How often does it happen?

It’s hard to say exactly, because most people keep their self-harm very private. Some say as many as 1 teenager in 10 could be affected. Health professionals probably see only the tip of the iceberg, and certainly nothing like this number. The problem mainly affects girls and is rare in boys (7:1 female:male ratio). It is very much more common than suicide.

Why do young people harm themselves?

It is not necessarily attention-seeking. Self-injury is a way of dealing with very difficult feelings that build up inside. People say different things about why they do it. Some say that they have been feeling desperate about a problem and don’t know where to turn for help. They feel trapped and helpless. Self-injury helps them to feel more in control. Others talk of feelings of anger or tension that get bottled up inside until they feel like exploding. Self-injuring relieves this tension. Feelings of guilt or shame may also become unbearable. Self-harm is way of punishing oneself. Some people try to cope with very upsetting experiences like trauma or abuse by convincing themselves that the upsetting event(s) never happened. These people sometimes suffer from feelings of numbness or deadness. They say that they feel detached from the world and their bodies, and that self-injury is a way of feeling more connected and alive.

Self-injury is always a sign of great upset. Sometimes people can end up killing themselves accidentally. The difficult feelings that lead to self-harm can be caused by a number of things. Young people who are depressed or have an eating disorder are at risk. So are people who take illegal drugs or excessive amounts of alcohol. In fact, eating disorders and drug or alcohol misuse are a kind of self-harm in themselves. The commonest trigger is an argument with a parent or close friend. When family life involves a lot of abuse, neglect or rejection, people are more likely to harm themselves. ‘Copy cat’ self-harm sometimes happens in a group. It can have tragic results.

Why they need help

Anyone who is harming themselves is struggling to cope and needs help. If people don’t get help when they need it, problems are likely to continue. Problems may also get a lot worse and the effects may ‘snowball’. Some people will continue to harm themselves more and more seriously. They may even end up killing themselves.

What can you do to help?

A person who is thinking of killing themselves often tries to let someone else know how upset they are. They are most likely to share their upset feelings with friends of their own age or adults they know well. But self-injury is different and is often kept secret – even from friends or family. The person feels so ashamed, guilty or bad that they can’t face talking about it. There may be clues, such as refusing to wear short sleeves or take off jumpers for games.

If you are a parent or teacher, you can help by

• recognising signs of distress and finding some way of talking with the young person about how they are feeling.


• listening to their worries and problems and taking them seriously.


• offering sympathy and understanding.


• helping with solving problems.


• staying calm and constructive – however upset you feel about the self-harm.


• being clear about the risks of self-harm – making sure they know that, with help, it will be possible to stop once the underlying problems have been sorted out.


• making sure that they get the right kind of help as soon as possible.

If you are a teacher, it is important to encourage students to let you know if one of their group is in trouble, upset or shows signs of harming themselves. Because friends often worry about betraying a confidence, you may need to explain that self-harm can be dangerous to life. For this reason it should never be kept secret. It’s better to get help than to suffer in silence.

Specialist help available

If you feel that more professional help is needed, the family doctor should be able to advise. They will be able to tell you what help is available locally and make a referral to your local child and adolescent mental health service. Here the team includes child psychiatrists, psychologists, social workers, psychotherapists and specialist nurses who can offer expert help.

Many young people who harm themselves do need specialist help. Everyone who has taken an overdose needs an urgent assessment by a doctor as soon as possible, even if they look OK. The harmful effects can sometimes be delayed. Even small amounts of some medications can be fatal.

All young people who need hospital treatment for self-harm should have a specialist mental health assessment. Often, this will be done by a child and adolescent psychiatrist in a community clinic or hospital. The aim is to discover the causes of the problems and to prevent repetition. It is very helpful when parents or carers can take part. This makes it easier to understand the background to what has happened, and to work out what sort of help is needed after the young person leaves hospital.

Psychological treatment can make all the difference. There are different approaches, depending on what is causing the problem. It often involves both individual and family work. Individuals will need help with how to cope with the very difficult feelings that cause self-harm. Families often need help in working out how to make sure that the dangerous behaviour doesn’t happen again, and how to give the support that is needed. If depression or anxiety are part of the problem, medication may be helpful. Occasionally, intensive help may be needed. Sometimes recovery from very damaging or traumatic experiences happens slowly. Then specialist help is needed over a longer period of time.