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Dr Sally Marlow

Self-harm seems to be everywhere, but there’s very little information around for the public on what it is and what to do about it.

It’s an area which raises many questions for people: who does it, and why?

Dr Sally Marlow, Impact and Engagement Fellow at King’s College London, explores these questions in Â鶹ԼÅÄ Radio 4’s Hurting, and discovers that the answers aren’t always obvious.

When it comes to self-harm, society is quick to blame social media, but that’s only part of the story – the reasons why people self-harm are many and complicated, and if society is to support those with self-harm, we need to look beyond the physical wounds and understand the extreme levels of distress that those who hurt themselves often feel.

What is self-harm?

Self-harm is not a mental illness itself, and the term self-harm covers more than cutting, which is the behaviour which most often comes to mind. In the UK self-harm is defined as any “intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act”.

There’s quite a lot to think about in that description. First, the person harming themselves has to intend to do it, rather than it be an accident. Then, there are a range of acts which fall under the definition: self-poisoning could include overdosing on medications, or ingesting toxic substances.

Self-injury is wider still. As well as cutting, it includes other acts such as pulling out hair, scratching and picking at skin, burning; and actions which can be more violent such as punching or banging heads against walls. Finally there is the bit of the definition which covers motivation, and this covers acts where the motivation was to end life, as well as acts which do not.

Who self-harms?

Currently around 200,000 people a year turn up at Accident and Emergency departments having harmed themselves, but this is the tip of the iceberg – most people who self-harm do not go to A&E. In the UK some estimates for the number of people who self-harm each year are as high as 20 times this number, ie four million.

What’s more, the stereotype that teenage girls and young women self-harm is not helpful. Whereas a few decades ago, hospitals would typically see three women to every one man who self-harmed, today men self-harm in almost equal number to women, with one man for every 1.2 women.

Also we know that more and more people are self-harming. Studies suggest that rates nearly tripled between the year 2000 and 2014, especially in women aged 16 to 24 – with a staggering one in five reporting in 2014 that they’d self-harmed. But it's not just young women. Self harm happens across all ages and genders.

There’s no single answer to why people self-harm, but there are some underlying things which make people more likely to hurt themselves. Some people who self-harm have a mental health problem like depression or anxiety, but most do not. People who have experienced trauma are more likely to self-harm, as are those who have experienced discrimination, such as those in the LGBTQ community, as we also know that people who are socially isolated are more vulnerable.

Some researchers believe that deprivation, poverty and austerity make people more likely to harm themselves, and the recession could explain the recent rise in numbers of people self-harming. There is also a theory that social media may be contributing to the rise, and there have been a number of recent tragic high-profile cases including 14-year-old Molly Russell, who took her own life in 2017 after viewing graphic images of self-harm on Instagram.

It's important to say that not everyone who hurts themselves wants to end their lives. However, if a person goes to A&E having self-harmed, they are then 30 to 50 times more likely to complete suicide than people in the rest of the population. Furthermore, half of all people who die by suicide have a history of self-harm.

What is going on for people at the moment they harm themselves?

Many people report that their emotions have become overwhelming and unmanageable at the point at which they hurt themselves. They describe extreme distress, and being unable to find any way to relieve that distress. Sometimes this might be a result of relationship difficulties or arguments, but at other times the triggers could be other things such as academic pressures, or work stress.

Many talk of not knowing how to articulate their distress and ask for help, turning to self-harm to communicate to the world the hurt no-one can see on the inside, by hurting themselves on the outside where it can be seen. A common attitude is to dismiss those who self-harm as doing it for attention. However this minimises how desperate those who self-harm often feel, and ignores the fact that people who self-harm need help and support.

The good news is that nine out of ten young people who self-harm will have stopped by the time they are adults. However, for those who continue to self-harm into adulthood, the pattern of behaviour can become severe, and often can be linked to a mental illness called Emotionally Unstable Personality Disorder (this used to be known as Borderline Personality Disorder).

There are treatments which work for this group of people, such as Dialectical Behavioural Therapy, or DBT. This helps them work on their thoughts, feelings and behaviours, so that they can manage intense emotions and relationship difficulties, understand why they have been self-harming, and find other strategies instead. However, DBT is not available everywhere, and only those whose self-harm is considered severe will be referred for this type of treatment. Moreover, waiting lists are long, despite the fact that delays in treatment can often exacerbate the problem.

What can we do about self-harm?

The first step is for society to suspend its judgements on people who self-harm, and instead have understanding and empathy. Self-harm often brings with it secrecy and shame, and stigmatising those who self-harm makes the problem even worse. The evidence tells us that by intervening early we can help those who self-harm to find other ways to manage their distress, and there may be a role for schools and colleges in providing support.

Social media could be harnessed for the good rather than the bad, by creating virtual therapeutic spaces, available any time of day or night. We also have evidence-based treatments for those whose self-harm is more severe and persists. However, as with so many areas of health and mental health, resources are lacking, and that, coupled with the negative attitudes many in society have towards those who self-harm, mean the majority of those who need help don't get it.

For help and advice...

• Visit the Â鶹ԼÅÄ Action Line page for information and support for issues covered in our recent programmes.
• If you, or someone you know, has been affected by self-harm, visit this page to find organisations which may be able to help.
• If you, or someone you know, is feeling emotionally distressed, visit this page to find organisations which offer advice and support.