What is Self-harm?
Self-harm is defined as intentional self-poisoning or injury, irrespective of the apparent purpose (National Institute for Health and Care Excellence (NICE), 2022). This includes both physical and psychological injury and would include any behaviour that serves a function of self-harm and adversely affects a person’s psychological or physical health.
Self-harm can take a number of forms but all self-harm is a sign of emotional distress and should be taken seriously. While the reasons behind self-harming behaviour can be multi-faceted and complex it is predominantly accepted to be a coping strategy for managing distressing or overwhelming thoughts, feelings and experiences.
“Self-harm is most often used as a coping strategy for dealing with psychological pain. It isn’t attention-seeking, it isn’t a ‘cry for help’ or something that can be ‘cured’. Self-harm can affect anyone, of any age, from any background. People who self-harm don’t always have suicidal feelings. Instead, the act of self-harm is often a coping mechanism to help them deal with life’s stressors.”
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Examples of self-harming behaviours can include but are not limited to:
- Cutting
- Burning
- Head banging
- Hair pulling (trichotillomania)
- Self-poisoning
- Scratching
- Severe bruising or breaking bones by inflicting blows to the body
- Inserting objects into the body
- Ingesting harmful substances
- Swallowing objects
- Tightly binding body parts
- Asphyxiation / suffocation
- Digital Self-harm
Other risk-taking behaviours which may also be associated with self-harm include:
- Eating problems and eating disorders (for further information and guidance on supporting pupils with eating problems and eating disorders please refer to Healthier Minds)
- Drug and alcohol misuse
- Dangerous driving or extreme sports
- Unsafe sex/multiple sexual partners (Risks of Child Sexual Exploitation)
Digital Self-harm
Digital self-harm has appeared with the increased use amongst young people of social media. Digital self-harm involves anonymously posting hurtful and sometimes verbally abusive remarks about oneself online and is more commonly seen in boys than girls. It differs from other forms of self-harm in that it does not cause physical harm but is still driven by the same strong and overwhelming feelings of distress.
Risk Factors
The factors that increase a young person’s vulnerability to self-harm are complex and it is impossible to predict with any certainty who might be at risk. However, certain social groups or adverse experiences are associated with an increased risk including:
- self-harm or suicide behaviour in family members or friends
- childhood trauma or abuse
- care experienced
- socio-economic deprivation
- mental health concerns
- gender dysphoria
- neurodevelopmental needs
- LGBTIQ+
- substance misuse
- parental separation or conflict
- bereavement
- bullying
- relationship difficulties
- academic pressures
(Platt, 2009)
The influence of media and social media
Young people are highly influenced by how topics such as self-harm are portrayed through social media. Media coverage has the potential to normalise self-harm behaviour, especially if it is portrayed as a common or effective way of coping with emotional distress. Traditional media is subject to guidance around how self-harm is reported. However, social media content is much more difficult to control and children and young people are vulnerable to the effects of normalised or glamourised self-harm behaviour. The types of content that children and young people are viewing should be explored as part of any assessment and support.
Protective Factors
Where a young person has a number of protective factors in their life, their risk of self-harming behaviour will be reduced. Identifying a young person’s protective factors can be a helpful part of creating a safety plan. This includes but is not limited to:
- nurturing and supportive family relationships
- friendships and feeling of belonging within a social group
- sense of connectedness (school community, groups, job, sports teams etc)
- good physical health including adequate sleep routines, good nutrition and physical exercise
- ability to regulate emotions, behaviour and thoughts
- optimistic outlook on life and a general sense of hopefulness
- good problem-solving skills
- sense of purpose and aspirations
- positive self-image
- resilience in the face of adversity
- religious faith or spirituality
Functions of Self-harm Behaviour
As with all behaviour, self-harming behaviour is communicating something about the young person’s experience. Various studies e.g. Stänicke, Line & Haavind, Hanne & Gullestad, Siri (2018) have explored the reasons behind self-harming behaviour providing us with a greater understanding of this complex area. While the reasons behind self-harm can be multi-faceted and complex it is predominantly accepted to be a coping strategy for managing distressing or overwhelming thoughts, feelings and experiences. The young person may be seeking:
- temporary release from intense feelings, pressure, anxiety and stress
- to experience the sense of being real or alive; of feeling something other than emotional numbness and dissociation
- to externalise and/or take control of emotional internal pain
- to inflict self-punishment related to feelings of poor self-image and self-worth
- to stay alive in spite of significant emotional distress
- on rare occasions, to influence others or connect with others
Warning Signs
People who self-harm will often work hard to hide their injuries and their behaviour, however, there are often indicators, which may present as more general emotional wellbeing and mental health concerns or as specific self-harm indicators:
Specific to Self-harming behaviour
- Consistently wearing long sleeves even at inappropriate times or in warm weather
- Reluctance to participate in physical activity
- Avoiding changing clothes in front of others e.g. for p.e. or in changing rooms
- Spending more time in the bathroom
- Unexplained cuts or bruises, burns or other injuries especially on the non-dominant side
- Blood on clothing or tissues
- Reporting frequent ‘accidents’ which cause physical injury
- Regularly bandaged arms/wrists
- Frequently talking about self-harm
- Regularly asking for first aid supplies
- Razor blades, scissors, knives, plasters have disappeared
- More regularly showering or bathing
- Talking about self-harm
More general wellbeing indicators
- Consistent low mood
- High levels of stress and anxiety
- Mood changes
- Expressing feelings of low self-esteem or worthlessness
- Changes in eating or sleeping patterns
- Withdrawing from, or changing, friendships
- Withdrawal from, or loss of interest in hobbies and activities that were previously enjoyed
- Misuse of substances
- Spending more time alone, becoming more private or defensive
- School absenteeism
