Self-harm is purposeful injury or harm to oneself. Some people self-harm as a way of dealing with very difficult thoughts and feelings that they can’t cope with in more positive ways. Many young people self-harm and it is thought that around 10% of young people self-harm at some point (NHS Choices June 2015). Not everyone with depression self-harms, and similarly, many young people who self-harm are not depressed. Self-harm can also be a suicidal act although not everyone who self-harms is suicidal. Those who self-harm may be at a higher risk from suicide though.
Here young people talk about self-harming, how it had started, their motives for self-harm and the support they had received from family, peers and professionals. Some young people we spoke with had also experienced suicidal feelings or had attempted suicide and here they talk about those experiences and how to get help if feeling suicidal.
A few people remembered starting to first self-harm at the age of 9 and 10 but most started self-harming in their teens. Those who had started at a younger age, said they didn’t necessarily realise at the time that it was ‘self-harm’ but more just about causing physical pain or as one woman described, “being accident-prone”.
I’ve always sort of as I said, sort of through half way through primary school I found it hard to make friends. I was okay till probably about year 4, so I should probably be I dunno, age 8, which was when a lot of stuff at home kicked off, which was when I, you know, started to feel different and everything started kicking in. So really you know I was, I was self harming from then, sort of the trivial things that people put it, but you know sort of the, I was very in inverted commas accident prone. That I was just you know, I was doing stuff to hurt myself rather than anything else, but it wasn’t picked up on till I was sort of 14 when I started cutting, so. So you know from age 8 onwards I was different as I would term it. You know?
What does accident prone mean?
I suffered a lot of injuries that I passed off as accidents mostly. You know sort of, you’d sort of throw yourself down the stairs with sort of at, I fell. Or you know you’d bang your hand against the wall and go, “Oh no, I just caught it.” You know, you just do stuff or you’d not stop yourself from doing stuff that you could see might happen, that you could easily prevent but you know it was all termed as accidents when I did them so.
Quite a few people also said that self-harm had started off with what they described as harmless “scratches” but had gradually become worse, and more frequent, leading to injuries and for few, permanent physical bodily damage. These people said they had never intended self-harm to become a regular thing but that they had become “obsessed” or “addicted” to it over time. One woman said it was “never meant to go that far” and another that it had just “spun out of control”.
Making sense of self-harm
Young people described how complex self-harming was and talked about the wide-ranging reasons behind their behaviour. Many said they were very aware of the reasons why they were self-harming at the time of doing it, rather than it being a random act.
Many people described self-harm as “a form of control”. For them, it was a way to control or contain what otherwise felt like uncontrollable feelings of upset and depression, or an “overwhelming” life. In this sense, self-harming was like “a bad coping strategy” for young people who didn’t know how else to ease their pain.
It’s addictive. It’s not one of these things you can just stop doing. I think people don’t understand that at all. It’s not as easy as, “Well I shouldn’t be doing that, so I won’t.” Because it’s difficult and it’s not attention seeking. It’s not one of these things that people do to, “Hey look at me I’ve got problems.” It’s, “I need a release; I need some control over something.” Because that’s what it’s for. And it’s not just me who feels that way, it was a discussion I was having at the unit the other day, it’s because everything else just feels so crazy, that way you’ve got some control over something. Even if it’s not exactly the most sensible thing in the world to be doing. A lot of the time, I mean I have attempted suicide in the past, but a lot of the time it’s not as a suicide attempt it’s I need some control. I need to let this out. And I really think that needs to be more understood. Obviously not, it it’s never gonna be one of these sociable, socially acceptable things which is perfectly understandable, but at the same time it should be understood that just because you’re doing that to yourself, you’re not doing it for attention.
Similarly, many also described it as “a release” of pain, upset, stress or anger. One woman said for her, self-harm was the only way to “express her feelings” and another one described it as a way to “let out the pain inside”. A couple of people compared the effects of self-harming to crying; a release of tension and sadness. When they were unable to shed tears they would self-harm. For many, self-harming was closely connected to depression and they said they self-harmed because they felt so low and down. Some said they only self-harmed during depressive episodes and bad periods of life. In turn, scars from self-harm could then make depression worse and make people feel bad or ashamed about themselves and their bodies. Many young people also said that self-harming was like an addiction, and compared it to smoking or drugs.
For some people, self-harming was about punishing themselves and causing pain and injury because they felt so low and negative about themselves. A couple of people said they felt unable to deal with “extreme emotions”, especially happiness, and hence self-harmed, as a way to “balance” out their emotions.
People also pointed out that sometimes, and in some ways, self-harming was a way of to seek attention. They wanted to clearly distinguish between seeking attention for the sake of it, and seeking attention as a way to get help. One man described his self-harming as “cries for help”. A couple of people emphasised that “attention seeking” through self-destructive behaviour is always a problem and maybe the only way for someone to seek help.
It’s the general reaction to it. They completely ignored it at my old school ‘cos I wasn’t the only one that used to self harm. I used to do it in obvious places, but people used to do it blatantly obvious and that was cries for help and I was going to say I don’t see anything wrong with that, but I guess that doesn’t make much sense. I think that if someone’s having to cry out for help that loudly then something has to be done. I think even at the psychiatric unit they don’t really know how to deal with it, because when I came in the other week and my arms were covered in marks the reaction I got was, “Oh you shouldn’t be doing that it’s really bad for you,” [laughs]. That’s really helpful, why didn’t I think of that, thanks guys.” I think that people generally don’t understand mental health and they don’t understand self harm because of that, ‘cos it’s such a common thing and people do it in so many ways, and it’s just, I hate the fact that people associate it with attention seeking. It’s not, of course there are always going to be some people where they just want the, want the attention whatever the cost, but if someone’s honestly having such a difficult time that’s the only way they feel they can let out how they’re feeling, then they need help.
Other people’s reactions
People felt there was a general lack of understanding about self-harm. Many felt criticised and judged for doing it. They had experienced people staring at the scars, whispering behind their backs or openly making fun of them. Many wanted to keep the scars or marks hidden at first but said in time they had learnt to accept them as a part of themselves and their past and didn’t want to hide them anymore. Some had been approached by strangers on the street or in the pub commenting or questioning their behaviour.
I was different and my friends were different and the majority, we were the minority in the school so we’d have like just loads of abuse hurled at us all the time like, dictionaries chucked at us and "Have you goththe time?" and, stupid stuff like that, and I remember one lad turned round to me and he goes, “Who lass, what’s that on your arm?” “Oh it’s nothing; it’s none of your business.” And he goes, he turns round and goes, “I wish my front lawn was like you and cut itself.” And I just looked at him, I just could not but laugh, just thought, “It’s great that you’ve got to pick on somebody for having something wrong with them. You wouldn’t pick on somebody in a wheelchair why pick on somebody that self harms. It’s the same thing. If anything you’ll probably gonna, I know self harm’s not, got nothing to do with killing yourself but like you’re going to drive them into doing it more aren’t you, you’re just making the problem worse” but…
People got really invasive and wanted to know constantly what was wrong. And the school would always phone my parents up and say, “Sarah’s got marks on her arms,” and as my parents would ask me, “Oh I hurt my arms, I hurt myself in woodwork ‘cos I’m clumsy.” So I always did have like bruises and that but I just said, “Oh I’m clumsy,” oh I’ve done this or I’ve done that, and they believed it.
That’s when it really started going wrong and I realised I could get away with it and I realised that nobody noticed how I felt and nobody really cares if like, it’s obvious what’s happening so why is nobody doing anything about it, so I thought why should I try to stop it if nobody else is gonna? Why should I care?
See 'Brief Outline'
Mandy' There was this thing on one of the forums this summer, we were going to a music festival, and they said, you know, “Oh you can see all these Emos with like cuts and scars on their arms.” And I just replied going you know, not everybody who has cuts and scars on their arms are gonna be Emo, you know, I don’t like that sort of music, am I Emo? I don’t have hair like that, am I Emo? I don’t you know wear this, does that make me Emo? So I got quite a healthy reply actually from a couple of other people who said well, “I didn’t have the courage to say that, but I’m exactly the same you know. I was, I was just going to go round in long sleeves so people didn’t mock me,” But you know that’s the whole point is, they’ve got all these stereotypical views, that we challenge because we’ve now got the confidence to do so.
It’s why we let people ask and why we’re so open. ‘Cos you know we’re just, we’ve learned to accept it, so, if we introduce people to it they might not be as sort of forward and aggressive with people that might not be at that same stage.
Frankie' But most people who seem like to tend judge us like are really depressed, sort of boring like morbid person which we are, but [laughs] we’re a little bit, but it’s a case of you know, if you like if you actually get to know us you should probably see we’re actually quite random sort of bubbly kind of crazy, crazy in a nice way girls. You know.
Frankie' That, that’s just the way it is. Yeah we’ve got issues but that doesn’t affect our personality, you know we just get like this…
Sian' We all have good days and we all have bad days don’t we? Like everyone. Really isn’t it?
Mandy' Averages out in the end.
Why do you think, or where have you got that confidence to be quite challenging of the stereotypes, and people’s preconceptions and all that?
Sian' Probably because we know each other and because we’ve gone through things the same, so that whereas before we went into the units and things, we probably all thought we were alone, but when we met other people the same and you did and you go…
Mandy' “Oh okay, I’m not alone.”
Sian' Think, “Oh there is other people out there.”
Mandy' You kind of just try and go, “I’m not a freak. I can, I can live with that,” you know? And as I said we haven’t really got an option but to live with what we’ve done.
Frankie' If people can’t accept you for the way you are then screw them, pretty much.
Sian' I agree.
Those whose parents had found out about self-harming, said their parents didn’t quite know how to handle the situation. Many said their parents had been really worried for them and also upset when they found out. Some parents had blamed themselves for young people’s self-harming, others had got angry. Many parents had also been very helpful and supportive, trying to speak with young people or help them to go for counselling. A couple of women said their partners or parents had been so desperate for them to stop that they’d tried to physically restrain them.
Cutting didn’t start until I was about 15 although I do remember times in between that were occasionally maybe a scratch or two, or, purposely doing something which I know really hurt. So the cutting didn’t really get regular till I was doing my GCSEs when I was getting really stressed. And it was just, it was it was very regular like, it definitely started off first of all as a coping mechanism because it just became it’s own thing, I was just doing it for the sake of doing it, and then when I got upset I did it even more, so it was kind of at least a couple of times a week I’d cut, the majority of the time it was because I was upset, because I was upset all the time, but if there wasn’t, anything major then it was maybe you know maybe a couple more than usual, and that went on through the whole of GCSE’s and sixth form college. And then because my Mum find out, found out it was quite, you know it was quite, she was upset, it was, you know, “Stop it. Don’t do it anymore.” And I did stop but I did kind of, I stopped cutting my arms, it would just moved it onto like shoulders or legs but it wouldn’t be so obvious, but then when she found that out as well it was kind of, “You know you have to stop this now,” because you know threats of, you know you’re gonna kill us all mentally or whatever, it’s kind of, I just had to, because, and because my parents didn’t like the concept of me going to see a doctor about it, especially Mum, she was like, “You know you’re clever enough to sort it out yourself, just sort it out.”
And, “You know, you’re kind of intelligent enough, you’re, you’re mature enough,” ‘cos I’m the elder sister, then like, “You’re old enough. You, you can do this, just fix it yourself. Like I don’t want to have to worry about this problem with you.” And it’s kind of, “Okay.”
So I, you know I did what I could, I did read about self help things and it was kind of you know so I started writing in a journal, it, it worked but it didn’t work. And even now, if, you know, it take, it might be like six months in between, like the time of one cut and another, but it’s kind of, it’s not, I personally don’t feel like it’s ever gonna go away completely.
Age at interview:
See 'Brief outline'
The only time they [parents] only found out about the depression and the self harming when I went into hospital obviously, and because I’d taken some tablets I had to have a blood test, and you can’t wear long sleeves when you’re having a blood test and so they saw obviously. and they were quite good about it in fact, I was surprised how sort of okay they were, because, because I’ve got eczema as well we had a dermatologist so they booked an appointment straight away and said what can we do about the scarring, how can we make them heal better, and I was expecting them to go completely mad but they were, they were quite good about it.
So they were kind of trying to think what we can do and how we can help, rather than being you know angry?
There was that part as well, but it was initially how we can help her, and then once things were sorted in their eyes there was sort of, “Right why the hell are you doing this”, and so.
Were they sorted in your eyes at that point?
They sorted out the sort of you know the cuts and things, and once, and medically I was fit and well, then it went onto the, “Why are you doing this,” and a more aggressive approach to it, sort of, whereas on the outside I was all healed up, on the inside I wasn’t and I was still you know, I was still self, wanting to self harm and I was still quite depressed, and so getting angry about it wasn’t the way to help.
Some people felt that professionals and even hospital staff were unsure how to handle self-harming or how to best help young people. A couple said their schools had been aware of the self-harm. One person said the school completely ignored the problem whereas another one had great support from college, including flexibility around assignments and deadlines when needed.
A few people also expressed worries about their work prospects and how visible scars might affect their future employment. A couple of them worked with children or wanted to do a course in child care. One woman felt it might be inappropriate for her to work with children who would see the scars and another said in her work she always covers the scars.
‘Cos I was self harming, because it like, I wanted to work with children ‘cos I been to [college name] for two years, and I’ve got NVQ1 and entry level 2, and I think, something like that. And I wanted to go back to college this year and do childcare, but then I’m thinking, well do you know what I mean? Working with kids, having scars on your arms, not really right is it really, do you know what I mean? But I was told when I’m angry, to hold ice in my hands, in the palm of my hands and close it because it will hurt, it will sting, but it won’t leave you marks, it won’t leave any or there’s elastic bands, I was told loads of it do you know what I mean? But I haven’t actually ever tried any of them out.
People described self-harming as something directed internally towards themselves and wanted to dispel the myth that people who self-harm would be a danger or a risk to other people.
Sian' I went swimming, and it’s really hard to go swimming when you’ve got scars on your arms and hands,
Mandy' And your legs.
Sian' Yeah and stomach and everywhere. And I’ve had people pull their kids away from me. And it just feels so bad to have someone pull their kids away from you, as if to say you gonna hurt my kid, I mean I wouldn’t even dream of hurting a kid you know, I work with children, and
Mandy' You wouldn’t dream of hurting anybody else.
Sian' I wouldn’t, I wouldn’t, no.
Mandy' You know it’s not even anger directed at people, it’s anger directed at yourself; it’s a form of a drug.
Getting support for self-harming
Some of the people we talked with felt there was very little information, support and knowledge about self-harm, however there is support available for self-harm. Many people we spoke with said they’d been keen to stop, but the support they received did vary. All the people said they were very aware that self-harming was “bad” for them but it wasn’t so simple to just stop. One woman compared self-harming to smoking and said:
“like smoking it’s an addiction and just saying, “Right I want it to stop now, and that’s it.” It doesn’t really work like that I’m afraid.”
Do you think you realised that it’s a problem and that you needed maybe some support for it?
No. Not, not until it sort of, it did come into the media a little bit like, there were, I saw in the newspaper like reports that this amount of young people do it and things like that. And then I sort of thought, oh yeah, oh yeah it’s really bad. And then it, when it got worse and it looked bad I realised, like ‘cos it started so small it didn’t. So, I don’t know. I didn’t realise what I was doing was, I knew it wasn’t right but I didn’t realise it was a problem. But, I think there’s quite a lot out, out there like to help with depression, but self harm’s a bit taboo still. Like, no-one really wants to talk about it, and help you with it I don’t think.
Many wanted to keep self-harming a secret and hide it from family members, for example. A few said they themselves hadn’t seen self-harm as a problem straightaway but only much later. Several people had looked for help, but said that stopping self-harming had been difficult and often a long process. One woman said that after years of resorting to self-harm it was very hard to learn to “cope without it”.
But like with my self harming I’ve done well ‘cos that’s one thing that I wanted to start on, I don’t want to self harm anymore. ‘Cos obviously it’s a scar for life really. But you know I stopped doing it, I ain’t done any yet, and I don’t want to do any more.
What do you think has helped you stop that then?
I’ve just put a stop to it. Like I just thought one day look, I’m gonna, ‘cos someone said to me the other day that I didn’t realise I’m going to walk up an aisle one day, getting married, the best day of my life, and then people would look at all these scars on my arms, and I don’t, I didn’t want people to look at me and think, they’re not, they’re not the best things to look at. But…
Yeah. So you kind of made a just a conscious decision yourself that I don’t want this. Does it make you feel good to think that you’ve been able to do that?
Yeah, but there’s sometimes I think it’s not gonna last. Like I could still, I could still do it. But I just got to have that, that hope that I’m not gonna do it.
There were tips the people had been given to help them to try and control the urge to self-harm. These included squeezing an ice cube in their hand or flicking themselves with rubber bands. Some people found that distracting themselves by, for example, listening to music, reading or going out helped them occupy their mind so that they weren’t consumed by thoughts of self-harm.
It’s calmed down at the moment, I’m 19 at the moment and it’s calmed me down. But it was worse, the worst year I had was last year and the year before, that was terrible I felt like self harming which, my way of getting, my way of coping with that now is when I feel angry and frustrated I listen to music, I put my music on, now I’m into metal and rock, so you can imagine what it’s like when I’m depressed. So I put my music on and that’s, that’s how I cope with it. And then after I start listening to my music for a while or sang along to it, my frustration and anger usually goes away. And then after that I don’t feel like self harming. So I know that’s a weird way of coping with it, but it, you know it’s my way of coping with it. I think everybody has a different way of coping with things.
Yes, well the important thing is you’ve found something that works for you.
I think I found that when I was 16. When like you know, I was 16 I thought, oh, so angry and feels like metal and rock is like shouting and screaming. Like I felt like you know my anger is gone listening to that. And it’s been like that ever since.
Some had been to counselling for depression and had been able to process the issue of self-harm too but said they were given no information specific to self-harm. A few had also looked out for information actively themselves, read self-help books and a couple of people had found good support websites and forums for people who self-harm. However, one woman also pointed out that going on the websites sometimes got her down and made the urge to self-harm worse rather than better.
I think there’s a lot of information available about depression because it’s quite a common thing, apparently sort of 1 in 4 people have some kind of mental health problem during their life, and it normally is depression. But you don’t get any information about sort of how common it is so, but the idea that you being alone in it still exists. It was only afterwards that I found out that it was quite common, and you know the self harm thing that sort of 1 in 10 people do it, ‘cos I’ve never known anyone else to do it.
A few young people we spoke with had experienced suicidal feelings or had attempted suicide. Some described having suicidal “thoughts” or “urges” but said they would never act on them. For them, it was more an aspect of their negative or pessimistic mindset. Some described suicide attempts more as a way to harm or hurt themselves than to end their lives, and a couple of people compared a suicide attempt to self-harm in the sense of attempting to exercise control over their life.
A couple of the people who had attempted suicide made a distinction between those attempts which were serious “cries for help” and the ones when they had really wanted to end their lives. Those who had attempted suicide several times said it had become a cycle, and they often ended up back in the A&E.
I think everything just kind of just piled into one, just got on top of me and that was it, I just thought “I can’t live anymore, blah blah blah blah,” and I just, I just tried to kill myself but, I think there was just something inside of me that said, just saying no. I think it was more of a cry for help and I wouldn’t do it, and I called, well I think I texted my Mum and Dad, and I told them what had happened and they both come home and they said, they said that I needed help, and after that we started calling hospitals and, and yeah I went into [hospital name], or the local hospital an stayed in there which wasn’t nice. It was [hospital name] mental unit that I stayed in for a while, again which wasn’t nice. Saw some unpleasant things in there.
People who had suicidal thoughts described having felt “utterly hopeless”, like they lacked a future or the desire to live. A couple had had a “breakdown” or felt that they’d struggled a long time and had “had enough”. Some said they felt like a “burden” or “baggage” to others. For most, a suicide attempt had been an accumulation of several things going wrong at school, at home and in relationships. For some, it had involved problems with alcohol and drugs and long term depression.
The process of getting over suicidal behaviour had been long and gradual but successful for many. Most had been admitted to hospital, for emergency crisis care as a minimum, or for a longer stay on the ward. People pointed out that it was the underlying urges of suicidal thoughts which needed to be tackled, rather than just the acts themselves. This way they had felt able to regain control over their lives and to rebuild their lives. Taking the first step to get the help and speak about what they were feeling had been the hardest but the best step young people said they had taken.
The next thing I remember her [GP] saying, ‘cos she was talking quite a lot over the phone, she said, “Oh yes, I did hear about so and so. Unfortunately yes she did commit suicide.” And, she said, “It’s such a shame ‘cos yeah she was a lovely girl.” And I sat there and I thought, oh my God. It just sort of like everything just whoooom…. just brought me back to where I was. And I thought… and that was all they said. And I thought, oh my God, this person there’s somebody else has committed suicide, that’s probably in the same or similar boat to me, that’s obviously suffering with depression. Don’t know what their story is, I don’t know whether they got help, I don’t know how far they’ve got, but they’ve committed suicide. And do you know what, they’re just gonna end up a statistic. That’s all they’ll be, a statistic.
And, I sat there and thought, is twenty odd years of what I’ve gone through, worth being a statistic? If I commit suicide, I’m just gonna be a statistic, I’m gonna be a fading memory. I’m not gonna have left my mark. Like, you know, why was I born? What, you know, what am I here for, I’ve got a purpose in life. I just….. ‘cos I haven’t found it yet, just because I’ve had a bad start doesn’t mean things can’t be different. So I sort of came round to the idea myself. But it was literally based on her having that conversation with somebody over the phone. I mean, if I hadn’t heard it, I probably would have said things would have been very different. But, something in what she said made me think, I don’t wanna be a statistic. And it’s the first time I’ve ever thought it.
Age at interview:
See 'Brief outline'
So I took them and I was, I had to be like put to sleep and stuff because the, the combination of the medications like affected my brain and it was, when they put me to sleep like it was either I woke up as a cabbage or not, so it was like, it’d got really, really bad to that point and I was in you know a critical unit for like 20, 48 hours. So, and then after when I came round and staff and they told me and I think that must’ve like woken me up and think do I really want to do this, ‘cos I’m, I would have probably ended up in a wheelchair paralysed or you know like, you know a vegetable or something like that, and that’s sort of, I think that’s sort of made me think twice about what I want out of my life and stuff.
And so I was like well I need to like, you know there’s people up there who want to have a life and here I am, I’m 18 years old and I want to do something with my life.
Age at interview:
See 'Brief outline'
My rationale with the suicidal feelings which I hope I never get again, but the likelihood is I will, that seemed like the perfectly reasonable rational way of sorting out the cure, ‘cos I was trying all these meds, I was doing all this, I was doing everything I was told to do, and it still wasn’t going. And I, you know they bandy the word “hopeless” around, I genuinely was hopeless. Like I could not see any way through, you know, and I couldn’t stand the idea that that would be my life. ‘Cos to me that wasn’t worth, a life worth living, but that’s why I was saying you’ve got to keep shouting at people until somebody listens, and somebody comes up with an idea, you know ‘cos otherwise you might die, and then the next day someone comes up with a brilliant idea that could’ve really saved you. You’ve got to just hang on, because it does get better.
Age at interview:
See 'Brief outline'
And the next morning, apart from feeling quite dreadful and hung-over, you know I was still here, but I took that as a sign, actually it turned into something quite positive and I thought to myself, “Well it didn’t work so you’re supposed to be here,” and I tried to draw strength from that and I thought you know, if it would’ve, if it was supposed to have worked then it would have. And I felt almost like I’d been given a second chance, so I thought okay, well you know this obviously isn’t the answer. And, that, then really just tried to seek help from the GP’s, and you know, and realised that I did have a problem and just be more open about it to everybody, to friends to family because no-one’s gonna know what’s going on in your head unless you, you know, you have to speak about these things. You have to. It might be hard, but you know no-one can understand what you’re going through, unless you speak up.