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Self-harm

About self-harm

 

Self-harm describes a wide range of behaviours that people sometimes use to cope with difficult feelings and distressing life experiences.  These behaviours may include cutting, burning, scalding, banging, scratching, pulling hair or swallowing objects or poisonous substances.  The majority of people who self-harm have no intention of ending their life. Most people who self-harm do it to cope with, and manage, their difficult feelings. 

 

To help us understand why people self-harm, it may be useful to think about other ways people cope.  While some people cope with feelings of stress, anger and frustration by having a glass of wine or smoking cigarettes, others manage similar feelings by self-harming.

 

Self-harm is an issue for a lot of children and young people, and many adults find it challenging to deal with. It is very difficult to say exactly how many children and young people self-harm, as they often hide this behaviour and don’t tell anyone about it. The average age self-harming starts is 12 years old, and girls are more likely to self-harm than boys. There are many other groups at increased risk of self-harming including children and young people who have learning disabilities, are in care, or have friends who are self-harming.


How self-harm works for people

 

However negative and self-destructive it may seem to hurt your own body, for some children and young people self-harm can serve many important functions.  Self-harm is primarily a way to cope, and in some cases it may feel like the only way to deal with their extremely distressing feelings.

 

Children and young people say self-harm works in the following ways: 

 

Control 

It is likely that most of the reasons for self-harm are underpinned by a desire for control. Self-harm is a way of regaining control, by controlling the injuries to their own body.  Determining the nature, where on the body, timing and severity of self-harm is a way of staking claim to their own body. 

 

Relief of feelings

Through hurting themselves, they may be able to release feelings that feel unbearable when held inside.

 

Distraction

Self-harm can help them cope by providing a distraction.  The physical pain and injury take the focus away from an emotional pain that feels much worse.

 

Self-punishing

They may have feelings of self-hatred or self-blame.  When these feelings are very powerful, they may use self-harm to punish themselves.  This may help reduce their guilt. 

 

Cleansing

They may see themselves as dirty, often as a result of abuse.  Self-harm may be a way of symbolically ridding themselves of the contamination they feel. 

 

Communication

Self-harm is primarily carried out to regulate feelings rather than to gain a response from others - they may never show or tell anyone else about their injuries.  However, self-harm may also be a way of trying to communicate feelings without using words. 

 

Comfort and nurturing

Self-harm can provide a release of tension which can be experienced as calming or comforting. It can also provide an opportunity to self-soothe or seek care and nurture from others. 

 

Making your body unattractive

Sometimes they harm themselves to make their bodies unattractive in the hope this will keep others away, particularly when they fear someone who abuses them sexually. 

 

Feeling real or alive

Sometimes their life experiences leave them feeling numb, dead or unreal.  Hurting their own body is one way of breaking through these feelings and actually experiencing something that makes them feel alive again. 


Things to think about

 

Children and young people who self-harm often carry feelings of shame, guilt, self-hatred, anger, frustration and isolation. However, there is a common misconception that children and young people who self-harm are attention-seeking.  In reality, most children and young people who self-harm do it in secret. Labelling someone as attention-seeking only serves to further their feelings of shame and guilt, this may make the self-harming behaviour worse. 

 

There are many different reasons why a child or young person self-harms.  In trying to understand why, ask yourself the following: 

 

  • Is the child or young person being bullied? 
  • Have they suffered sexual, physical and/or emotional abuse?
  • Have they lost a parent through death or separation?
  • Are they in conflict with parents or other family members?
  • Do they have a chronic illness or disability? 
  • Are they being subjected to excessively high expectations?
  • Are they worried about school work and exams? 
  • Do they have issues around their race, culture or religion? 
  • Do they have issues around their sexuality? 
  • Is there a possibility they have an unwanted pregnancy?
  • Have they experienced a loss or bereavement? 
  • Have they experienced the self-harm or suicide of someone close?
  • Are they feeling isolated? 
  • Do they have low confidence or sense of self-worth? 


Think about your response

 

Self-harm in children and young people can lead to strong feelings of anxiety, fear and frustration in the people who are trying to support them. It is really important that you manage your feelings when supporting a child or young person who is self-harming. To help you do this, don’t focus too much on the self-harming behaviour and ensure that you respond to the child or young person and the issues underlying the self-harm. 

 

A parent’s journey

A professional’s perspective

What you can do

 

  • Listening and caring is the most important thing you can do to help.  It might not seem much, but showing that you want to know and understand can make a big difference.

 

  • Show concern for the child or young person's injuries.  By offering the same concern you would show for any other injury, you are showing them that their body is worth caring about.  There is no need to overreact just because it is self-inflicted. 

 

  • If you accept that the self-harm helps them cope, this shows you understand that, at the moment, self-harm works for them when nothing else can. 

 

  • Seeing the person behind the self-harm is important to show that you care about the person themselves, and not just the self-harm.  The child or young person may find it more helpful for you to focus on their feelings, rather than on the self-harm.

 

  • The child or young person might hate their self-harm, even though they might need it.  It is helpful if you accept these changing and conflicting feelings.

 

  • It is important to recognise how hard it may be for the child or young person to talk to you.  It may take a lot of courage for them to discuss their self-harm and their feelings, and it may be difficult for them to put things into words.  Be gentle, patient and encouraging.

 

  • Help the child or young person find alternatives to self-harm.  Some children and young people find it helpful to develop a list of alternatives to their self-harm, and have said that their most successful alternatives are:
    • hitting a punch bag to vent anger and frustration
    • hitting pillows or cushions and having a good scream
    • going for a walk
    • physical exercise
    • writing down thoughts and feelings on paper and possibly ripping them up
    • keeping a diary
    • talking to a friend
    • creative activities e.g. art
    • looking at self-help websites
    • using a pen to draw on their skin in the place they might usually cut
    • holding an ice cube against their skin instead of cutting

 

  • Help the child or young person find further support, as they may need help in addition to what you can give. It is important to be aware of your own limitations and not offer more than you can cope with.

 


"You shouldn't be ashamed of who you are. That was something the workers told me"

Young Person


What not to do

 

  • Don’t tell the child or young person off or punish them as this can make them feel even worse, which could lead to more self-harm.

 

  • Don’t blame the child or young person for any shock and upset you feel. Although you may feel these things, it won’t help if you make them feel guilty. 

 

  • Don’t jump in with assumptions about why the child or young person is self-harming.  Different people have different reasons and it is best to let them tell you why they do it.

 

  • Don’t avoid talking about it.  Avoiding talking about it won’t make the self-harm go away, but will leave the child or young person feeling very alone.

 

  • Don’t try to force them to stop self-harming.  Doing things like hiding razor blades or constantly watching them doesn’t work and is likely to lead to self-harming in secret, which can be more dangerous.

 

  • Don’t ask a child or young person to promise not to self-harm.  This will not work, as it is likely to put a lot of emotional pressure on them and sets them up to feel guilty. 

 

  • Don’t treat the child or young person as irrational or incapable. This takes away their self-respect and ignores their capabilities and strengths.

 

  • Don’t panic or overreact as this can be very frightening for the child or young person. Stay calm and take time to discuss with them what should be done next. 

 

Managing risk and confidentiality

 

The issue of confidentiality should be openly discussed with the child or young person and jointly understood. For more information on confidentiality and sharing information please see page 39 of Fife's Self-harm Guidance at:

www.healthyfife.net/wp-content/uploads/sites/55/2017/09/Fife_Young_People_Self_Harm_300617.pdf


Who to contact if you're still concerned

 

For parents and carers

 

Please contact your GP or other health professional involved with your family.  You can also contact the Self Harm Support Service directly for advice or to refer your child, by phoning 01334 696250 (East Fife) or 01383 627031 (West Fife).

 

For professionals

 

You may continue working with a child or young person, or you may decide to refer them on to another service or professional. This decision will depend on the identified needs of the child or young person, including the level of risk they present. For more information, please see page 26 of Fife's Self-harm Guidance at:

www.healthyfife.net/wp-content/uploads/sites/55/2017/09/Fife_Young_People_Self_Harm_300617.pdf

 

Other resources

 

Resources packs from YoungMinds:  www.youngminds.org.uk/what-we-do/our-projects/no-harm-done/#project-outcomes

 

Calm Harm App:  www.calmharm.co.uk

Here are some quotes from young people about why they self-harm:

 

 

I’m in control

 

"I’ve always had to do what suited other people - different foster parents, children’s homes, schools.  Nobody ever asked me what I wanted."

 

"It’s like a control thing.  How deep, how often, where I cut - it’s all down to me. It’s my body and I’ll decide what to do with it."

 

Time-bomb ticking inside me

 

"I get mad about things, it all knots up inside me and I just want to scratch myself and slash at myself."    

 

"I hit myself because I’m so angry with myself - for being so stupid and pathetic, for being the sort of person bad things happen to."

 

"After I cut myself I feel good, like I’ve punished them, secretly.  I can be talking to them and I can feel my arm and it’s like ‘stuff you’, like I’ve got one over on them."


Getting out the badness

 

"The badness I feel becomes unbearable. I can’t take it any more so I cut.  The relief is instant. It’s like I’ve got what I deserve. The badness just drains away."

 

"Washing doesn’t work, however much I do it.  I cut myself where I was touched.  It gets rid of the dirt."

 

An excuse for some comfort

 

"When I feel empty it’s like there is nothing inside me.  I’d do anything to fill that gaping hole. I used to stuff myself with food but it was never enough.  But when I cut it just goes."

 

"It gave me an excuse to go to the nurse and be bandaged up and taken care of."

 

"I like looking after my cuts. It’s the one time I can be really nice to myself.  Then I curl up in bed and just snuggle down and go to sleep."

 

Showing there’s something wrong

 

"I thought if I had bruises on me, someone would realise that things weren’t all right at home, and would make it stop, somehow."

 

"I wanted my Dad to feel bad, to realise that it mattered what he’d done to me. That I was screwed up by it. I wanted him to be sorry."

 

"People always think I’m happy and together. Even if I say that I’m down they think it’s not serious. In the end I took tablets - not to die but to prove I wasn’t OK."


Something that’s mine - This is me

 

"Self-harm - it’s something special I do for myself, it’s mine, my secret. Like a friend, just for me."

 

"Cutting is like part of me, my identity. Sometimes when people are having a go at me about ‘looking nice’ or getting a good job or something (and I’m keeping my mouth shut), I think about my arms and my scars and then I don’t care."


Stopping the pain

 

"Sometimes my emotional pain is so strong that I don’t feel I can take it and that it’s going to destroy me. I just know I need to stop it. Cutting my arms seems to help me do that. The physical sensation ground me somehow - it brings me back to reality away from the overwhelming feelings. After hurting myself, I can care for and bandage the wounds and therefore feel justified in looking after myself. When feeling the physical hurt that it causes, I am numb to the emotional pain which is a million times worse and so much harder and scarier to deal with."