What to do if you get the urge to self-harm

Last month a paper in the Lancet Psychiatry reporting that one in five young women self-harm, or have self-harmed, made headlines across a number of national newspapers. The study's authors wrote that non-suicidal self-harm (eg, injuries not intended to end a person's life) had increased, and in 2014 about one in five women aged 16-24 years reported having done it.

Dr Dominique Thompson spent over 20 years working as a GP in a practice by the university in Bristol and her book for parents of teenagers is out in September. She says that although more people now know what 'self-harm' means, the coverage of this new data shows that most of us underestimate how common it has become.

"This is something that any nurse or GP who works with young people, in general practice, will be absolutely aware of. There has been a massive increase in the numbers that we were seeing, day in day out, really, and in lots of different ways," she says.

Thompson uses a "boiling pot" analogy to explain to teachers, parents and NHS staff how self-harm works as a coping strategy. If a pot on the hob boils over, you can take the lid off to cool it down temporarily. But as long as the hob is on, she says, the water will continue to boil over.

"Self-harm is a temporary release of pressure and the person doing it [needs to] feel better instantly. If your reaction is, 'Oh my God, you must stop doing that', it's like putting the pot lid back on. That's not the correct approach, even though our instinct is to say, 'dear God, stop'."

Distraction techniques

For those in the grip of an urge to self-harm, help is available. The mental health charity Mind has a resource on its website: its advice lists over 30 alternatives to self-harming.

The guidance groups these alternatives around different emotions to suggest ways that some techniques, such as writing or running, might be more effective depending on what might be behind an urge to self-harm. Although apps are not mentioned, there are a few specifically designed to distract from self-harm: distrACT and Calm Harm are both free, and approved by the NHS.

Mind also recommends looking at two other aspects of self-harm before or after the urge has passed: looking for triggers or patterns of self-harm, and asking whether it might be possible to delay self-harm when the urge hits. The charity recommends a strategy for introducing delays, as well as suggesting ways to explore reasons behind self-harm.

Stephen Buckley, who is the head of information at Mind, advises that even without knowing where the urge to self-harm comes from or what triggers it, people can still seek support for the behaviour. "For some people, self-harm is linked to specific experiences and is a way of dealing with something that’s either happening at the moment or has happened in the past. For others, the reasons are less clear and can be harder to make sense of. If you don't understand the reasons for your self-harm, it's important to remember that you are not alone, and that you can still ask for help."

"Recent findings published by the Lancet Psychiatry Journal are hugely worrying. That these findings also revealed a decline in the numbers of those receiving support from medical or psychological services is of particular concern," he adds.

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Getting to the root of the issue

Both young men and women self-harm, Thompson says, but in her experience, men sometimes present with injuries such as boxer's fractures from fighting or hitting walls, rather than typical self-harm injuries.

But self-harm in itself is not a diagnosis, Thompson advises. "Self-harm is a symptom of emotional pain. Anyone treating it should be asking: 'Why is this person self-harming?' That is the real question. It's not about the harm itself."

Self-harm is associated with a wide range of mental health conditions, including depression, anxiety, eating disorders, personality disorders and bipolar disorder.

If you're self-harming, even without suicidal intent, it's important to seek help. Your GP will be able to to treat physical injuries and can point you towards treatment or support services. You may even be able to self-refer for NHS talking therapies in your area - the lower age limit varies, and no services are available through self-referral for under-16s. However, some areas will allow self referral for anyone over 16 years, while others require patients to be over 17 or 18 years.

The authors of The Lancet Psychiatry study recommend that self-harm needs to be discussed more often with young people without normalising it, and that they should be offered more help to find safer ways to deal with emotional stress. But with GPs, hospitals and schools struggling with funding cuts and staff shortages, charities and apps must do what they can to bridge gaps in care for this growing concern.