CINAPS
Cambridge Independent Neuroscience and Psychiatry Services
Deliberate Self Harm
What is deliberate self harm?
Some young people deliberately harm themselves. Various methods are used, such as cutting with objects such as a knife or broken glass, burning, refusing to eat or taking overdoses.
Self harm is a sign that something serious is wrong and it is always necessary to seek advice from your GP or a trained and experienced mental health professional.
Is it attention seeking?
No, it is usually very unhelpful to see self harm as attention seeking and it is often very inaccurate. Self harm in children and young people must be taken very seriously and an understanding of the behaviour must be a priority as part of a comprehensive mental health, bio-psycho-social and risk assessment.
Why do young people self harm?
There are no easy answers to this question and multiple factors are often involved.
Many young people struggle to communicate emotions and young people and children often communicate their emotions and thoughts through behaviour rather than communicating 'feelings', for instance, child feeling sad will often kick a toy rather than say he or she is sad.
Self harm can also be a coping mechanism to manage very difficult emotions. Young people often describe a 'release' after self harming, where the intensity of their intolerable emotions decrease immediately.
Some young people cope with trauma by pretending that it never happened and they become detached or numb to the world.
Young people sometimes say that self harm changes their feelings of 'numbness' or 'nothingness' or 'being unreal' and makes them feel more connected to life and the world, and feel more 'real'.
Self harm is sometimes a way people punish themselves for something that they feel guilty about or responsible for, for example, some young people may refuse to eat to punish themselves.
Some young people say they feel more 'in control' when they harm themselves.
Some young people who were abused take on the role of abuser for themselves when they hurt themselves; they feel they are worthless and deserves to be hurt or in pain.
Complex reasons, causes and risk factors often exist. It is important to know that self harm is always associated with risk.
Risk factors:
Family conflict (past, current, chronic)
Abuse and neglect
Life events such as loss and trauma
Relationship difficulties
Lack of support and positive relationships
Feeling rejected and isolated
Bullying (including cyberbullying)
Temperament and personality traits
Depression and other mental illness such as
Eating disorders or
Substance Abuse
This list is not comprehensive.
Risk factors for suicide:
Mental health difficulties
Personality difficulties
Psycho-social stressors such as
Chronic conflict in relationships or at home or
Life events
Lack of psycho-social support
Self harm (past or current)
Previous suicidal ideas, intent or plans
Drug and alcohol use
This list is not comprehensive.
How is self harm managed?
OVERDOSES:
If a child, young person or adult has taken an overdose, it is important to take them to the Emergency Department / Accident and Emergency immediately, however small or insignificant the overdose was said to be.
It is not uncommon for young people to take a mixture of medications, without knowing the right dosage or what the combination was, which can be very dangerous and sometimes lethal. It is also important to know that people respond differently to medications based on factors such as their own physical health (kidneys, liver, heart etc).
The Emergency Department will rule out any medical complications such as kidney or liver damage and the child might be admitted to hospital for a few days. They will then refer the child, after he/she is medically stable and ready for discharge, to mental health services. The child should be seen by children's mental health services before he/she leaves the hospital to assess risk and to assess for any mental illness.
MANAGEMENT AND TREATMENT:
It is important to seek advice from your GP, who can refer you to CAMHS (Child and Adolescent Mental Health Services). Professionals in CAMHS will meet with you for a comprehensive assessment.
Risk assessment (assessing whether the child is a risk to themselves or others) is an important part of the work that CAMHS should do during every assessment and appointment.
Medication may be used when young people present with a severe mental illness, such as Depression, and is usually part of a comprehensive treatment package, including psychological and social intervention.
Some young people deliberately harm themselves. Various methods are used, such as cutting with objects such as a knife or broken glass, burning, refusing to eat or taking overdoses.
Self harm is a sign that something serious is wrong and it is always necessary to seek advice from your GP or a trained and experienced mental health professional.
Is it attention seeking?
No, it is usually very unhelpful to see self harm as attention seeking and it is often very inaccurate. Self harm in children and young people must be taken very seriously and an understanding of the behaviour must be a priority as part of a comprehensive mental health, bio-psycho-social and risk assessment.
Why do young people self harm?
There are no easy answers to this question and multiple factors are often involved.
Many young people struggle to communicate emotions and young people and children often communicate their emotions and thoughts through behaviour rather than communicating 'feelings', for instance, child feeling sad will often kick a toy rather than say he or she is sad.
Self harm can also be a coping mechanism to manage very difficult emotions. Young people often describe a 'release' after self harming, where the intensity of their intolerable emotions decrease immediately.
Some young people cope with trauma by pretending that it never happened and they become detached or numb to the world.
Young people sometimes say that self harm changes their feelings of 'numbness' or 'nothingness' or 'being unreal' and makes them feel more connected to life and the world, and feel more 'real'.
Self harm is sometimes a way people punish themselves for something that they feel guilty about or responsible for, for example, some young people may refuse to eat to punish themselves.
Some young people say they feel more 'in control' when they harm themselves.
Some young people who were abused take on the role of abuser for themselves when they hurt themselves; they feel they are worthless and deserves to be hurt or in pain.
Complex reasons, causes and risk factors often exist. It is important to know that self harm is always associated with risk.
Risk factors:
Family conflict (past, current, chronic)
Abuse and neglect
Life events such as loss and trauma
Relationship difficulties
Lack of support and positive relationships
Feeling rejected and isolated
Bullying (including cyberbullying)
Temperament and personality traits
Depression and other mental illness such as
Eating disorders or
Substance Abuse
This list is not comprehensive.
Risk factors for suicide:
Mental health difficulties
Personality difficulties
Psycho-social stressors such as
Chronic conflict in relationships or at home or
Life events
Lack of psycho-social support
Self harm (past or current)
Previous suicidal ideas, intent or plans
Drug and alcohol use
This list is not comprehensive.
How is self harm managed?
OVERDOSES:
If a child, young person or adult has taken an overdose, it is important to take them to the Emergency Department / Accident and Emergency immediately, however small or insignificant the overdose was said to be.
It is not uncommon for young people to take a mixture of medications, without knowing the right dosage or what the combination was, which can be very dangerous and sometimes lethal. It is also important to know that people respond differently to medications based on factors such as their own physical health (kidneys, liver, heart etc).
The Emergency Department will rule out any medical complications such as kidney or liver damage and the child might be admitted to hospital for a few days. They will then refer the child, after he/she is medically stable and ready for discharge, to mental health services. The child should be seen by children's mental health services before he/she leaves the hospital to assess risk and to assess for any mental illness.
MANAGEMENT AND TREATMENT:
It is important to seek advice from your GP, who can refer you to CAMHS (Child and Adolescent Mental Health Services). Professionals in CAMHS will meet with you for a comprehensive assessment.
Risk assessment (assessing whether the child is a risk to themselves or others) is an important part of the work that CAMHS should do during every assessment and appointment.
Medication may be used when young people present with a severe mental illness, such as Depression, and is usually part of a comprehensive treatment package, including psychological and social intervention.
Important factors that professionals will consider during an overdose or self harm:
What (and how much) was taken/done? (Seriousness)
When was it taken/done? (The context)
How did it happen? (The context)
Who was he/she with? (The context)
Did the child tell anyone?
Did the child believe it would be lethal?
Is it the first episode?
How regularly does it happen?
What was the most serious episode?
Was it planned or impulsive?
How did the parents/carers find out?
Did the child try to conceal it?
Is there a suicide letter?
Were final plans made/good byes said?
Was the child relieved that the attempt failed?
Does the child regret the behaviour?
How does the child feel now?
Does the child still want to die?
Intent or plans to die?
This list is not comprehensive.
Risk assessments are complex and must be completed by professionals trained and experienced in assessing risk associated with possible mental health problems in children; risk assessments include assessment of quality of communication, interaction and behaviour, along with general presentation (mental state examination). Professionals with appropriate training and experience are able to connect with children and communicate effectively with children who are in the worst place of their lives, without increasing risk.
Deliberate self harm often occurs as part of mental health or neurodevelopmental problems. Child Psychiatrists routinely assess for mental illness and neurodevelopmental disorders during self harm or post overdose assessments:
Mental Illness and Neurodevelopmental disorders where Self Harm can occur:
Mood disorders such as Bipolar disorder or
Depression
Anxiety disorders
Psychotic disorders
Attachment disorders and
Personality difficulties
Eating disorders
This list is not comprehensive.
Complications of Self Harm:
Infection and abscess
Damage to nerves or muscle
Bleeding and hypovolemic shock
Cardiac complications and arrest
Neurological (brain) damage
Liver and kidney damage or failure
This list is not comprehensive.
Self harm should always be taken seriously by adults who support or treat children. Discussion with a medical doctor is essential.
What (and how much) was taken/done? (Seriousness)
When was it taken/done? (The context)
How did it happen? (The context)
Who was he/she with? (The context)
Did the child tell anyone?
Did the child believe it would be lethal?
Is it the first episode?
How regularly does it happen?
What was the most serious episode?
Was it planned or impulsive?
How did the parents/carers find out?
Did the child try to conceal it?
Is there a suicide letter?
Were final plans made/good byes said?
Was the child relieved that the attempt failed?
Does the child regret the behaviour?
How does the child feel now?
Does the child still want to die?
Intent or plans to die?
This list is not comprehensive.
Risk assessments are complex and must be completed by professionals trained and experienced in assessing risk associated with possible mental health problems in children; risk assessments include assessment of quality of communication, interaction and behaviour, along with general presentation (mental state examination). Professionals with appropriate training and experience are able to connect with children and communicate effectively with children who are in the worst place of their lives, without increasing risk.
Deliberate self harm often occurs as part of mental health or neurodevelopmental problems. Child Psychiatrists routinely assess for mental illness and neurodevelopmental disorders during self harm or post overdose assessments:
Mental Illness and Neurodevelopmental disorders where Self Harm can occur:
Mood disorders such as Bipolar disorder or
Depression
Anxiety disorders
Psychotic disorders
Attachment disorders and
Personality difficulties
Eating disorders
This list is not comprehensive.
Complications of Self Harm:
Infection and abscess
Damage to nerves or muscle
Bleeding and hypovolemic shock
Cardiac complications and arrest
Neurological (brain) damage
Liver and kidney damage or failure
This list is not comprehensive.
Self harm should always be taken seriously by adults who support or treat children. Discussion with a medical doctor is essential.
Please see Helpful Links for more information relating to support and guidance for children, young people and famlies.
