COPING WITH SELF-HARM

What is Self-harm?

Self-Harm is defined as intentional harmful behaviours used as an expression of personal distress. Self-harm can sometimes be a standalone behaviour, but it can also be an indicator of a further mental health condition.

Types of Self-harm

Cutting
Burning
Hair pulling (Trichotillomania)
Self-injurious activity (such as punching or hitting oneself)
Drinking harmful liquids
Exercising too much
Restricting oral intake

Increasing oral intake
Misusing alcohol or substances
Having unsafe sex
Getting into fights where you know you will get hurt
Gambling

Why do People Self-harm?

People may self-harm to:

Communicate something that is hard to put into words
Turn invisible thoughts or feelings into something visible
Change emotional pain into physical pain
Reduce overwhelming emotional feelings or thoughts
Have a sense of being in control
Escape traumatic memories
Have something in life that they can rely on
Punish themselves for their feelings and experiences
Stop feeling numb, disconnected, or dissociated
Create a reason to physically care for themselves
Express suicidal feelings and thoughts without taking their own life
Coping strategy

Signs of Self-harm

Unexplained cuts, bruises or burns – often on their wrists, arms, thighs and chest
Unlikely excuses for injuries
Increased curiosity into risky behaviours
Becoming withdrawn and wanting to spend more time alone
Wearing extra clothing to cover skin
Become more secretive

Refusing to get changed in front of other people
Signs they have been pulling their hair out
Changes in usual behaviour
Changes in eating patterns/ unexplained weight loss or gain
Increase in alcohol or substance consumption
Signs of becoming less confident and lower self-esteem

Framing Conversations Around Self-harm Act

Be direct – when speaking to someone who you believe is struggling with self-harm behaviours or thoughts.

Don’t avoid the topic – this can make it harder for people experiencing these feelings to be open and feel understood.

Use open questions – such as ‘How are you?’ or ‘I can see you’ve been distant recently, is there anything you would like to speak about’.

Let the individual know you are there for them.

Listen

Show genuine interest – it can be a difficult topic to speak about, let the individual know you are there to hear them.

Give space and time – let them know you are there when they feel ready to talk.

Have empathy and understanding about what they are doing and what they are going through.

Respond

Be non-judgemental – It is difficult to open up about self-harming, show that it is not something to be ashamed of and it is very brave for somebody to open up about this.
Relate to them as a whole person – not just their self-harm. Talk about the underlining feelings and remember that for some – self-harm is a coping mechanism to manage distressing thoughts and feelings.
Reassure them there is help and support available when they feel ready and offer to help them access the correct support.
Ask the individual how they would like to move forward and involve them in the decision making. This is important to allow the individual to take control of their journey and recovery.
Do not promise to keep it a secret.
Remind them of their positive qualities and what they do well.

Helpful Things to Say

“It is okay not to be okay.”

“What can I do to support you?”

“How do you think you and I can keep you safe?”

“What can be put in place when you are feeling this way?”

“What has been helpful or unhelpful for you in the past?”

“Are you ready to get some support for this?”

“Thank you for sharing this with me”

“I may not completely understand but I am here to support you and listen.”

“I have noticed you don’t seem yourself recently, is there anything that’s bothering you?”

Use language that displays hope and promotes a culture of recovery.

What not to say

“You’re not thinking of doing something silly are you”

This can cause the person to stop confiding in others, and further isolation due to fear and judgement.

“It’s not that serious”

This downplays the seriousness of the situation.

“This is attention seeking behaviour/ it is just a cry for help”

Yes, this person wants your attention, and this is the way they are seeking your help. If they share their feelings with you, it means they trust you. Telling the individual they are an ‘attention seeker’ only affirms their feelings of loneliness and inadequacy.

“It’s not that bad”

“Stay positive”

“Others have it worse”

“You’re being selfish”

This belittles and invalidates a person’s feelings and prevents them from expressing themselves.

“You have a lot to live for”

The individual will either already know this or not feel like they do. This can lead to increase feelings of guilt and shame.