What is deliberate self-harm?

Deliberate self-harm is any act by an individual with the intent of harming him/herself physically and that may result in some harm. For example, you may cut or burn yourself, with the intention to cause pain and injury to yourself, or you may poison yourself with drugs with the aim of making yourself ill or die. Taking drugs to self-harm is different to taking drugs for pleasure because the reason for doing it is to cause harm to yourself.

Some people think of self-harm as a continuum, with suicide at one extreme, and no self-harm at the other end while in between are serious harm, moderate and minor harm. However, other people think of self-harm as quite different from suicide or attempted suicide. This difference in approach seems to be because they think of the reasons for self-harm as different from the reasons for suicide, or perhaps that people who commit suicide have sought to end all feeling, while people who have self-harmed have just tried to make themselves feel better. For the purpose of this fact sheet we will consider self-harm as distinct from suicide; - we use the term self-harm to refer to deliberate harm to yourself but where the aim is not death.

Who self-harms?

An estimated 1 % of people in developed countries self-harm. Some people are more likely to self-harm than others. This includes:

• Young people between 15 and 25 years

• Women

• People of Asian origin

• People who are dependent upon alcohol or street drugs

• People with psychiatric disorders including depression, bipolar disorder, personality disorder and schizophrenia

• People who have a strong dislike of themselves

• People who are very sensitive to rejection

• People who have a lot of pent-up anger

• People who tend to be impulsive

• People who have few effective coping strategies

• People who feel that their lives are out of control.

Why do people self-harm?

The usual reason seems to be the need to seek relief from unbearable emotional distress. This is quite different from Munchausen's syndrome, where people with the condition cause harm to themselves in order to achieve a specific physical symptom and often to get hospital admission to a medical ward.

Each person who self-harms has his or her own reasons for doing it. Often it is a coping mechanism that helps you deal with the pain and distress caused by life's problems. The reasons for self-harm suggested by doctors and other professionals are often different to those put forward by service users. For example, many professionals believe that self-harm is often a cry for attention but many service users strongly disagree with this and say that the main reason is that self-harm is the only way they can express the distress they feel. Some reasons why you self-harm may include:

• Feeling it is the only way to express your distress

• Needing relief from strong emotions such as anger

• Finding that self-harm relieves tension and distress

• Wanting to escape from certain situations in life

• Wanting to escape from feelings of numbness

• Wanting to change something in life

• Wanting or needing attention

• Wanting or needing to manipulate other people

• Pressure from friends (e.g. to show how tough you are or to fit in with the crowd)

• To follow the example of role models (e.g. pop stars).

Some doctors and other professionals think of self-harm simply as a behaviour, resulting from other difficulties. However, others suggest that it is a psychiatric disorder involving problems with perception, thought, emotions and/or behaviour. Many people who self-harm have signs of other psychiatric disorders such as depression, psychosis or personality disorder. Some research suggests that low levels of a substance in the brain called Serotonin may be involved with self-harm (Winchel & Stanley, 1991).

Do people repeatedly self-harm?

Research suggests that if you have self-harmed before then you are likely to repeat some form of self-harm. One study found that within two years 11 % of patients who self-harmed went on to self-harm again (Isacsson, Wasserman & Bergman, 1995). They also found that 2 % of people who self-harmed went on to commit suicide within two years. Approximately 10 % of people who self-harm go on to commit suicide within ten years. So if you have self-harmed you are at risk for self-harming again unless you get appropriate support and treatment. Remember that there is support and treatment that will help you.