Self-harm can be seen as a wide range of ‘self-destructive’ behaviour, and thus it can include the abuse of drugs or alcohol, promiscuity, eating disorders or risk taking behaviour such as driving at excessive speeds, as will as the deliberate infliction of wounds - self injury.

Self-injury seems to be about controlling emotions which are perceived as ‘dangerous’ by the survivors. If they have found no voice for expressing their abuse and the effect it has had upon them, they may experience feelings which are very intense. These feelings may build up until the survivor needs to ‘release’ them, and one way of doing so without discussing their secret is to externalise them. If you are feeling a very strong internal pain and you cause external pain by cutting yourself, it gives you a focus for your pain. If your abuse is a secret or if people have not believed you, you may find that the external cut is a more valid sort of pain. Children have talked about how receiving sympathy following a fall has briefly replaced the care they did not receive from the abuser, and encouraged them to see external, visible wounds as an acceptable form of pain. As a society, we seem to give out the message that emotional pain is less acceptable, and this is clearly exacerbated when we are talking about ‘taboo’ subjects such as child abuse.

So, although it might seem ironic that someone who gets hurt by another person on a regular basis would begin to hurt their own body too, it actually makes a lot of sense. Common forms of self injury include: cutting by using knives, broken glass, razors or even relatively blunt objects such as pens; burning, especially using cigarettes or matches; scratching, using fingernails or household objects; piercing, using knives, pens, compasses or other suitable objects. Self-harmers can be incredibly innovative and resourceful. The lengths that they will go to if they are denied access to razors to find something else to cut with is testament to their need for this coping mechanism. Very few institutions allow patients to self-harm, and this demonstrates a real failure to understand why most people do it.

For some survivors the self-harm is very obviously linked to their abuse. They may cut or burn the parts of their body they feel have been most violated; or they may use ‘weapons’ used in the abuse, such as cigarettes; or they may self injure in the room where the abuse took place; or they may do it at the time most abuse occurred, or on a significant anniversary. For others the link is less direct; the abuse is the cause of the feelings self-injury addresses, but where and when they hurt themselves will depend upon how they feel.

Some survivors do not feel much pain when they hurt themselves, either because they have got used to it, or because they are disassociating while they self harm. Some find that they have to hurt themselves more over time in order to get the effect they need, and it is also common for the effect to last less and less over time, and for the feelings of shame about it to get worse over time and for these feelings to kick in more quickly. This is where the development of alternative coping mechanisms is absolutely crucial.

Self-injury is not an addiction - although the high caused by endorphins (the body’s pain management chemicals) can seem addictive - but it can be highly habit forming. In fact, it often becomes a highly ritualised event. A woman may set aside a certain evening, arrange all the items she needs and look forward to ‘her’ time; or she may regard it as a necessary evil and prepare accordingly.

Everyone is different. If you know someone who self harms, it is important that you listen and respond to them in a non-judgemental way; especially if they have chosen to disclose to you or seek your help and support.

Some key issues that you may choose to discuss with them might include:

The reasons why they self-harm: it is useful to explore what form their self-harm takes and what they get out of it. Not everyone who self harms understands why they do it, and they may be frightened by it.

The fact that they are not alone: many self-harmers are so ashamed by what they do that they imagine they are the only ones who do it. You can reassure them that other people self harm without trivializing what they do.

Alternative coping strategies: These are not going to be able to take the place of self-harm overnight, but it is a good thing to try and come up with other possible reactions to the feelings which usually make them self-harm. You could ask them about music which makes them feel happier or calmer; ask whether or not they have ever tried writing anything down or painting/drawing a picture; discuss any activity they enjoy - gardening, sport, sewing, swimming, cycling etc, and see whether or not any of these things might become alternative methods of coping with emotional stress over time.

The fact that it is possible to stop: Many people stop hurting themselves when the time is right for them. Everyone is different and if they feel the need to self-harm at the moment, they should not feel guilty about it - it is a way of surviving, and doing it now does NOT mean that they will need to do it forever. It is a huge step towards stopping when they begin to talk about it, because it means that they are starting to think about what might take it’s place eventually.