Self-injury: understanding it and getting support

The NHS keeps its description simple: self-harm is when somebody intentionally damages or injures their body. In practice that includes cutting, burning, hitting, scratching, pulling out hair and taking an overdose. NICE's guideline uses the wider wording of intentional self-poisoning or injury, irrespective of the apparent purpose.

NICE says its guideline does not cover repetitive, stereotypical behaviour such as head banging, which is a different pattern. It also stresses that each person self-harms for their own reasons, and that reasons can change from one episode to the next.

Self-harm is a behaviour, not a diagnosis. It can sit alongside depression, anxiety, trauma, eating disorders or substance use, or occur without any of them.

The NHS says self-harm is most often described as a way to express or cope with emotional distress. It is often a build-up of many smaller things rather than one event. The reasons it lists include being bullied, pressure at school or work, family or relationship problems, money worries, low self-esteem, grief, abuse, confusion about sexuality and contact with the criminal justice system.

The NHS also names difficulty controlling emotions, often linked to past trauma, and living with conditions such as ADHD or autism. It adds that sometimes the reason is simply unknown.

Some people describe self-harm as a way of staying alive, because it helps them get through overwhelming feelings. Understanding that function is usually the key to finding safer ways of coping.

People often hide it, so signs can be easy to miss. The NHS guidance for friends and family describes physical and emotional clues.

• Keeping fully covered at all times, even in hot weather.

• Unexplained cuts, bruises or burns, usually on wrists, arms, thighs or chest.

• Unexplained blood stains on clothing or tissues.

• Signs of hair pulling.

• Becoming very withdrawn, low in mood, tearful or showing low self-esteem.

• Talking about ending things or not wanting to go on.

The NHS says to speak to a GP if you are harming yourself, having thoughts of harming yourself, or worried about minor injuries such as small cuts or burns, because untreated wounds risk infection. A GP will listen, discuss options such as self-help or support groups, treat minor injuries and ask questions to understand the cause. Honesty helps, even if you do not know why you do it.

If needed, the GP can arrange an assessment with a local community mental health team. For under-18s the referral is to children and young people's mental health services. For urgent mental health help, the NHS points to its urgent-help page, which says you can use NHS 111 or, in an emergency, 999.

Free listening services are available at any hour or evening. The NHS lists Samaritans on 116 123, the Shout text line on 85258, and Childline for under-19s on 0800 1111.

The NHS says an assessment may cover what led to the self-harm, how you feel afterwards, your relationships and living arrangements, what you have tried to reduce it, any injuries, whether you think you will do it again, whether you have thoughts of ending your life, medicines, alcohol and drugs.

NICE says people attending an emergency department or minor injury unit after self-harm should be offered referral for a psychosocial assessment by a mental health professional as soon as possible, alongside physical care. It also says a safety plan should be written with the person and agreed by them.

Notably, NICE advises against using risk scales or low, medium and high categories to predict future suicide or to decide who is treated. The assessment is meant to be about the person's needs, not a score.

After assessment, the care team agrees a care plan with you. The NHS says this can include talking therapy, with CBT and dialectical behaviour therapy (DBT) given as examples, and medicine as an option alongside therapy if you have a condition such as depression or schizophrenia.

NICE is more specific. For adults it recommends a structured CBT-informed psychological intervention such as CBT or problem-solving therapy. For children and young people with significant difficulty managing emotions and frequent self-harm, it suggests considering DBT adapted for adolescents. It says not to offer drug treatment as a specific way to reduce self-harm, and not to withhold therapy because of diagnosis, age or substance use.

The NHS says specialists may be involved for underlying causes, such as bereavement counselling, support after sexual assault or domestic abuse, or an eating disorder service.

The NHS suggests listening without judging, asking how they would like to be supported, letting them know you are there, and encouraging them to see a GP or use a listening service. It advises letting them stay in control of their decisions while getting medical attention if needed.

It is just as clear about what to avoid: do not try to force them to stop, do not threaten to remove their control, and do not call them attention-seeking. Any amount of self-harm can signal severe distress. Carers should look after themselves too, and adult carers can ask the local authority for a carer's assessment.