Self-harm and self-injury

What is self-harm?

Self-harm is a term that has historically been used to cover a broad range of behaviours. It refers to deliberately causing pain or damage to your own body, and can be suicidal or non-suicidal in intent. Self-injury is a type of self-harm, and refers to deliberately causing pain or damage to your own body without suicidal intent.

Self-injury is more common in young people. Some people who self-harm may also have suicidal thoughts.

Self-harm can take on different forms and its frequency can vary from person to person – some may do it once, while others can do it for many years. It can include:

• cutting, burning, biting or scratching the skin
• picking at wounds or scabs so they don’t heal
• pulling out hair, punching or hitting the body
• taking harmful substances (such as poisons, or over-the-counter or prescription medications).

Self-harm is normally a sign that a person is feeling intense emotional pain and distress.

There are many support options for self-harming behaviour, whether you are seeking support for yourself or someone you care about.

Getting support for self-harming behaviour

If you are self-harming and you are worried, try to talk to someone you trust – like a friend, family member, doctor, teacher or school counsellor. It can be hard to build up the courage to open up to someone, but remember, they care about your wellbeing. It may take time for them to understand, but it doesn’t mean they aren’t there for you.

If you would rather talk to someone you don’t know, there are many options. You can:

• See a doctor, counsellor or psychologist. If you have a mental health condition, your GP can work with you to draft up a mental health treatment plan, which can include counselling sessions at a low cost.
• Contact eheadspace to talk to a counsellor. You can do this online or over the phone (Tel. 1800 650 890 – normal call charges apply on mobile). It’s confidential, so you don’t have to give your name, and it’s available to young people aged 12–25 and their families and friends.
• Visit a headspace centre – there are centres all over Australia where young people (12–25 years) can get health advice, information and support – usually free or at a low cost.
• Call Kids Helpline (Tel 1800 55 1800) – Kids Helpline is for young people aged between five and 25. You can talk to a counsellor about anything at any time.
• Call Beyond Blue to talk to a counsellor at any time (Tel. 1300 22 4636). Beyond Blue also provides youth-friendly information on self-harm.
• Visit ReachOut for youth-friendly information on self-harm, and online programs to help young people who may have depression and anxiety.

Seeking help for suicidal thoughts

Sometimes the distress you feel can be so overwhelming that you may have thoughts about ending your life.

If you are thinking about suicide, don’t be afraid to ask for support – talk to someone you trust and feel comfortable with, such as a family member, friend, teacher, doctor or other health professional.

If you or someone you know is badly hurt or is at serious risk of harm, contact emergency services. Dial triple zero (000) or visit your nearest emergency department. You can also contact your doctor or mental health crisis service.

You can also call:

• Lifeline (Tel. 13 11 14)
• SuicideLine (Tel. 1300 651 251).
• Suicide Call Back Service Tel. 1300 659 467
• Kids Helpline Tel. 1800 55 1800.

How do I know if someone is self-harming?

It can be difficult to recognise whether someone is self-harming as many people who self-harm keep it a secret. Trust your instincts, especially if you think they are distressed or in trouble. Some signs may include:

• new marks on the body (such as bruises, cuts or burns)
• withdrawal from friends, family, school and work
• a drop in performance at school, work or activities
• changes in mood, sleep and eating patterns
• avoidance – not attending activities they once enjoyed or avoiding occasions where their injuries will be exposed (such as the beach or pool)
• wearing unsuitable clothing to cover up wounds
• making excuses for injuries or behaviour
• being secretive – hiding sharp or dangerous objects.

Supporting someone who self-harms

People who self-harm need care, understanding and support in order to recover. Stigma from others can be damaging and may stop them from getting the support they need. According to a 2012 report by Orygen (Looking the other way: young people and self-harm), it is thought up to half the people who self-harm never seek help.

If you think someone you know might be self-harming, it is important to try to talk to them about it, and encourage them to seek professional help. Don’t try to force them to stop, as it can make matters worse. Talking to people who self-harm about their behaviour can be safe and very helpful if done in a supportive way.

How to talk with someone who self-harms

It can be difficult to approach someone who is self-harming. If you cannot do it on your own, ask someone else for help.

ReachOut and eheadspace have some helpful advice on how to start a conversation with someone who self-harms. Try the following suggestions:

• Ask them how things are going or how they are feeling.
• Let them know you are there if they feel down or stressed.
• Tell them you are worried about them, and why.
• Ask if they are thinking about suicide. If they are, or you think they might be, call your local hospital or mental health service. Or call a helpline such as Lifeline (Tel. 13 11 14) or SuicideLine (Tel. 1300 651 251).
• Stay calm, listen carefully and don’t judge them. If they seem upset or angry it may just mean they are feeling ashamed or worried about what you might think.
• Encourage them to seek support from a person they trust –such as a GP, teacher or counsellor.

If the person who is self-harming is not ready to talk about it, try another time or suggest they speak to someone who makes them feel comfortable.

Other ways to lower their distress may include:

• distraction – go for a walk, play a game, watch a movie or listen to their favourite music
• diversion – find a substitute action that causes no injury (such as punching a pillow or squeezing an ice cube)
• deep breathing.

It can be helpful to draft up a safety plan or learn mental health first aid so you know what to do in a crisis.

Encourage the person to seek support for themselves, or offer to help them make contact with one or more of the suggested supports.

Support people need support too

If your child, friend or other family member is self-harming, or you think they might be, seeking support from a mental health professional is important for you too. Talk to someone you trust about what’s going on and how you feel. However, upsetting it can be to see a loved one in trouble, remember that self-harming behaviour is treatable and not everyone who self-harms is suicidal.

Self-harming behaviour is treatable

Self-harming is a serious behaviour – it’s a sign someone is feeling significant distress and they’re not doing it to seek attention. Usually they are deeply ashamed and go to great lengths to hide it from others. They may suffer in silence and really need support to open up about how they are feeling.

Although self-harming behaviour can be treated, many people don’t seek support because they:

• think people will not understand
• do not trust their information will be kept private
• do not believe anyone will be able to help
• are afraid people (including health professionals) will react negatively to their self-harming behaviour – perhaps because they have in the past
• are ashamed, guilty or angry about their self-harming behaviour
• believe they should be able to cope on their own.

No one has to cope alone; self-harming behaviour is treatable. Support can include working on recognising triggers, learning how to manage difficult emotions and help with self-care (such as caring for wounds and learning other coping strategies).

For anyone who self-harms, just realising it is a not a long-term solution to problems is a step in the right direction. Once they make a decision to seek support, it’s important that they take it slowly and are not too hard on themselves. It can take time to break the cycle of self-harm and there may be setbacks along the way.

Finding alternatives to self-harm

It can be difficult to break away from self-harm. Treatment will include learning to find other ways to manage intense feelings. By distracting or diverting the behaviour, feelings and urges may become less intense and decrease over time.

The person who is self-harming may like to develop their own ways to distract themselves, or use some of these ideas:

• wear a rubber band around your wrist and snap it when you feel distressed
• eat an ice-cube – the sensation can take your mind off intense feelings
• hold an ice-cube in your hand
• keep a journal and jot down your thoughts
• exercise – it releases endorphins and can help lift your mood
• be mindful – do some colouring, try meditation, relaxation or do a craft activity like knitting or painting
• draw on your body in the areas where you normally hurt
• punch a pillow
• make your environment safe – get someone you trust to take away any harmful objects and keep you away from any places where you are likely to harm
• keep a distraction box – store some things that bring you comfort in a box or bag (such as photos, a favourite toy, chewing gum, fiddle toys, craft). Keep it somewhere handy and explore it when you feel like self-harming.

Who is at risk of self-harm?

People of all ages self-harm, but young people are more at risk. According to the 2015 Australian Child and Adolescent Survey of Mental Health and Wellbeing, around one in ten Australian teens have self-harmed. It is more common among girls than boys, and usually starts around the ages of 12 to 14 years, just after the onset of puberty.

Those who are at increased risk of self-harm include young people:

• aged 15–19
• with a mental health condition or personality disorder
• from Aboriginal or Torres Strait Islander backgrounds
• in immigration detention or juvenile justice facilities
• in out-of-home care
• who live in rural and remote areas
• who identify as lesbian, gay, bisexual, trans and gender diverse, intersex, queer and asexual (LGBTIQA+).

Aboriginal and Torres Strait Islander young people (aged 15–24) are five times more likely to self-harm than non-Indigenous young people.

Why do people self-harm?

There are many reasons why people self-harm. Even for one person the motivation can vary. Some people do it as a way of expressing their distress, taking back control or escaping from situations they find troubling. Others may find it makes them ‘feel’ something when they are numb and devoid of all feelings. Some people find self-harm gives them a sense of relief.

Whatever the reason, self-harm is normally a sign that a person is feeling intense emotional pain and distress.

For young people, many stressful things (stressors) happen all at once. Not only are they dealing with changes to their bodies, they are trying to juggle demands they didn’t have when they were younger (such as study, work, relationships, being more independent and having more responsibility).

Stressors that may increase the risk of self-harm include:

• family breakdown or conflict
• relationship difficulties
• knowing others who self-harm
• having a family history of self-harm
• being bullied
• school or work problems
• alcohol and drug abuse
• past trauma, neglect or abuse.

Personal factors that may increase someone’s risk of self-harm include:

• a previous history of self-harm
• experiencing aggression or violence
• mental health conditions
• low self-esteem
• poor body image and self-hatred
• physical illness or disability
• impulsivity – acting without thinking
• poor coping skills
• difficulties with problem solving.

What are the risks of self-harm?

Although self-harm may bring relief in the short-term, it doesn’t help the person address the reasons they are doing it in the first place. Unless the problems that are causing the self-harming behaviour are addressed, people will continue to use it as a way to cope.

Unfortunately, self-harm can be dangerous – it can lead to serious injury and even accidental death. It can also lead to a higher risk of developing physical and mental health issues, substance misuse and unemployment.

Although most people who self-harm don’t want to die, their behaviour can become more frequent and addictive as they seek out methods to deal with overwhelming emotions. Some people who self-harm have feelings of shame, self-loathing and helplessness and may have suicidal thoughts. Many people who attempt suicide have a history of self-harm.

Where to get help

• Your GP (doctor)
• Counsellor – such as a school or student counsellor
• Psychologist
• Headspace
• eheadspace Tel. 1800 650 890
• Lifeline Tel. 13 11 14
• SuicideLine Tel. 1300 651 251
• Kids Helpline Tel. 1800 55 1800
• ReachOut
• Beyond Blue Tel. 1300 22 4636
• youthbeyondblue Tel. 1300 22 4636
• Mental Health Foundation of Australia Tel. (03) 9826 1422