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Self-injury
Self-harm is when somebody intentionally damages or injures their body. It is a way of coping with or expressing overwhelming emotional distress.

Although some people who self-harm are at a high risk of ending their lives, many people who self-harm do not want to end their lives. In fact, the self-harm may help them cope with emotional distress so they don't feel the need to kill themselves. Often when people self-harm the intention is to punish themselves, express their distress or relieve unbearable tension.

This can be caused by problems such as:

• social factors – such as being bullied, having difficulties at work or school, or having difficult relationships with friends or family
• trauma – such as physical or sexual abuse, or the death of a close family member or friend
• mental health conditions – such as depression.

These issues can lead to a build-up of intense feelings of anger, hopelessness and self-hatred.

There are many different ways people can intentionally harm themselves, such as:

• cutting or burning their skin
• punching themselves
• poisoning themselves with tablets
• misusing alcohol or drugs
• deliberately starving themselves (anorexia nervosa) or binge eating (bulimia nervosa)

People often try to keep self-harm a secret because of shame or fear of discovery. For example, they may cover up their skin and avoid discussing the problem.

Therefore, it is often up to close family and friends to notice when somebody is self-harming, and to approach the subject with care and understanding. The signs may include:

• unexplained cuts, bruises or cigarette burns, usually on their wrists, arms, thighs and chest
• keeping themselves fully covered at all times, even in hot weather
• signs of depression, such as low mood, tearfulness or a lack of motivation or interest in anything
• becoming very withdrawn and not speaking to others
• changes in eating habits or being secretive about eating, and any unusual weight loss or weight gain
• signs of low self-esteem, such as blaming themselves for any problems or thinking they are not good enough for something
• signs they have been pulling out their hair
• signs of misuse of alcohol or drugs

Someone who is self-harming can seriously hurt themself, so it is important that they speak to a GP about the underlying issue and request treatment or therapy that is likely to help them.

It is important for anyone who self-harms to see their GP. They can treat any physical injury and recommend further assessment if necessary.

Your GP is likely to ask you about your feelings in some detail. They will want to establish why you self-harm, what triggers it and how you feel afterwards.

Your GP may ask you some questions to see if you have an underlying condition such as depression or anxiety. If the way you self-harm follows a particular pattern of behaviour, such as an eating disorder, you may be asked additional questions about this.

It is important that you are honest with your GP about your symptoms and your feelings. If you don’t know why you self-harm, tell your GP this.

In most cases, psychological treatment (also known as talking treatment) is recommended for people who self-harm.

Psychological treatments, such as cognitive behavioural therapy (CBT), involve sessions where you meet with a therapist to talk about your feelings and thoughts and how these affect your behaviour and wellbeing. Evidence suggests these kinds of treatments can be effective in the long term for people who self-harm.

If you have a mental health problem such as depression, your treatment may involve medication as well as psychological treatment.

Seeking immediate help for an injury or overdose
Some physical injuries may need treating in an accident and emergency (A&E) department, minor injuries unit or walk-in centre. For example, you may need to call 999 for an ambulance if:

• you or somebody else have taken an overdose of drugs, alcohol or prescription medication
• somebody is unconscious
• you or somebody else are in a lot of pain
• you or somebody else are having difficulty breathing
• you or somebody else are losing a lot of blood from a cut or wound
• you or somebody else are in shock after a serious cut or burn

If your injury is less serious, you could be treated at a minor injuries unit (MIU). These healthcare services are run by doctors or nurses to assess and treat minor injuries, such as minor burns and scalds, infected wounds and broken bones.

NHS walk-in centres, where a nurse can treat you without appointment, are also available for minor cuts and bruises.

Helping someone who self-harms
If you are worried about someone who is self-harming, there are a some things you can do to help them:

• make time to gently and sympathetically discuss the problem with them and listen to what they say without judging them or being critical
• try to appreciate how difficult they are finding life and show them you understand
• discuss the possibility of seeking professional help
• get medical help if any injuries are serious
It's important not to react in a strongly negative or critical way (such as getting angry), as this kind of reaction is likely to make the problem worse.

If they don't want to discuss their self-harm with you, you could suggest they speak to an anonymous helpline or see their GP.

The Sheffield Mental Health Guide has information about support groups, counselling services and other organisations in the Directory of Services. To search the Directory for services and resources about self injury, click here.

The Sheffield Help Yourself Guide also has information about local support groups and services that may be able to help you. To visit the Help Yourself website click here.

Source: NHS Choices Website

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Artwork generously donated for use by Caroline Appleyard - www.appleyard-art.co.uk