Welcome to the TRN Self Harm page.

Self-injury or self-harm has been described as an expression of acute psychological distress. It is an act done to oneself, by oneself, with the intention of helping oneself rather than killing oneself. Paradoxically, damage is done to the body in an attempt to preserve the integrity of the mind.

Who self-harms?

• About 1 in 10 young people will self-harm at some point, but it can occur at any age.
• It is more common in young women than men.
• Gay and bisexual people seem to be more likely to self-harm.
• Sometimes groups of young people self-harm together - having a friend who self-harms may increase your chances of doing it as well.
• Self-harm is more common in some sub-cultures – "goths" seem to be particularly vulnerable.
• People who self-harm are more likely to have experienced physical, emotional or sexual abuse during childhood.

The United Kingdom has one of the highest rates of self-harm in Europe, at 400 per 100,000 of the population. It is estimated that there are at least 170,000 cases of self-injury that come into the hospital each year.  There are in all likelihood, many more cases of self-injury that go unreported because the clients refuse to seek medical or psychiatric attention. The highest rates for females are in the 15-24 age groups, and for males 21-34.

Some forms of self harms are;
Scab picking, infecting oneself, scratching, bruising or breaking bones, castration, any behaviours that cause immediate harm, inserting objects into body, cutting, punching self, skin-picking, hair-pulling, burning, or scalding amongst others. Taking an overdose on purpose can be seen as self- harm as well, cut themselves, bang their head, and other behaviours that hurt on purpose.

People self-harm for a number of reasons, they include;
Attention seeking, anger release, to look less attractive, self  punishment and to punish others indirectly, control issues, dissociation, unreality, numbness ,self-nurturing in the face of abandonment, shame, and psychological motivations such as personality disorders. People who have experienced abuse, abandonment, excessive control, and emotional deprivation in their lives are known to see self harm as their way of taking control of their lives in the face of feeling out of control. Depressed people, feeling hopeless, isolated, and not listened to can use self-harm to feel better.

It can feel to other people that these things are done coolly and deliberately, almost cynically. But someone who self-harms will usually do it in a state of high emotion, distress and unbearable inner turmoil. Some people plan it in advance, others do it suddenly. Some people self-harm only once or twice, but others do it regularly and it can become an addiction.

Some of us harm ourselves in less obvious, but still serious ways. We may behave in ways that suggest we don't care whether we live or die, we may take drugs recklessly, have unsafe sex, or binge drink. Some people simply starve themselves or purge after eating.

Those who self-harm can feel in control, and reduce uncomfortable feelings of tension and distress. If you feel guilty, it can be a way of punishing yourself and relieving your guilt. Either way, it can become a fix for feeling bad just as a drug, or food, or sex can.

Most people who self-harm are not mentally ill. However, some may be depressed, or have severe personality difficulties, or be addicted to alcohol and drugs. Help is needed as the risk of killing yourself increases after self-harm, not purposely perhaps, but accidentally. Everyone who self-harms should be taken seriously and offered help.

Just as with other addictive and mental health problems, a lot of people who self-harm don't ask for help. Many young people who self-harm know that they have serious problems, but don't feel that they can tell anyone, it is theirs’, so they don't talk to friends, family, or professionals. Other young people don't feel that they have serious problems, they use self-harm as a way of coping, but their situation stays the same.

Those who are most likely to harm themselves badly:

• use a dangerous or violent method;
• self-harm regularly;
• are socially isolated;
• have a psychiatric disorder.

They should be assessed by someone with experience of self-harm and mental health problems.

However, many people find that it's helpful just to talk anonymously to someone else about what is happening to them. Knowing that someone else knows what you are going through can help you to feel less alone with your problems. It can also help you to think about your difficulties more clearly; maybe even see ways of solving them that you wouldn't think of on your own. 

Self-harm is often the result of a crisis in a close relationship. If this is the case, help with the relationship will be needed rather than help with self-harm.

Therapy can always help. Being listened to in a supportive and caring environment can often create an understanding as to what the behaviour does for the person. Then healthier coping strategies can be developed.

Where this is appropriate, family meetings with a therapist can help to relieve the tiring, daily stress for everyone in the family.

When you want to harm yourself

The feelings of self-harm go away after a while. If you can cope with your upset without self-harming for a time, it will get easier over the next few hours. You can:

• Talk to someone and if you are on your own perhaps phone a friend.
• If the person you are with is making you feel worse, go out.
• Distract yourself by going out, singing or listening to music, or by doing anything harmless that interests you.
• Relax and focus your mind on something pleasant in your very own personal comforting place.
• Find another way to express your feelings such as squeezing ice cubes, which you can make with red juice to mimic blood if the sight of blood is important, or just drawing red lines on your skin.
• Give yourself some harmless pain by eat a hot chilli, or have a cold shower.
• Focus in your mind on positives.
• Be kind to yourself, such as getting 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, and you feel safe, think about the times that you have self-harmed and what, if anything, has been helpful.

• Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there.
• Where were you, who were you with, and what you were 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.
• How did other people react?
• What did you do about the feeling?
• Could you have done anything else?
• Make a crisis or relapse prevention plan so you can talk to someone instead of self-harming. Being able to get in touch with someone quickly can help you control your urge to self-harm. While you are talking, your wish to harm yourself may start to go away. 

If you decide that you don't want to stop self-harming, you can still.

• reduce the damage to your body, for example, use clean blades.
• keep thinking about possible answers to the things that make you harm yourself.
• every so often, re-visit your decision not to stop.

Self-harm can be very damaging physically and psychologically, in the end, you'll do better by stopping.

There are a number of questions to ask yourself to see if you are ready to stop. If you can honestly say YES to half of the questions below, or more, then why not try stopping?

• Are there at least two loving people who are willing to help me stop?
• Do I have friends that know about my self-harm, who I can go to, or talk to if I get desperate?
• Have I found at least two alternative safe ways that reduce the feelings that lead me to self-harm?
• Am I able to tell myself, and to believe it, that I want to stop hurting myself?
• Can I tell myself that I WILL tolerate feelings of frustration, desperation, and fear?
• If necessary, is there a professional who will also give me support and help in a crisis?

If I harm myself and need treatment?

You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many Accident and Emergency departments now have either a psychiatric liaison nurse, or a social worker, who will be able to talk with you about how you are feeling, and to see if there are any further ways of helping. They should be able to consider all your needs, whatever they may be, and to write an assessment of them. You should be able to go through this with them and, if you disagree with their assessment, to write this in the notes. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.

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

It can be very upsetting to be close to someone who self-harms, but there are things you can do. The most important is to listen to them without judging them or being critical. This can be very hard if you are upset and perhaps angry about what they are doing. Try to concentrate on them rather than your own feelings.

Do

• Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation to other things.
• Take some of the mystery out of self-harm by helping them find out about self-harm perhaps on the internet at the local library.
• Find out about getting help - maybe go with them to see someone.
• Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.

Don't

• Try to be their therapist, you have enough to deal with as their friend, partner or relative.
• Expect them to stop overnight, it's difficult and takes time and effort.
• React strongly, with anger, hurt, or upset as this is likely to make them feel worse. Talk honestly about the effect it has on you, but do this calmly in a way that shows how much you care for them.
• Struggle with them when they are about to self-harm it's better to walk away and to suggest they come and talk about it rather than do it. Just as with any addiction, stopping someone acting out is not going to work.
• Make them promise not to do it again or make your involvement with them the basis for an agreement for stopping.
• Make yourself responsible for their self-harm or become the person who is supposed to stop them. You must get on with your own life as well. Make sure you talk to someone close to you, so you get some support.

Self-harm is an addictive process. Changing the behaviour takes time, willingness, and courage. It also takes support from other. TRN is a place where understanding and support can be found for both the person who is self-harming, and family and friends.