hurting themselves

by Claire Laurent

'Cutting myself is such a private thing. I find it hard to talk to other people about how I feel. They don't understand. They think I'm seeking attention – that's the last thing I want.'

© Stockbyte

Deliberate self-harm involves acts such as poisoning, overdosing, cutting or head banging causing some tissue damage to the body. The intention is to cause harm rather than to kill oneself although of course there is a danger that death could result from the act. It is considered to be a deliberate non-fatal act done in the knowledge that it could be fatal.

Self-harm is called many things – self-injury, self-abuse, parasuicide or self-mutilation. The latter expression is not often used because generally the aim of deliberate self-harm is not to maim the body. Self-harm tends to be repetitive. It's not about seeking sexual pleasure, body decoration or even being cool or part of a gang – although this can be a starting point for some who then find relief from the act and so repeat it.

how common is it?

'Cutting was always a very secret thing ... You feel so ashamed, so bad about yourself. You feel no one will ever understand.'

Recent research of more than 1,000 15- to 21-year-olds commissioned by the Department of Health, shows that more than 50% knew someone who had self-harmed. A study in the British Journal of Psychiatry in 1998 of teenagers presenting at Accident & Emergency departments for treatment for self-harm found that every hour three young people self-harm.

However, visits to hospital A & E departments for treatment by self-harming teenagers represent only the tip of the iceberg. A study published in the BMJ in November 2002 found that out of a study of 6,020 teenagers aged 15 and 16 years, 398 (6.9%) reported an act of deliberate self-harm in the previous year, although only 12.6% of these presented at hospital for treatment. The same study found that self-harm was four times more common amongst girls than boys.

'Whether deliberate self-harm is becoming more common or whether it's simply more openly discussed than previously is not clear,' says Dr Rory O'Connor, health psychologist and a member of the suicidal behaviour research group at the University of Strathclyde. It's likely, however, that the figures don't include some who regularly self-harm but find ways to keep this to themselves, not seeking medical help and thereby putting themselves at further risk of scarring or infection.

why self-harm?

'The feeling of wanting to hurt myself would build up. I could put off doing it for a while but I couldn't last forever. I knew I had to get help.'

Dr O'Connor says there are three main reasons why young people self-harm: 'It's a form of communication, a form of problem solving and a form of coping.

'You are trying to communicate intolerable psychological pain, feelings of not being able to cope or feelings of shame, which is common in those who have been abused. They want to make real their mental pain,' he says.

Dr O'Connor says: 'They have tried to solve their problems though other solutions and haven't been able to and they can't think of alternatives. Self-harm can bring them relief from their painful emotions and it is this that can make the act repetitive. They find relief from it and so repeat the act whenever life becomes too stressful to deal with.'

the risk factors

• bullying
• concerns about gender orientation
• personal or family history of mental illness
• personal or family history of self-harming behaviour
• alcohol/substance misuse
• feelings of apathy, anger or hopelessness
• history of sexual abuse
• promiscuous behaviour
• copycat behaviour.

copycats

'Young people copying others who self-harm can be a real problem', says Dr O'Connor. 'There is a danger of it becoming a behaviour that defines a group and that's very worrying. If someone in the gang does it then others in the gang may do it too. It becomes the cool thing to do. The problem is what happens when you up the ante? If you do it once to copy and get a buzz or a rush out of it, a release, then irrespective of your motivation to do it the first time, do you increase the self-harm the next time?' In this way he says that youngsters might continue to self-harm with or without the peer pressure that started it off.

warning signs

While cuts to the body or an overdose seem evidence enough, getting someone to talk about self-harm and to admit they might have a problem is not always easy. And of course, cuts and bruises can be covered up and excused so parents might not be aware their child has a problem.

'Parents need to look out for mood changes,' says Dr O'Connor. While he admits this isn't easy given your average teenager he says parents should watch for whether a young person is functioning fully: Are they sleeping properly? Are they eating? Are they still socialising and doing the things they usually enjoy?

He says parents need to keep lines of communication open and to listen to problems young people might voice. 'A crisis may look minor from the outside but the impact on a young person's wellbeing can be quite remarkable,' he says. See also our feature on depression if you are concerned that your child might be depressed.

A government campaign in England called Read the Signs has been launched to encourage young people to recognise the signs of mental ill health and to try and tackle the stigma that still surrounds it. For more information see help and info.

how to help

'What helped was having someone to talk to who was reliable and didn't rush me. I haven't done anything to myself for ages now. Sometimes I feel like it, but I don't need to do it any more, and the feeling goes.'

Most people who self-harm are unhappy about their behaviour and are likely to feel embarrassed or defensive if questioned about it. It's important to give young people the chance to talk, without criticising their self-harming behaviour.

'We should be training our young people in how to engage in positive mental health strategies,' says Dr O'Connor. 'They don't know how to cope with the changes and challenges of modern life.'

To do this young people need to know how to express their feelings in more appropriate ways and to be encouraged to find solutions other than self-harming. Going for a walk or playing sport can help channel anger, while drawing or writing about how they feel can be relaxing. Dr O'Connor says it's important for parents to boost their child's self esteem, giving verbal praise and helping them set achievable goals. He says parents need to check they're giving supportive messages and not creating unreasonable expectations for their children.

treatment

The first port of call for treatment is likely to be your child's GP. He or she will refer them on to specialist mental health services such as a clinical psychologist or perhaps to the practice counsellor. However, you may find the school has a counsellor who is in touch with the sort of pressures your child faces and can help them deal with some of them, or the school may refer them to an educational psychologist. It depends, says Dr O'Connor both on what's available and the cause of a young person's self-harm.

Cognitive behavioural therapy (CBT) may be useful to help a young person think positively and develop new and more positive ways of responding to stress. For more information see our feature on cognitive behavioural therapy.

Thanks are due to YoungMinds for permission to use quotations from their publications in this feature.

help and info

Channel 4 is not responsible for the content of third party sites.

You might like to check out a feature which also discusses self-harm, focusing on adults rather than children.

organisations

Basement Project
PO Box 5
Abergavenny
NP7 5XW
Tel: 01873 856524
Website: freespace.virgin.net/basement.project/default.htm
A community resource providing support groups and helpful low-cost literature for individuals. Has a particular focus on abuse and self-harm.

ChildLine
45 Folgate Street
London E1 6GL
Helpline: 0800 11 11 (24 hours)
Textphone: 0800 400 222 (Mon-Fri 9.30am-9.30pm; Sat-Sun 9.30am-8pm)
'The Line': 0800 88 44 44 (Mon-Fri 3.30pm to 9.30pm; Sat-Sun 2pm-8pm. NB: this is a special helpline for young people living away from home)
Website : www.childline.org.uk
UK's free, 24-hour helpline for children and young people. Trained volunteer counsellors provide comfort, advice and protection. Lines can be busy so please try again if you don't get through the first time. Young people can also write to the following freepost address: ChildLine, Freepost 1111, London N1 0BR.

National Self-Harm Network
PO Box 7264
Nottingham NG1 6WJ
E-mail: info@nshn.co.uk
Website: www.nshn.co.uk
Campaigns for a better understanding of self-harm and provides a free information pack. Contact NSHN if you are worried because you self-harm or you are close to someone who does.

Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org.uk
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website).

Young Minds
102-108 Clerkenwell Road
London EC1M 5SA
Tel: 020 7336 8445 (Just for info and publications)
Parents Information Service: 0800 018 2138 (Mondays and Fridays 10am-1pm; Tuesdays, Wednesdays and Thursdays 1-4pm)
Email: enquiries@youngminds.org.uk
Website: www.youngminds.org.uk
National charity committed to improving the mental health of all children and young people. Campaigns for better provision of child and adolescent mental health services. Provides information to anyone with concerns about the mental health or emotional well-being of a child or young person. Can give information on mental health issues, and details of local and national advice services. Leaflets for young people, and other helpful information are available on their award-winning mental health site.

Youth Access
1-2 Taylors Yard
67 Alderbrook Road
London SW12 8AD
Tel: 020 8772 9900 (Mon-Fri 9am-1pm, 2-5pm)
E-mail: admin@youthaccess.org.uk
Website: www.youthaccess.org.uk
A national membership organisation for youth information, advice and counselling agencies. Provide details of and referrals to local youth agencies and counselling services for young people aged between 14 and 25, but do not offer direct advice.

websites

Warning: some of these websites may contain 'triggering' material; please make yourself safe before visiting them.

Child & Adolescent Self-harm in Europe (CASE) Study
www.ncb.org.uk/projects/project_detail.asp?ProjectNo=145
A European multi-centre study in the field of child self-harm to provide better information on the scale and characteristics of the problem. Coordinated through the Research Department of the National Children's Bureau.

Deliberate Self-Harm In Young People
www.rcpsych.ac.uk/.../self-harminyoungpeople.aspx
Factsheet from the Royal College of Psychiatrists. Part of the Mental Health and Growing Up series of factsheets available on the website.

Project SPEAR
www.projectspear.com
This website has been produced to encourage and support those who are struggling with personal issues including self injury. Support materials, personal stories, advice and experience are offered for those who want help, and for those who want to help others.

SIARI
www.siari.co.uk
Extensive UK resource offering information and support to people who self-harm and their carers. Features self-injury research and references, book lists, poems, artwork, stories, message boards, access to an online support group for helpers and a section for counsellors.

Understanding Self-Harm
www.mind.org.uk/Information/Booklets/Understanding/Understanding+self-harm.htm
Produced by Mind, this booklet is for anyone who self-harms, for their friends and family and the mental health workers who care for them. It should help give readers a greater understanding and knowledge of the condition and of what can be done to help.

Young People and Self-Harm
www.selfharm.org.uk
This website provides information on a wide range of activities and initiatives that relate to young people and self-harm. Includes details of useful contacts and publications.

reading

Children and Adolescents Who Try to Harm, Hurt or Kill Themselves (Department of Health, 2000)
This booklet presents analysis of self-harm reports by parents about their children and by the children themselves. It shows the prevalence of reported self-harm by socio-demographic and psychiatric characteristics of young people as well as family social and economic functioning. Can be accessed free from www.statistics.gov.uk/statbase/Product.asp?vlnk=7373&More=N

'Deliberate Self Harm in Adolescents: Self report survey in schools in England by K Hawton et al. in the BMJ vol. 325 (2002) pages 1207-1211.
Can be read or downloaded as a PDF from http://bmj.bmjjournals.com/

The Hurt Yourself Less Workbook (National Self-Harm Network, 1998)
One of the National Self-Harm Network's recommended books, this is a workbook written by people who self-injure for people who self-injure. It has many exercises to explore self-harm and how your life may be affected by it. It aims to help you understand it better and to be kinder to yourself.
Available to order from www.nshn.co.uk/resources.html#books (£10 for NSHN members, £12.50 for those who identify themselves as people who self-harm, and £25 for professionals and organisations).

Teenage Suicide and Self-Harm (60-minute audio tape & 40-page booklet) by John Coleman, Juliet Lyon and Roz Piper (TSA, 2002)
Aimed at parents and carers, this pack covers issues concerning suicide and self-harm such as recognising the risk, a suicide in the family, and helping distressed young people. It features a list of helpful organisations at the back of the booklet. Available from the Trust for the Study of Adolescence www.tsa.uk.com

What's the Harm? A book for young people who self-harm by Lois Arnold and Anne Magill (The Basement Project, 1997)
This book is helpful for young people (and adults) beginning to explore their own self-harm. Looks at topics such as staying safe, and getting help. Available from The Basement Project http://freespace.virgin.net/basement.project/

(February 2003, resources updated December 2004)