What is Self-injury?

Self-injury is deliberate and purposeful behaviour that inflicts physical injury to a person’s own body.  It will vary for each young person and may be something that is tried once or twice and then stopped, in response to a specific problem or event, or it may be a way of coping over time.

How do people Self-injure? 

The most common form of self-injury among young people is cutting.  Other types include burning the skin until it marks or bleeds, picking at wounds or scars, self-hitting, swallowing, inserting or injecting objects and pulling hair out by the roots.  At the more extreme end of the spectrum, self-harm can include breaking bones, hanging and deliberately overdosing on medication.

There are other deliberate behaviours that can be harmful to a young person’s health that are not normally included in the definition of self-injury.  These can include self-starving, drug or alcohol use, repetitive unsafe sexual practices and dangerous driving.

Many young people self-injure in secret without anyone else knowing.

Scarred by Scars

Self-injury scars can be quite confronting.  Try not to be shocked or repulsed.  Be sensitive. For some young people they can be shameful or to others they can be a sign of survival.

Why do people injure themselves?

Self-injury is essentially a coping mechanism, not dissimilar to substance use.  Some young people even refer to it as a way of “self-protection”.  Self-injury is a very personal act and every young person who self-injures has their own reasons for doing so.

It's something that needs to be done to get me living

Some of these may be to:

• Express and communicate their pain
• ‘Feel something’ instead of feeling numb
• Relieve Intense pain or distress
• Manage unbearable negative feelings, thoughts or memories (or hearing voices)
• To feel good
• Gain control over pain
• Feel real or connected
• Punish themselves due to feelings of guilt, shame

“It made the pain go away.  The more I did it, the more I wanted to do it.  I wouldn’t have to cry and I’d feel happy again”

Some young people acknowledge that having others around them who self-injure can influence them to start or continue the behaviour themselves.  There are times with young people in out-of-home care that self-injury is happening with a few people who live together and in a way makes it quite normal.  In this way there may even be a motivation to feel connected by self-injuring.

Many young people realise that in the long term, self-injury is not an effective coping mechanism, but find it hard to give it up as they are often unable to find other ways to cope with their distress.

Why Self-injury is NOT Borderline Personality Disorder…

Self-injury is a behaviour not a disorder or illness.  Whilst self-injuring behaviour is strongly suggestive of an underlying psychological or emotional problem, many young people who self-injure do not have any mental illness.  Many people assume the young person has borderline personality disorder (BPD) because self-injury is a feature of this however only a small minority of those who self-injure have this diagnosis.

“Because I didn’t want to kill myself, I just wanted some of the hurt and all of the pain just to go away”

Why Self-injury is NOT Suicidality…

For most young people self-injury is a coping mechanism, not a suicide attempt.  This may seem strange but, in many cases, people use self-injury as a way to stay alive rather than end their life.There is however a risk that a person may accidentally hurt themselves more than they planned.  People who repeatedly self-injure may also begin to feel as though they cannot stop, and this may lead to feeling trapped, hopeless and suicidal. People who self-injure are also more likely than the general population to feel suicidal and to attempt suicide.   

Debunk some other MYTHS about self-injury. 

Signs that someone is self-injuring

• Unexplained cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
• Keeping themselves fully covered at all times, even in hot weather
• Signs of depression, such as low mood, tearfulness or a lack of motivation or interest in anything
• Becoming very withdrawn and not speaking to others
• Changes in eating habits or being secretive about eating, and any unusual weight loss or weight gain
• Signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough for something
• Signs they have been pulling out their hair

Are you are worried about someone self-injuring?

Some young people stop self-injuring on their own, without any help, while others need support to find new ways of coping.  It is not always obvious whether someone is self-harming, in fact some young people go to long lengths to conceal their injuries, but if you are concerned about them it is important to talk with them about it.  It can be difficult to know what to do and it is perfectly natural to feel overwhelmed.  The best way to help someone is to provide support and encourage them to ask for professional help. 

LOOK

Let them know what you have noticed, that you are worried and that you would like to help. 

LISTEN

Try to make them feel safe enough to discuss their feelings. Remain calm, maintain an open attitude and acknowledge their feelings, whatever they may be.  By listening you can begin to understand what is happening and why.  Don’t assume you know it all or jump to conclusions.  Be aware that the young person might feel ashamed of their actions and worry about your judgements.  Your initial reaction will have a great impact, so be careful not to be angry, negative or buy into the myths.  If a young person’s initial attempts to seek support are negative or unhelpful this might add to their distress and their self-injury might become more frequent or serious.

TALK

Let them know you are there for them, you might find it hard to understand but you can support them.  Keep the conversation open but be patient.  Be realistic, self-harming can take a while to stop.  Encourage them by noticing times they have coped with difficult things without self-injuring and help them to achieve the goals they set for themselves.

Check whether the person is thinking about suicide, and call your local hospital or mental health service if you think they are. Call an ambulance (phone 000) or take the person to the emergency department of the local hospital if they need urgent medical attention. Follow the procedures provided by your agency.

Supporting someone who self-injures can be a stressful experience, so think about getting support for yourself as well.

Click here to find out more about how to respond to self-injury.