BBC – Mental health – Self harm.


Friends, relatives and professionals are often so distressed when someone deliberately harms themselves that they don’t know how to help, leaving the person inflicting self-harm feeling alone. James Tighe explains the help available.

 Self-harm is a way of dealing with very strong emotions. For some people it gives the relief that crying may provide for the rest of us.  Some self-harming people feel so angry and aggressive they can’t control their emotions. They become afraid that they may hurt someone, so they turn their aggression inwards to get relief.

People who self-harm are often labelled as ‘attention seeking’. However, a person who self-harms may believe this is the only way to communicate their distress, and self-harm can be a hidden problem that goes on for years.  It may start as a spur-of-the-moment outlet for anger and frustration (such as punching a wall) and then develop into a major way of coping with stress that, because it remains hidden, generates more stress.

The severity of self-harm doesn’t depend on the severity of a person’s underlying problems. Usually, as time passes, the person who is self-harming becomes more accustomed to the pain they inflict on themselves and so has harm themselves more severely to get the same level of relief.This spiral can lead to permanent injury and serious infections.

The most common forms are cutting the arms, hands and legs, and less commonly the face, abdomen, breasts and even genitals. Some people burn or scald themselves, others inflict blows on their bodies, or bang themselves against something.  Other forms of self-harm include scratching, picking, biting, scraping and occasionally inserting sharp objects under the skin or into body orifices, and swallowing sharp objects or harmful substances.  Common forms of self-injury that rarely reach medical attention include people pulling out their own hair and eyelashes, and scrubbing themselves so hard they break the skin (sometimes using cleaners such as bleach).

How common is it?

About ten per cent of admissions to UK medical wards are as a result of self-harm. Women are at the most risk of self-harming between the ages of 15 and 19; men, between 20 and 24.

Women have higher rates of self-harm than men.

Methods of self-harm vary, but the majority of hospital admissions are for drug overdoses – only five to 15 per cent are caused by cutting.

These figures probably hide another group of people who regularly self-harm to relieve stress. These people have usually found ways to keep their problem hidden and, when they do harm themselves badly enough to need treatment, will often have a story prepared, or will not seek help at all. The result can be permanent disfigurement or a serious infection.

About half the men admitted to hospital for self-harm and a quarter of women have drunk alcohol in the hours beforehand. This is a very worrying figure. A person who has taken a drug overdose runs the risk of the drugs interacting with the alcohol. Both tcould become more potent when mixed, with tragic consequences.

Self-harm paradox

It’s important to make a distinction between self-harm and attempted suicide, though people who self-mutilate often go on to attempt suicide.  In the case of attempted suicide (most usually by swallowing pills) the harm caused is uncertain and basically invisible. By contrast, in self-harm by cutting, the degree of harm is clear, predictable and often highly visible.

Many people indulge in behaviour that’s harmful to themselves, such as smoking or drinking to excess. But people don’t smoke to damage themselves – harm is an unfortunate side-effect. The reason they smoke is for pleasure. Yet people who cut themselves intend to hurt themselves.  If you self-harm as a way of coping with stressful or difficult feelings, such as anger, frustration or worthlessness, the important thing to realise is that you’re not alone. Many people do this and come through it. There is help out there.  The kind of personal exploration needed to resolve these issues is often best done with a mental health professional or counsellor. But this doesn’t mean that people who self-harm can’t take some control of their situation.  Most people who self-harm want to stop hurting themselves and they can do this by trying to develop new ways of coping and communicating. However, some people feel a need not only to change their behaviour but also to understand why they have resorted to harming themselves.

There are a number of techniques that can reduce the risk of serious injury or minimise the harm caused by self-inflicted injury. This list is not exhaustive – different people find different things useful in various situations. So if one doesn’t work, try another.

  • Stop and try to work out what would have to change to make you no longer feel like hurting yourself
  • Count down from ten (nine, eight, seven)
  • Point out five things, one for each sense, in your surroundings to bring your attention on to the present
  • Breathe slowly – in through the nose and out through the mouth 

If you still feel like cutting, try:

  • Marking yourself with a red water-soluble felt-tip pen instead of cutting
  • A punch bag to vent the anger and frustration
  • Plunging your hands into a bowl of ice cubes (not for too long, though)
  • Rubbing ice where you’d otherwise cut yourself
    If you’re nervous about seeking professional help and wish to remain anonymous it may be a good idea to contact the Samaritans.

Professional help

Self-harm is almost always a symptom of another underlying problem. While the problem can be addressed directly through behavioural and stress-management techniques, it may also be necessary to look at and treat other problems. This could involve anything from medication to psychodynamic therapy.

Most local mental health teams are prepared to see and assess people who self-harm but, where the underlying problems are too complex, may decide to refer the patient to more specialist services.

Self-harm theories

A lot of people say they start self-harming behaviour in childhood, disguising scratches and bumps as accidents and progressing to more systematic cutting and burning in adolescence.

There are different theories as to why people self-mutilate. One is that because victims of childhood sexual abuse were forbidden to reveal the truth about their abuse, they use self-mutilation or self-cutting to express the horror of their abuse to the world.

Another theory is that sexual abuse in early childhood leads to extremely low self-esteem. If very low self-esteem develops, self-harm as an expression of self-hatred is understandable.

One research finding is that self-harmers tend to grow up in an ‘invalidating environment’ – one where the communication of private experiences is met with unreliable, inappropriate or extreme responses. As a result, expressing private experiences is trivialised or punished.

The problem with these theories is that (in the case of the sexual abuse theory, for example) not everyone who’s been sexually abused starts to self-harm, and not everyone who self-harms has been sexually abused.

Another theory is that self-cutting triggers release of the body’s natural opiate-like chemicals to reduce the pain. Perhaps self-cutters have become addicted to their body’s heroin-like reaction to cutting, which is why they do it again and again. They may also experience withdrawal if they haven’t done it for a while.

Drugs used to treat heroin addicts may behelpful with self-cutters, but mostly for those who describe a ‘high’ after they’ve cut themselves.

Another theory, which inpatient units often use, is based on the psychological principle that all behaviour has consequences that are somehow rewarding. Cutting usually leads to a sequence of behaviour – increased attention, for example – that may become the rewarding reason to repeat the behaviour.

Staff in specialist units are specially trained to ensure that no consequences follow from an episode of cutting that could be rewarding. Instead, when the patient stops cutting themselves they’re rewarded with increased attention from staff.

Self-harm culture

It’s essential self-harm is destigmatised so that people seek help early on. Modifying our bodies is part of contemporary culture, for example piercing, cosmetic surgery (breast enhancement and nose jobs), hair removal, skin bleaching, hair straightening and tattooing.

This article was last reviewed in September 2006.
First published in June 2000.

If you would like to comment on this article from the BBC, then please send your comments to:     I will be very pleased to hear from you.        Oberon.


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