviour, often with clothing, jewellery, and/or tattoos.

Research has shown that individuals harm various parts and places of the body.

Some forms of self harm such as overdosing and

poisoning may not leave behind visible evidence on the body.

Self harm is usually a consequence of a negative

mind state, so an individual may show signs of this alongside. This can include anger, loneliness,

sadness, frustration, guilt, anxiety, stress, powerlessness, distress, emptiness, numbness, disgust,

abandonment, and having very low self-esteem.

How Prevalent is Self Harm? Self harm is recognised as a hidden health

problem world-wide, and prevalence estimates of self harm are variable. Some research suggests the

self harm prevalence rates to be 1 in 15 people whereas other research suggests it to be 1 in 10.

Although people of all ages have reported to self

harm, adolescence seems to be the age group with the highest prevalence. Although males have

been reported to self harm, research demonstrates that it is mainly prevalent among

females. This coping mechanism is prevalent among people within many ethnicities and

cultures.

The typical age for a person to begin self harming is suggested to be 11 years old. This can continue

for a short while if an individual resolves their problems and/ or seeks help. On the other hand

the behaviour can continue for a number of years, often into adulthood if left untreated.  

What are the Causes of Self Harm? Self harm is often a symptom or consequence of

an underlying issue or mental health disorder. Self harm is a complex issue and people harm

themselves for many different reasons, everyone’s reason being unique. Some can include:

Trying to cope with negative feelings

These feelings can include anger, loneliness, sadness, frustration, guilt, anxiety, stress,

powerlessness, distress, emptiness, numbness, disgust, abandonment, and having very low self-

esteem. Research has shown that self harm can be a short-term relief from such feelings. The

reason for a sense of relief during and/or after the harming varies greatly among individuals and is

often psychologically complex.

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A way of communicating that help is needed

When someone feels as though they do find it easy to use the conventional ways of communicating

feelings, they may choose to harm themselves.

Gaining control over one’s life and/or body When an individual has been abused (emotionally,

physically or sexually), traumatised, abandoned, neglected, over-protected, severely bullied or has

felt that they have limited control of their life or their body, self harming may be a chosen way in gaining

some control back.

It is important to note that self harm is often associated and intertwined with underlying mental

health conditions. These can include Personality Disorder, Depression, Eating Disorders, Anxiety

Disorders, Bipolar Disorder, and Obsessive Compulsive Disorder along with many more.

Of course, self harm is a multi-determined behaviour that cannot be fully explained by one single

explanation or model. Evidence suggests that various other factors such as biological (e.g.,

serotonergic dysfunction), and environmental (e.g., media, social modelling) which can also help explain

the development and maintenance of self harm.

Misunderstandings and Stigma about Self Harm There have been and still are many misconceptions as to why people self harm.

One misconception is that people may believe that

self harming individuals are trying to commit suicide, although the majority are not. In fact self harm has

been labelled as ‘life saving’ by some. This behaviour can actually be a way of emotionally coping with

negative aspects of life. Yet, many people who have committed suicide have harmed in the past; this

demonstrates that there is a link.

Self harm can be a difficult concept for non-self-

harmers to understand. It goes against instincts and damaging one’s body is seen as alien. This

leads to the common misconception of ‘people harm to seek attention’. In fact, many individuals

hide their behaviour and can find it very difficult to speak about it. Also individuals can find it

challenging to seek help due to being afraid of what people may think or say. This can lead to

thousands of self harmers suffering in silence.

Research and public awareness campaigns have certainly helped people to understand. Self injury

awareness day falls on March 1st every year. Supporters may wear a yellow or range ribbon.

Alternatively you can buy a key-ring or wristband from: http://www.lifesigns.org.uk/ to show support.

Supporters are encouraged to raise awareness by printing out factsheets available online to inform

parents, friends, teachers, local radio stations and local MPs.  

What are the Diagnostic Criteria for Self Harm? Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-harm. Formal proposal

went under review in 2010 to include Non-Suicidal Self-Injury as a distinct diagnosis in the forthcoming

5th edition of the Diagnostic and Statistical Manual of Mental Disorder.

What is the Prognosis if left untreated? If left untreated the risk of many problems is

increased. Problems with self injury can include infection, long-term tissue damage, permanent

scarring, injuring a vein or artery, acute pain, and loss of blood.

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Other self harm behaviours such as substance abuse

and overdosing can lead to risks in circulatory-system disease, blood poisoning and digestive-system

disease.

The risk of death is also increased if the behaviour goes on without treatment.

What is the Prognosis if treated? People will reduce the risk of all the negative

physical health implications once treated. If treated, an individual would have learned to cope

with their emotions and inner pain in a more healthy way. Many individuals have found that after

treatment they lead healthy, positive lives in a world without suffering in silence and self harming.

Case Examples and Well-Known Sufferers Here is a link to an academic journal which includes

a clinical case with details of one treatment process: http://www.wjh.harvard.edu/~nock/nocklab/

Nock_Teper_Hollander_2007.pdf

Individuals who have been known to have self harmed include Princess Diana, Russell Brand, Tulisa

Contostavios, Johnny Depp, and Angelina Jolie.

Guidelines for Help: National Institute of Clinical Excellence (NICE) The National Institute for Health and Clinical Excellence (NICE) was set up in 1999 to reduce

variation in the availability and quality of NHS treatments and care.

NICE quality standards are a set of specific, concise

statements that act as markers of high quality, cost effective patient care, covering the treatment and

prevention of different diseases and conditions.

NICE provides a set of guidelines related to self

harm and the role of the NHS. For example the guideline, ‘Self harm- longer-term management’

provides information about:

•  The care people who harm themselves can expect to receive from healthcare professionals

in hospital and out of hospital •  The information they can expect to receive

•  What they can expect from treatment •  What kinds of services best help people who

harm themselves

Recommended Intervention for Self-Harm •  Psychological help that is structured for people

who self-harm, with the aim of reducing self-harm.

•  Assistance needs to be tailored to individual need and could include cognitive-behavioural,

psychodynamic or problem-solving elements. •  Therapists need to be trained and supervised in

the therapy they are offering to people who self-harm.

•  Therapists need to work in collaboration with the person to identify the issues causing distress or

leading to self-harm. •  Drug treatment is not recommended as a

specific intervention to reduce self-harm.

For more information please visit this link which provides access to many NICE publications

related to self harm.

Treatment Pathways for Self Harm The pathway of treatment for each person will depend on the individual and the psychological

issues relating to the self harming. The organisation chosen will also offer different treatment

approaches.

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Evidenced-Based Treatment Recommendations for Self Harm There are many psychological approaches used in

the treatment of self harm and associated conditions. This is not an extensive list of all the

therapeutic approaches used but here are some examples of evidence-based approaches: teaching

emotion regulation, distress tolerance, Dialectical behaviour therapy, Mindfulness, risk management,

Occupational therapy, Cognitive behaviour therapy, Cognitive analytic therapy, Transference-focused

psychotherapy, Mentalization-based therapy and the prescription of medication.

Some ways in which help is offered may include

Individual counselling sessions, Group therapy, Family therapy or a combination.

The aims of treatment will vary for each individual.

Some examples may be to reduce the number of self-harm incidents, improve well-being, reduce risk,

improve social functioning, reduce negative emotions such as depression and anxiety and to

enhance self-esteem.

Self harm is often intertwined with mental health conditions therefore treatment should focus on the

underlying psychological factors along with the behaviour.

Advice for Breaking the Cycle When you feel ready there are many ways in which you can get help, support and advice.

Firstly it may be worthwhile reading a self-help book. There are many helpful books out there; some

recommended books include:

The Scarred Soul: Understanding and Ending Self-

Inflicted Violence. Alderman.

Healing the hurt within: Understand and relieve the suffering behind self destructive behaviour. J.

Sutton.

A Bright Red Scream: Self-mutilation and the language of pain. Marilee Strong. Virago. 

Further self-help recommendations include

substituting self harm for a different behaviour:

•  using a red felt tip pen to mark where you might usually cut

•  hitting pillows or cushions, or having a good scream into a pillow or cushion

•  rubbing ice across your skin where you might usually cut

•  getting outdoors and having a fast walk •  all other forms of exercise – these are really good

at changing your mood and releasing adrenaline

•  making lots of noise, either with a musical instrument or just banging on pots and pans

•  writing negative feelings on a piece of paper and then ripping it up

•  keeping a journal •  smashing or destroying something

•  putting elastic bands on wrists, arms or legs and flicking them

•  calling and talking to a friend (not necessarily about self-harm)

•  something creative •  getting online and looking at self-help websites

•  calling a helpline

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Where can you get help? Some self help websites include:

www.siari.co.uk www.youthnet.org

www.lifesigns.org.uk www.childline.org.uk

www.samaritans.org.uk www.selfharm.org.uk

www.nshn.co.uk www.befrienders.org

Some useful telephone numbers include:

• Samaritans – 08457 90 90 90 • ChildLine – 0800 1111

• Parentline Plus – 0808 800 2222 • NSPCC – 0808 800 5000

• NHS Direct- 0845 4647

There are now many counselling and therapeutic services and organisations available. There are

numerous trained professionals who would be able to support you such as Counsellors, Psychotherapists,

Psychologists and Psychiatrists. Here is a list of available services:

The NHS - seeing your GP and asking for a referral to

see a specialist.

Charities - (such as MIND, Rethink, Young Minds, Mental health foundation and National self harm

network) some may provide support groups, therapy and advice in your local or near-by area. See their

websites for further details.

Counselling and psychotherapy clinics - Search through online directories or contact your council for

organisations that offer can therapeutic help. (Harley Therapy is one such clinic)

When seeing a healthcare professional you will

normally have an initial assessment. This will include some questions to identify the issues, causes and

problems. Try to be honest and open in your answers. The person asking the questions is there to

understand and help.

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Note: This Guide has been researched and

produced by Harley Therapy, and is free to download. It is subject to the usual disclaimers,

and is not for reproduction. However, please do feel free to share this on social media using the

'Share' button on the webpage.

Many thanks.

References Alderman, T. (1997) The Scarred Soul: Understanding and Ending Self-inflicted Violence. Oakland, CA: New Harbinger Publications.

Bergen H, Hawton K, Waters K, Ness J, Cooper J, Steeg S, Kapur N.

(2012) Premature death after self-harm: a multicentre cohort study. Lancet 3;380.

Boyce, P., Oakley-Browne, & Hatcher. (2001).The problem of

deliberate self-harm. Current Opinion in Psychiatry, 14 (2) 107-111.

Claveirole, Anne; Martin Gaughan (2011), Understanding Children

and Young People's Mental Health, West Sussex, UK: John Wiley &

Sons.

Fox, C; Hawton, K (2004), Deliberate Self-Harm in Adolescence,

London: Jessica Kingsley,

Hawton, K., Townsend, E., Arensman, E., et al (2003) Psychosocial and

pharmacological treatments for deliberate self-harm (Cochrane

Methodology Review). Cochrane Library, issue 4. Chichester: John

Wiley.

Hollander, Nock &Teper (2007) Psychological Treatment of Self-Injury

Among Adolescents. Journal of clinical psychology: In session, Vol. 63

(11), 1081–1089.

Kettlewell, C. (2000) Skin Game. New York: St Martin’s Griffin.

Klonsky, E. D. (2007), "The functions of deliberate self-injury: A review of

the evidence", Clinical Psychology Review 27(2): 226–239.

Klonsky, E. D., Oltmanns, T. F., and Turkheimer, E. (2003). Deliberate self-

harm in a nonclinical population: Prevalence and psychological

correlates. Am. J. Psychiatry 160(8): 501–1508.

Laye-Gindhu, A.; Schonert-Reichl, Kimberly A. (2005), "Nonsuicidal Self-

Harm Among Community Adolescents: Understanding the "Whats"

and "Whys" of Self-Harm", Journal of Youth and Adolescence 34 (5): 447–457.

National Institute for Clinical Excellence (2004), National Clinical

Practice Guideline Number 16: Self-harm, The British Psychological Society, retrieved 2009-12-13.

Putnam F, & Trickett, P., (1997) Psychobiological Effects of Sexual

Abuse. Annals of the New York Academy of Sciences. Psychobiology of Posttraumatic Stress Disorder, 821, 150-159

Sutton, J. (1999) Healing the Hurt Within: Understand and Relieve the

Suffering Behind Self-destructive Behaviour. Oxford: Pathways.