Why do people self-harm and how should I talk with someone who is deliberately injuring themselves?

Self-injury is a maladaptive coping mechanism that some people use:

• To escape from unbearable anguish
• To change the behaviour of others
• To escape from a situation
• To show desperation to others
• To’ get back at’ other people or make them feel guilty
• To gain relief of tension
• To seek help
• To die

Self-injury can take many different forms which may include:

• Cutting, scratching, or pinching skin, enough to cause bleeding or a mark which remains on the skin
• Banging or punching objects to the point of bruising or bleeding
• Ripping and tearing  skin
• Carving words or patterns into skin
• Interfering with the healing of wounds
• Burning skin with cigarettes, matches or hot water
• Compulsively pulling out large amounts of hair
• Deliberately overdosing on medications when this is NOT a suicide attempt

Adapted from Whitlock et al (2006). Self- injurious behaviours in a college population. Paediatrics, 117:1939-1948.

If you are worried that someone you know may be deliberately self-harming, don’t ignore it. Let the person know that you have noticed their injuries, remain calm without passing judgements.

Self-harming is a coping mechanism, so the focus of your conversation needs to be more on relieving the distress, rather than stopping the self-harming behaviour. Self-harming is not an illness in itself but can often be a symptom of either a mental illness or serious psychological distress which needs treatment. Encourage the person to get professional help or emergency medical help if there is a high risk of permanent harm or death.

Adapted from Mental Health First Aid Australia. Non suicidal self-injury: first aid guidelines. Melbourne: Mental Health First Aid Australia 2008.