Self-Harm

Warning

Introduction

Self-harm is when someone deliberately hurts or injures themselves.

There are many different forms that self-harm can take, including:

  • Cutting
  • Burning
  • Consuming poison
  • Using drugs or alcohol
  • Binge eating or restrictive eating

Self-harm is not a diagnosis itself, but rather a sign of emotional distress. Self-harm is more commonly seen in those suffering with depression, anxiety, previous trauma, and borderline personality disorder.

Signs and symptoms

Someone may present to healthcare services after having self-harmed. They may present themselves, in need of medical attention or they may be brought in by a concerned friend or relative.

Otherwise, someone may have self-harmed but act to conceal this due to shame and fear associated with it. Signs to look out for are wearing long sleeves even in hot weather, unexplained cuts, bruises, or burns.

Assessment

When seeing someone who has self-harmed it is important to focus assessment in some important areas:

  • Is medical treatment needed for the injury?
  • Suicide risk- was there any intent to end their life? See Risk Assessment 
  • Evidence of mental illness - depression, anxiety, psychosis
  • Sensitively explore the emotions that led to the act of self-harm- try to develop a shared understanding with the person about why they have self-harmed.

Treatment

The mainstay of treatment is managing the underlying cause of self-harm, e.g. anxiety, depression, personality disorder.

Initial management should focus on:

  • Medically treating any injuries
  • Developing a safety plan with the person to minimise further risks of self-harm

Last reviewed: 21/02/2024

Next review date: 21/08/2024

Author(s): Core Trainee in Psychiatry, NHS Fife & Medical Education Fellow, NHS Lothian.

Author email(s): mypsych@ggc.scot.nhs.uk.

Reviewer name(s): Medical Education Fellow, NHS Lothian.