Someone has told you they're self-harming. Now what?

For many people, self-harm can be a difficult behaviour to understand. It also comes with a lot of stigma.

This can make talking about it difficult as people who self-harm often anticipate negative responses and judgement^[1].

But if someone tells you they’re self-harming, how you respond is critical to their health and wellbeing.

Read more: It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury^[2]

What is self-harm? Why do people do it?

The term self-harm could mean someone’s intentional damage to their body as a way of coping or an attempt to end their life. But we think these are very different behaviours.

So we prefer the term self-injury to describe the range of non-suicidal behaviours people use mostly to cope with difficult feelings^[3] (such as intense distress or anxiety) and thinking styles (for instance, self-criticism).

Self-injury is common. About one in six adolescents^[4] report having self-injured at some point in the past.

But no two people’s experiences are alike. And people self-injure for many reasons other than to cope. This includes to punish themselves or to feel something when feeling emotionally numb.

So, if someone tells you they self-injure, it is critical to avoid assuming why they do it.

Telling someone is a big step

Given its associated stigma^[5], many people who self-injure do not tell anyone. When they disclose, it is usually to friends or family^[6].

When disclosing to friends or family^[7], someone values the quality of the relationship, disclosing to people they trust. They may not be seeking tangible aid (for instance, professional support). Instead, they are looking for social support, understanding, and a safe space to talk about their experiences.

Someone with more severe self-injury, or who also has suicidal thoughts or behaviours^[8], is more likely to disclose their self-injury, perhaps as a way of accessing professional or medical support.

Read more: It's RUOK Day – but 'how can I help?' might be a better question to ask^[9]

What not to do

When someone tells you they self-injure, you may feel concerned about their safety and wellbeing. You might be upset someone you care about appears to be struggling. You might feel overwhelmed and unsure how to respond. These and other reactions are understandable and expected.

But it is important not to over-react or respond with high-intensity emotions. This can signal you are uncomfortable, which may make the person less likely to talk.

It is also not advised to ask a large number of questions (such as, what they do, when they do it) as this can seem like an interrogation.

Another common reaction is to stress the importance of stopping self-injury. Although this is usually because they care for the person and want them to be safe, a problem-solving approach may not be what people need. The person disclosing may simply want a chance to share their experience.

Many people have mixed feelings^[10] about stopping – wanting to stop self-injury, but also wanting to hold onto a trusted coping strategy.

Read more: Why do people intentionally injure themselves?^[11]

What to do

If someone discloses they self-injure, it is important to respond supportively, with compassion, and without judgement. It is important to give the person space to share what they want in their own words, to actively listen^[12], and to validate this is likely a difficult conversation for them.

It is also important to recognise someone may share a bit about their experience now but may not be ready to talk about everything yet. Being patient is therefore important.

Telling someone you are there to listen and support them can go a long way in letting them know they can come to you again if they need to and they are not being rushed or pressured if they are not yet ready.

References

1. ^{^} negative responses and judgement (www.tandfonline.com)
2. ^{^} It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury (theconversation.com)
3. ^{^} difficult feelings (pubmed.ncbi.nlm.nih.gov)
4. ^{^} one in six adolescents (pubmed.ncbi.nlm.nih.gov)
5. ^{^} stigma (psycnet.apa.org)
6. ^{^} friends or family (www.sciencedirect.com)
7. ^{^} disclosing to friends or family (onlinelibrary.wiley.com)
8. ^{^} suicidal thoughts or behaviours (www.csmh.uwo.ca)
9. ^{^} It's RUOK Day – but 'how can I help?' might be a better question to ask (theconversation.com)
10. ^{^} mixed feelings (www.tandfonline.com)
11. ^{^} Why do people intentionally injure themselves? (theconversation.com)
12. ^{^} actively listen (www.sciencedirect.com)
13. ^{^} charnsitr/Shutterstock (www.shutterstock.com)
14. ^{^} Teens with at least one close friend can better cope with stress than those without (theconversation.com)
15. ^{^} support someone (www.amazon.com)
16. ^{^} Most people thinking about suicide don't tell anyone. Here's why and what we can do about it (theconversation.com)
17. ^{^} bring you closer (psycnet.apa.org)
18. ^{^} Understanding Self-Injury: A Person-Centered Approach (www.amazon.com)
19. ^{^} Self-injury Outreach & Support (sioutreach.org)
20. ^{^} International Consortium on Self-Injury in Educational Settings (icsesgroup.org)