Self-harm can consist of any of the following behaviors:
- Cutting, pinching or scratching skin
- Burning skin
- Preventing wounds from healing
- Pulling out hair
- Punching or banging objects until bleeding occurs
- Purposefully overdosing on medication without suicidal intention
Reasons people self-harm:
- To feel something other than numb
- To relieve tension
- To get a feeling ‘out’ (usually anger or sadness)
- On a deeper level it may be a form of self-punishment
- Subconsciously, it may be to demonstrate desperation
- It is a coping mechanism.
- It is not necessarily suicidal, but may be a precursor to it
When helping someone who self-harms, address the underlying distress, but the actual self-harming behavior.
It is a coping mechanism – so focus on what needs to be coped with.
Focusing on the self-harm behavior may be experienced by the person as shaming or judgmental.
ASSESS for risk of harm: Assess if medical attention is needed. If the person appears unconscious, confused or disoriented, or if the person has rapid bleeding, call 911. Also call 911 if you find someone who’s overdosed or ingested poison.
LISTEN nonjudgmentally: If the person isn’t experiencing life-threatening injuries, state what behavior you’ve noticed and that you’re concerned for their well-being. It is important to remain nonjudgmental. The behavior may be hard to understand, but by remaining calm and focusing on the emotional distress that has led to the self-harm, you will be most helpful.
GIVE reassurance and information: Always emphasize that recovery is possible. If they want or need more information about what they’re going through, tell them about S.A.F.E. Alternatives (Self-Abuse Finally Ends). They can read the resources online or they can call the information line at 1-800-DON’T-CUT (366-8288).
ENCOURAGE appropriate professional help: Because self-injury is a symptom of an underlying issue, it’s important to support the person in finding the appropriate help. Often, the person is experiencing psychological distress or a mental illness that needs to be addressed. While you want to be persuasive, make sure the person is still making their own decisions about how to proceed with treatment. But you can feel free to call doctors to find one accepting new patients, go with them to appointments, offer to drive or help out in similar ways.
ENCOURAGE self-help and other support strategies: Ask the person what has helped them feel better in the past or what supports – whether it’s family, friends, faith communities or other groups – have been beneficial. Encourage them to tap into those sources of comfort and to try other self-help strategies, like exercise, relaxation training or whatever best suits their situation.