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About this leaflet
This leaflet is for anyone who wants to know more about
self-harm, particularly anyone who is harming themselves, or feels
that they might. We hope it will also be helpful for friends and
The leaflet looks at the different sorts of self-harm and why
someone might do it.
- some of the help available
- what you can do to help yourself
- what friends or family can do to help.
At the end of the leaflet is a list other publications which can
give you more information.
What is self-harm?
Self-harm happens when you hurt or harm
yourself. You may:
- take too many tablets – an overdose
- cut yourself
- burn yourself
- bang your head or throw yourself against
- punch yourself
- stick things in your body
- swallow things.
It can feel to other people that these
things are done calmly and deliberately – almost cynically.
But we know that someone who self-harms is usually in a state
of high emotion, distress and unbearable inner turmoil. Some
people plan it in advance, for others, it happens on the spur of
the moment. Some people self-harm only once or twice, but others do
it regularly - it can be hard to stop.
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
Other words that
are used to
These terms were previously used to describe
self-harm, but are now going out of use:
Deliberateself-harm (DSH): the
word 'deliberate' tended to blame people for their self-harm.
Suicide/Parasuicide: these suggested that
harming yourself is the same as wanting to kill yourself - which is
often not the case.
How common is
- About 1 in 10 young people will self-harm
at some point, but it can happen at any age.
- The research probably under-estimates how
common self-harm is. It is usually based on surveys of people who
go to hospital or their GP after harming themselves. However, we
know that a lot of people do not seek help after self-harm. Some
types of self-harm, like cutting, may be more secret and so less
likely to be noticed.
- In a recent study of over 4000 self-harming
adults in hospital, 80% had overdosed and around 15% had cut
themselves. In the community, it is likely that cutting is a more
common way of self-harming than taking an overdose.
It happens more often in
- young women.
- prisoners, asylum seekers, and veterans of
the armed forces
- gay, lesbian and bisexual people: this
seems, at least in part, due to the stress of prejudice and
- a group of young people who self-harm
together: having a friend who self-harms may increase your chances
of doing it as well
- people who have experienced physical,
emotional or sexual abuse during childhood.
What makes people self-harm?
Research has shown that many people who harm
themselves are struggling with intolerable distress or unbearable
situations. A person will often struggle with difficulties for some
time before they self-harm.
Common problems include:
- physical or sexual abuse
- feeling depressed
- feeling bad about yourself
- relationship problems with partners,
friends, and family
- being unemployed, or having difficulties at
You may be more likely to harm yourself if
- that people don’t listen to you
- isolated, alone
- out of control
- powerless – it feels as though there's
nothing you can do to change anything.
It's more likely to happen if you are using
alcohol or drugs – it may feel that these are as out of control as
the rest of your life.
You may feel like harming yourself if you
want to show someone else how distressed you are or to get back at
them or to punish them. This is not common – most people suffer in
silence and self-harm in private.
How does it make you feel?
Self-harm can help you to 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 'quick fix' for feeling
Does this mean I'm mentally ill?
Probably not. However, you may be depressed,
have personality difficulties, find it difficult to get on with
other people or have problems with alcohol and/or drugs. You could
still do with some help.
Is self-harm the same as attempted suicide
Usually not. But if you start to harm
yourself, the risk of killing yourself is greater than for people
who don't self-harm. So anyone who self-harms should be taken
seriously and offered help.
A lot of people who self-harm don't ask for
help. Why not? You might be aware that you have some serious
problems, but don't feel that you can tell anyone – so you don’t
talk about it. You may not feel that you do have a serious problem,
but see self-harm as a way to cope with life. Unfortunately, at the
moment, if you do go to hospital after self-harming, you've only
got a 50:50 chance of being seen by a specialist in this area.
You are most likely to harm yourself badly
- use a dangerous or violent method
- self-harm regularly
- don't see many people
- have a mental illness.
You should really see someone who has a lot
of experience of helping people who self-harm, and who knows about
mental health problems.
What help is there?
You may find it helpful just to talk
anonymously to someone else about what is happening to you. 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. You can do
this on the internet or by telephone. Telephone helplines are
listed at the end of this leaflet.
A group of people, who all self-harm, meet
regularly to give each other emotional support and practical
advice. Just sharing your problems in a group can help you to feel
less alone - others in the group will almost certainly have had
Self-harm is often the result of a crisis in
a close relationship. If this is the case, get some help with
sorting out the relationship - it may be more difficult in the
short-term, but it will be better for you (certainly less
dangerous) in the long-term.
One-to-one talking treatments can help, such
If you are still living with your family, it
may help to have a family meeting with a therapist. This can help
to relieve the tiring, daily stress for everyone in the family. It
is not always appropriate, for instance, if you are the victim of
physical or sexual abuse within your family.
This is different from a self-help group.
A professional will lead (or facilitate) the group to help
the members to deal with problems they share, for example, in
getting on with other people.
There isn't much good evidence yet of which
therapies work well for people who have harmed themselves.
However, what evidence there is, suggests that
problem-solving therapy and cognitive-behavioural therapy are
useful. A health professional will make suggestions based on
your individual problems and on what is available locally.
What if I don't get help?
About 1 in 3 people who self-harm for the
first time will do it again during the following year.
- About 3 in 100 people who self-harm over 15
years will actually kill themselves. This is more than 50 times the
rate for people who don't self-harm. The risk increases with age
and is much greater for men.
- Cutting can give you permanent scarring. If
nerves or tendons are damaged by cutting, this can lead to numbness
How can I help myself?
The feelings of self-harm will go away after
a while. If you can cope with your distress without self-harming
for a time, it will get easier over the next few hours. You
- Talk to someone – if you are on your own
perhaps you could phone a friend. Telephone helplines are listed at
the end of this leaflet.
- If the person you are with is making you
feel worse, go out.
- Distract yourself by going out, listening
to music, or by doing something harmless that interests you.
- Relax and focus your mind on something
pleasant – 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' - eat a
hot chilli, or have a cold shower.
- Focus your mind on positive things.
- Be kind to yourself – allow yourself to do
something harmless that you enjoy.
- Write a diary or a letter, to explain what
is happening to you – no one else needs to see it.
When you don't feel like harming yourself
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
- Think about where you were, who you were
with, and what you were feeling?
- Try to work out why you began feeling like
- 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?
- Could you have done anything else?
- Make an audio recording. Talk about your
good points and why you don't want to self-harm. Or, ask someone
you trust to do this. When you start to feel bad, you can play this
back to remind yourself of the parts of you that are good and
- Make a 'crisis 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
What if you don't want to stop self-harming?
If you decide that you don't want to stop
self-harming, you can still:
- reduce the damage to your body (for
example, by using clean blades if you cut yourself)
- keep thinking about possible answers to the
things that make you harm yourself
- every so often, re-consider your decision
not to stop.
be very damaging
end, you'll do
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
- Are there at least two people who are
willing to help me stop?
- Do I have friends that know about my
self-harming who I can go 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,
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
Emergency Department. Many Emergency Departments now have easy
access to a health professional who knows about self-harm, such as
a psychiatric nurse or doctor, or a social worker. They will be
able to talk with you about how you are feeling, and to see if
there are any ways of helping you. They should be able to properly
assess all your needs, whatever they may be. You should be able to
go through your assessment with them. Staff may want to go through
a questionnaire with you, to try to judge 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 yourself- and
perhaps angry - about what they are doing. Try to concentrate on
them rather than your own feelings – although this can be hard.
- Talk to them when they feel like
self-harming. Try to understand their feelings, and then move the
conversation onto other things.
- Take some of the mystery out of self-harm
by helping them find out about self-harm perhaps by showing them
this leaflet, or by using the internet or the local library.
- Find out about getting help - maybe go with
them to see someone, such as their GP.
- Help them to think about their
self-harm not as a shameful secret, but as a problem to be sorted
- Try to be their therapist – therapy is
complicated and 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
- this is likely to make them feel worse. Talk honestly about the
effect it has on you, but do this calmly and 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.
- Make them promise not to do it again.
- Say that you won't see them unless they
- Feel 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-help and support
Free national helpline for young people, free confidential advice
on all sorts of problems: 0800 1111.
Telephone and email support for anyone who is worried, upset, or
suicidal; 08457 90 90 90; ROI 1850 60 90 90; email: firstname.lastname@example.org.
Direct: a helpline with health advice provided
by NHS nurses; 0845 4647.
The Silent Cry: a
charity to help people to deal with self-harm whether a sufferer,
relative or partner.
The Scarred Soul:
Understanding and Ending
Self-inflicted Violence by Tracy Alderman: New
Healing the Hurt
Within: understand self-injury
and self-harm, and heal
the emotional wounds by Jan Sutton: How
To Books Ltd.
Effectiveness of interventions to prevent
suicide and suicidal behaviour: a systematic review. (2008).
Leitner,M.,Barr,W.,& Hobby, L. Health and Community Care
Research Unit, Liverpool University and Scottish Government Social
The epidemiology and management of self-harm
among adults in England (2005).Gunnell, D. & Bennewith, O.,
Journal of Public Health; 27, p.67-73.
In what way are adolescents who engage in
self-harm, or experience thoughts of self-harm, different in terms
of help-seeking, communications and coping strategies? (2005).
Evans, E., Hawton, K. & Rodham, K., Journal of Adolescence, 28,
Mental disorders, suicide and deliberate self-harm in lesbian,
gay and bisexual people, a systematic review (2008) BMC Psychiatry,
National Institute for Health and Clinical Excellence.
management. (Clinical guideline CG133.) 2011.
Royal College of Psychiatrists College Report CR
158: Self-harm, suicide and risk: helping people who self-harm
Suicide and deliberate self-harm in young
people (2005). Hawton, K. & James, A., BMJ, 330,
Suicide following deliberate self-harm:
long-term follow-up of patients who presented to a general hospital
(2003) Hawton, K., Zahl, D. & Weatherall, R., British
Journal of Psychiatry, 182, p.537 - 542.
Understanding resolutions of deliberate self-harm: qualitative
study of patients' experiences (2005). Sinclair, J. & Green, J.
BMJ, 330, p.1112 – 1115.
This leaflet was produced by the Royal College
of Psychiatrists’ Public Education Editorial Board.
Series Editor: Dr Philip Timms
Original author: Professor Anthony Bateman
Expert Review: Dr Jim Bolton and Dr Philip
User and Carer input:members of the RCPsych
Service User and Carers’ Forum
Illustration by Lo Cole: www.locole.co.uk
This leaflet reflects the best available evidence available at
the time of writing.
© Updated: January 2012. Royal College of
Psychiatrists. This leaflet may be downloaded, printed out,
photocopied and distributed free of charge as long as the Royal
College of Psychiatrists is properly credited and no profit is
gained from its use. Permission to reproduce it in any other way
must be obtained from the Head of Publications. The College
does not allow reposting of its leaflets on other sites, but
allows them to be linked to directly.
For a catalogue of public education materials or copies of our
The Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG. Tel: 020 7235 2351 x
This leaflet is made available through the
generosity of the Charitable Monies
Allocation Committee of the mental health charity St Andrew's,
Royal College of Psychiatrists: Charity registration number
(England and Wales) 228636 and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our
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