About self-harm
Self-harm or self-injury is the direct, deliberate act of hurting or injuring your body. Often this is done as a way to cope with intense difficult emotions, overwhelming situations and life events. This does not necessarily mean wanting to die, but instead is a response to emotional pain or an attempt to communicate how you’re feeling to others.
Self-harming is not uncommon, and there are many reasons why people self-harm. It does not mean you are weak, crazy or attention-seeking. It may mean you are overwhelmed by how you are feeling right now, and this is a way you hope will help you feel better. You might also self-harm because you want to punish yourself, because you are feeling emotionally numb or not connected to reality and want to “feel something”, or because you want to feel part of a community.
Self-harming can start out with minor harm, but over time can become much more dangerous and even life-threatening. You may find it makes you feel better for a while but does not prevent the feelings coming back. If your self-harm is impacting on your physical, emotional or relational wellbeing, it is important to get help so you can work towards finding new strategies.
What did I need to know? I needed to know that I was not bad, I was trying to survive and communicate, and I could learn new ways. I needed to know that I was not to blame, and that this was not an indication of there being something wrong with me; rather, I was facing some really hard life circumstances. That other people face this and have learned new ways of doing things.
Who is most at risk of self-harming behaviours?
Throughout our lives, we all develop ways of self-soothing or dealing with strong emotions. Many of these techniques involve injury or risk to the person doing them, e.g. using drugs and alcohol, binge eating or limiting food, or practising unsafe sex.
The type of self-harm discussed on this page is more common in young people, but anyone can be at risk of self-harming behaviours. Women are more likely than men to be hospitalised for self-harm. Self-harm can be linked with different kinds of difficult emotions, or overwhelming situations and life events. There is no clear reason why some people self-harm and others do not. It can be connected with difficult experiences including:
- pressures at school or work
- bullying
- money worries
- physical, sexual or emotional abuse
- childhood trauma, abuse or neglect
- bereavement or grief
- lack of support or acceptance of your sexuality or identity
- relationship breakups or losing friends
- problems in connection with family, whānau, friends or community
- an illness or health problem
- intense or difficult feelings, such as depression, anxiety, anger or numbness, that might be experienced as part of a mental health condition
- feeling you do not have the words to describe what is going on for you.
I have found it useful to understand that everybody does some form of self-harm across their lives. There are some forms of self-harm that society accepts and others that it does not. Understanding that has helped me not feel so weird.
Tell someone what is going on
If you self-harm, you may feel embarrassed about it, or worry that other people will judge you or try to make you stop if you tell them about it. Many people who self-harm keep it a secret for this reason.
If you’re harming yourself, it’s very important to talk to someone you trust. If you don’t want to talk to your health professional or someone you know, you can call a helpline where you will remain completely anonymous yet be able to talk to someone who understands what you are going through.
Treatment options
When you are ready, the best thing you can do to stop self-harming is to talk to someone. Speak to a doctor, counsellor, peer support person or other mental health professional. They will listen to you in private and ask some questions about you and your situation.
This is so they can help you and, together, you can develop a plan of action for changing the self-harming behaviour and look at any underlying mental health issues.
If you have harmed yourself and are taken to hospital you will be seen by doctors who will help you while you are there. They may refer you to specialist mental health professionals when you leave hospital.
The kinds of treatment options that your health professional will discuss with you include:
Talking therapies and counselling
Supportive counselling helps many people who self-harm to understand what the underlying issues are around their behaviours and to develop strategies to cope differently.
Talking therapies such as Cognitive Behavioural Therapy (CBT) can help change the thoughts that lead to self-harm. Your therapist can help you understand your patterns of self-harm and recognise causes and triggers. Therapy can also help explore the underlying issues more deeply. Finally, it will help you learn different strategies to cope and problem-solve, and to build long-term wellbeing.
It has been helpful for me to learn to frame self-harm as an attempt at self-care, or a self-soothing strategy. I learned to look at wholebeing care strategies – caring for my hinengaro, wairua, tinana and whānau. I learned strategies that were caring for all cornerstones, and supported me across time.
Medication
If you are dealing with underlying issues such as depression or anxiety [links], your doctor may prescribe medication. Finding the right medication can be a matter of trial and error – there is no way to predict which ones will be effective or well tolerated (have fewer troublesome side effects).
Even if you are pregnant or breastfeeding, medication might be an option. It is best to discuss with your health provider what might be on offer for you.
If you are prescribed medication, you are entitled to know:
- the names of the medicines
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for
- what their side effects (short- and long-term) are
- what the process of stopping taking them (withdrawal) could look like.
If you are unhappy with the effects of your medication, make sure you talk this through with your doctor and make a plan to change gradually.
I think the most important thing to me was getting to a place in my own head when I felt I was ready and wanted to stop. Once I came to my own understanding and my mentality shifted around self-harm, it became very easy to stop.
Other strategies to help you stay well
- Keep taking any medication your doctor has prescribed for you
- Keep attending all your appointments with mental health professionals and any other support people
- Look after yourself – get enough sleep, eat good food and exercise
- Discuss with your health professional and your family/whānau if you can reduce stress in your life – for example, taking a break from study or working part-time
- Cut down on or stop taking alcohol and recreational drugs
- Keep your home safe – get rid of pills, weapons etc that you could use to hurt yourself
- Try complementary therapies – relaxation, mindfulness, yoga, exercise, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress. Find what brings you joy, and do it regularly.
- Stay connected with your whānau and friends. Sometimes we are embarrassed to let people know what’s going on, but loneliness can make things worse. Connection, awhi and support from others will be a great help.
When my self-injury was able to be seen through the lens of me trying to do something good for me, it changed the story about me around being broken. This shifted the blame and gave me faith that I could change. These words simplify what is a complicated process and an ongoing practice for me to manage my experiences.
Worried about someone else?
If you have noticed scars, marks, or behaviours in someone that concern you, but you are not sure whether the person is self-harming, talk to them. Ask them if they would like to talk about what’s going on for them and be patient.
Remember they might not want to open up straight away, but letting them know you are there for them is a big help. Show them you care and that you are concerned. Make sure they know you will not be angry, and they are not in trouble – you only want to help.
Many people who self-harm will try to keep it a secret. Although there can be obvious signs, such as exposed cuts or burns, or attempts at overdosing, many signs are less obvious.
They can include:
- unexplained injuries, such as scratches or burn marks
- health complaints such as stomach pains and headaches
- wearing clothes inappropriate to conditions, e.g. being covered up all the time, even in summer
- avoiding situations where they have to expose arms or legs, e.g. swimming
- dramatic changes in mood, especially in adolescence, or in adults with previous history of self-harm
- changes in eating and sleeping patterns
- losing interest in friends and favourite things, and withdrawing from activities they used to take part in
- breakdown in regular communications with family, whānau or friends
- washing their own clothes separately
- problems with relationships
- low self-esteem
Warning signs in young people
Many young people who think about self-harm have experience of depression, so it’s important to recognise the signs of depression in teens:
- excessive irritability or change in mood
- boredom
- seeing their friends less often
- dropping out of regular activities
- lowered grades or interest in schoolwork.
Teenagers can be more at risk of depression and suicide if they have family members who have depression, live in difficult family environments, or drink excessive amounts of alcohol or experiment with drugs.
Depression can also express itself in being aggressive or impulsive. Children who have no or few friends, and some very high achievers who may be under pressure to do even better, are also at risk.
Supporting someone who is self-harming
If someone tells you they are self-harming or they want to hurt themselves, take them very seriously.
- If they are seriously hurt or have taken any poisonous substances, get help immediately. Call emergency services on 111 and ask for an ambulance to take them to the emergency department (ED) at your nearest hospital.
- If you are worried they might be suicidal, ask them. It could save their life. Asking about suicide will not put the thought in their head.
- Ask them directly about their thoughts of suicide and what they are planning. If they have a specific plan, they need help right away. If the person is feeling unsafe, or you think they are at high risk, don’t leave them alone. You could ask someone else to be with them when you need to leave or need time out.
- Ask them if they would like to talk about what’s going on for them, and be patient. Remember they might not want to open up straight away, but letting them know you are there for them is a big help.
- Support them to access professional help, like a doctor or counsellor. Go with them if possible and if they are okay with that.
I found having the support of a family member helpful when going through services, as it’s not something I could have done alone in my youth. Services may have changed now, but when I was younger, they felt very overwhelming and intimidating.
How to support someone's recovery
To support someone who is building new coping strategies, away from self-harm, it’s important to identify both the support they need and the support you need to be a source of strength for them. Know that you can’t do everything, and you don’t need to deal with this by yourself – it’s okay to ask for help.
- Be prepared to be there, offer support and stay involved. Keep talking to them and don’t avoid talking about the hard things in their life, even if those conversations are difficult.
- Find ways to support them when they are feeling especially overwhelmed. Don’t ignore or try to distract from the feelings.
- Rather than asking if they are safe with themselves and what you can do to stop them from self-harming, focus on the feelings – ask how big their feelings are at the moment and what you can do to support them.
- If they don’t want to talk with you, ask other people you both trust to support them – friends, family or whānau members, youth workers or others.
- Help them to access professional help, like a doctor or counsellor. You could offer to go with them or help them to make an appointment.
- If they would like you to, help them to make a plan of different ways they could cope when they feel the need to hurt themselves.
- Let them make their own decisions about reducing or stopping their self-harm.
- Try to understand why they are self-harming, rather than judging their behaviour. Listen to them and ask for clarification where needed. Don’t assume that self-harm means they want to die – often, self-harm is evidence that they want to live and are trying hard to manage difficult emotions.
- Encourage and support them to do what they enjoy and connect with others.
- Accept them for who they are and let them know you care.
- Support them to make plans for their future, solve problems and set goals.
- Be open about your own struggles and ways you have learnt to care for yourself. Let them see you using these strategies.
- Help them to see their own strength and their own value in your relationship. This might mean giving them the opportunity to support you and contribute to your wellbeing. Be open to learning from them, and tell them what they have taught you about dealing with hard times.
Looking after yourself
Supporters: caring for yourself
Remember to take care of yourself when you are caring for others.
- Make sure you’re getting enough sleep, eating properly and exercising.
- Be kind to yourself. Being in this situation can be very difficult, and it’s okay to feel fear and worry. Take time out when you need to – you can’t do everything.
- Find someone you can talk to about this – a friend or family member you trust, or a counsellor.
How to build a support network
It’s important to involve others to help you and the person you’re supporting – don’t try to do everything yourself.
To build a support network:
- Ask the person you’re supporting to tell you what they need, what works for them and who should be involved. The support network might include elders, kaumātua, kuia, spiritual leaders or community groups they’re part of, as well as friends, family and whānau.
- Bring the group together in a safe space. Let people know some of the context for the meeting in advance – try not to surprise them with new information that you know they will have a big reaction to.
- Talk openly and honestly about the situation. This can be difficult – it’s okay to take it slowly.
- Develop a plan together to support the person – identify how different people can help. Get professional help if you need it. Talk to your local doctor, medical centre, community mental health team or counselling service.
Thanks to Joanna Macfarlane, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.