Skin and Mind Self harm and the skin Self-harm and the skin TRIGGER WARNING – This article discusses self harm, which some individuals may find distressing. Leading experts in psychodermatology, Dr Alia Ahmed, Dr Reena Shah and Dr Rukshana Ali have compiled some useful advice and resources for anyone affected by self-harm. What is self-harm? Self-harm is estimated to be prevalent in 17% of adolescents[1] and has a lifetime prevalence of 7% in the UK[2]. Self-harm occurs when an individual intentionally causes damage or injury to their body as a means of coping with/ escaping from difficult feelings, thoughts and emotions. Some physical methods of self-harm that can be seen on the skin are cutting, hitting or biting. Those who self-harm may be experiencing significant levels of guilt, shame, anger, low self-esteem, self-hatred, stress, depression or anxiety. Factors such as impulsivity, bullying, feelings of hopelessness can also be present and it can be addictive. It is a way of surviving a difficult period and at times, the behaviour helps the person feel in control. Advice for people who self-harm Often talking to someone you trust or a professional (e.g. psychologist), can help you explore how you are feeling and find a way to break the cycle. It can be helpful to think about how to control the behaviour, its triggers, patterns and what to do in a crisis. Keeping a diary of the self-harm and triggers can help to increase insight. Instead of self-harming, you can try some of the following (whilst you are working on getting help): Running your hands under cold water to feel a different sensation Wrapping ice cubes in a tea towel and holding them against your skin Drawing on your skin with a felt tip Snapping a rubber band on the wrist Ripping up bits of paper Scream or shout or hit a pillow/cushion Peeling or scratching the skin of a piece of fruit Think about increasing positive coping mechanisms and experiences in your day-to-day life (e.g. socialising, watching a good programme, relaxation and mindfulness). There is a good app called Calm Harm which provides support and strategies to resist or manage the urge to self-harm. Scarring adds to the psychological impact of dealing with self-harm. There are many feelings associated with scars as they are a physical reminder of having survived a difficult time in your life. Often scars are less noticeable to other people and it can be empowering to accept your scars. The scars do not define you as a person, working on your self-esteem and developing a positive body image can enhance your mental health. The Japanese art of repairing broken bowls using molten gold is called Kintsugi (literal meaning of “golden journey”). The idea is that even when something is repaired, it is made stronger and is still beautiful. It is hoped that despite the visible scars, with time, the right support and recognising your strengths, you can also have a ‘golden journey’ or (s)kintsugi. Some ideas on how to manage scarring include making sure fresh wounds and scars are covered up to avoid infection. Some young people prefer to keep their scars hidden either by long sleeves, wearing watches/bracelets or with camouflage make-up, but this can limit what you wear or do. To build up confidence on living life with your scars, start by having your scars on show at home (e.g. wearing short sleeves) and talk about them to family and friends. You could practice some phrases like “you might notice some scars on my arms. I used to self-harm but am working on/no longer doing this.” Advice for parents of children who self-harm It can be deeply distressing for parents to discover their child has been self-harming. Firstly remain calm and to talk to your child about it. Find a quiet time to sit down and ask them about what has happened. Your child may be embarrassed or ashamed or may find it difficult to talk about but offer them a non-judgemental space and take things at their pace. Don’t be scared to use language like “I can see you have self-harmed, what’s going on?” Ask them when it happens, what triggers it and what they do. Try to problem solve with them, keep calm and avoid interrupting. Help manage fresh wounds and check if they need any medical assistance. Let them know if it’s easier to text, write or email what has been happening as sometimes talking can be hard. It can also be helpful for the young person to hear that you are worried about them and want to help them. It can be helpful to ask the young person what they have been using to self-harm and to remove it (e.g. if they are using blades) and to come and tell you or another trusted adult if they feel they want to self-harm again. Encourage them to use some of the strategies listed above or anything else that helps them to relax to manage their feelings in the meantime. You may feel like you want to constantly supervise or be around your child to keep them ‘safe’, but take the lead from your child. This can be anxiety provoking but let them know you want to show your support and trust without smothering them. Self-harming does not automatically mean someone is suicidal. If you are concerned about a young person’s mental wellbeing you should speak to your GP, 111 or in an emergency dial 999 or go to A&E. It is important that you see beyond the young person’s self-harming and encourage them to engage in previously enjoyable activities or arrange family time together (e.g. watching a movie). Also, praise their positive qualities, bravery and strength in talking about it. Make sure you have support. Talk to friends and family or your GP as it can be a worrying time for you too. Look after yourself by making sure you have time to eat, take a break and do something that helps you relax too. It can also be helpful to speak to other parents who have been in a similar situation. Dr Alia Ahmed, Consultant Dermatologist Dr Reena Shah, Senior Clinical PsychologistDr Rukshana Ali, Lead Clinical Psychologist in Paediatric Dermatology Links to further resources: Childline – 0800 1111 (under 19 years old, free from any phone). If you do not want to talk you can text SHOUT to 85258.Samaritans 116 123SANELine 0300 304 7000 (4.30pm-10.30pm)National Suicide prevention helpline UK 0800 689 5652 (6pm –midnight every day)Young Minds Changing FacesMindThe Mix – for 25 year olds and under Donate to British Skin Foundation research Managing self-harm scars References [1] Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014 Jun;44(3):273-303. doi: 10.1111/sltb.12070. Epub 2014 Jan 15. PMID: 24422986. [2] McManus S et al. Prevalence of non-suicidal self-harm and service contact in England, 2000– 14: repeated cross-sectional surveys of the general population. Lancet Psychiatry 2019;6(7):573–81. Manage Cookie Preferences