Self-harm: what you need to know

Depressed girl.
People self-harm in an effort to cope with deep emotional distress.

An estimated one in six adolescents have self-harmed at least once while research indicates about 6 per cent of young people are actively and chronically self-harming. What should you know about this serious and growing problem?


What is self-harm? 

Self-harm is when you intentionally hurt or injure yourself. Cutting yourself is the most common form. Other forms include self-hitting, punching or head-banging, self-burning, hair-pulling, and scratching, amongst others.


Why do people self-harm? 

Concerned family members often fear it is a suicide attempt or gesture, but researchers refer to self-harm as NSSI – non-suicidal self-injury. Usually, people self-harm in an effort to cope with deep emotional distress. They want to feel better and to cope with very painful emotions, not end their life. Self-harm is a form of emotional regulation. The person may want to shift their attention from very difficult thoughts, to release overwhelming emotions or to feel something physical to fight feelings of numbness. The brain releases endorphins to counteract physical pain, which results in a short-lived sense of well-being and relief. This is known as pain offset relief (for example, if you dip your hands into ice-cold water, you will experience a brief feeling of intense relief or euphoria after removing your hands). Over time, the person begins to associate self-harm with relief and returns for more.


Many young people experience difficult emotions but they don’t self-harm. Why don’t self-injurers do the same?

Researchers have found the more negative your self-image, the more likely you are to endure pain. People who self-harm are much more likely to describe themselves as “bad”, “defective”, or “deserving of punishment”.


Is it a cry for help? 

Sometimes, but it’s more common for people to be secretive and ashamed about their self-harming behaviours.



Sad girl.
Warning signs include negative self-talk and expressions of hopelessness.

Are there signs to look out for? 

Some warning signs include unexplained scars, cuts, bruises or other wounds; frequently wearing bandages and having plasters and antiseptics hidden; keeping oneself covered all the time, even in hot weather, and/or avoiding sports; behavioural and emotional instability and impulsivity; being very withdrawn; negative self-talk and expressions of self-loathing, shame or hopelessness.


Who is most vulnerable? 

Although often associated with young girls, males actually account for between one-third and a half of cases. Self-harming tends to rise significantly from the age of 12 and declines from the mid-20s onwards. People who have been bullied or rejected by peers are more likely to self-harm. Gay and bisexual people – especially bisexual females – are especially vulnerable.


What are the consequences of self-harm? 

It can make a bad situation worse, leading to unintended physical problems such as injuries requiring medical attention or permanent scars. Not only does it not address the person’s underlying problems, it compounds existing difficulties by worsening feelings of shame and low self-esteem. People who self-harm are more prone to depression and at greater risk of suicide, so it’s important to learn healthier ways of regulating difficult emotions.


How should I talk to someone who is self-harming? 

Adopt a stance of ‘respectful curiosity’, to borrow a phrase used by self-harm experts from Cornell University (1). Don’t lecture the person or make them feel guilty. If you find yourself feeling angry, take time out and return to the conversation when calm. Aim to be empathetic, patient, open, low-key and non-judgmental. Freely discuss thoughts and feelings. Talk about the self-harm; skirting around the issue only reinforces shame.


I self-harm. How can I stop? 

Reaching out to someone and talking about your problems is a good place to start. Try to identify the triggers that drive your urges and aim to find new coping techniques. These can range from journaling your feelings to soothing activities (listening to calming music, taking a hot shower, cuddling your dog, wrapping yourself in a warm blanket) to exercises that release tension or anger (screaming into a pillow, vigorous exercise, punching a cushion, etc). Seek to distract and delay – if you can wait 20 minutes, the urge will lessen and pass.


I need external help. 

Your GP can recommend a good therapist. You can also call the Samaritans by emailing jo@samaritans.ie or 116 123, or contact Pieta House, which provides free therapy to people engaging in self-harm, by calling 1800 247 247.


(First published in Southern Star, August 6, 2020)



(1) - http://www.selfinjury.bctr.cornell.edu/perch/resources/respectful-curiosity.pdf