A compassionate guide to understanding self-harm

There are some topics in mental health that people still struggle to talk about openly. Self-harm is one of them.

Even among professionals, it can bring up fear, uncertainty, discomfort and, at times, misunderstanding. For families and friends, it can be frightening. For the person experiencing it, it is often wrapped in shame, secrecy, confusion and exhaustion.

Before we go any further, I want to say this gently. This blog talks about self-harm, self-injurious behaviour, emotional distress and risk. Please look after yourself while reading. Pause if you need to. Step away if this feels too close. You do not have to force yourself through difficult material in one sitting.

Self-harm is often spoken about in ways that are unhelpful. People may describe it as dramatic, attention seeking, manipulative, reckless or impossible to understand. Sometimes people avoid talking about it altogether because they worry that saying the wrong thing will make it worse.

But silence and judgement both create problems.

Self-harm usually makes much more sense when we stop viewing it through a moral lens and start viewing it through an emotional, psychological and nervous-system lens. That does not mean it is safe. It does not mean it should be minimised. It does not mean we ignore risk. But it does mean we try to understand what the behaviour is doing for the person.

Most of the time, self-harm is not about wanting to shock people or cause trouble. It is much more often about trying to survive something that feels unbearable inside.

·       It can be a way of releasing pressure.

·       It can be a way of interrupting numbness.

·       It can be a way of expressing pain when words have stopped working.

·       It can be a way of punishing the self.

·       It can be a way of turning emotional pain into physical pain

·       It can be a way of getting through a moment that feels impossible.

And, importantly, it can become a learned pattern. Not because the person is weak. Not because they want self-harm to be part of their life. But because the brain and body can learn very quickly when something produces relief, even brief relief.

This is why self-harm deserves a response that is both compassionate and serious. Compassion without seriousness can minimise the risk. Seriousness without compassion can increase shame. We need both.

I wanted to write this because self-harm is one of those areas where people often need clarity as much as kindness. They need help understanding why it happens, why it can become repetitive, why shame often keeps it going, how social learning can play a role, and what kinds of therapy and practical strategies can actually help.

My own understanding of self-harm has been strongly shaped by an emotion regulation framework. In clinical work, I have often seen self-harm in people who are not trying to die, but are trying to manage unbearable internal states. I have also understood something of this at a human level.

When my dog was critically unwell at the vets, I remember sitting in the waiting room feeling so distraught that I had the impulse to claw the skin from my chest. I did not act on it, but in that moment I understood something important. Sometimes emotional pain feels so physically unbearable that the body wants to do something with it. The distress does not stay neatly in the mind. It floods the chest, throat, stomach, skin and muscles. It becomes embodied.

That does not mean every instance of self-harm is about the same thing. It does mean that one of the most useful questions we can ask is:

What is the self-harm doing for this person in this moment? And what do they need.

That question opens the door to understanding. And understanding is usually where change begins.

What do we mean by self-harm?

Self-harm is a broad term. It generally refers to intentionally hurting yourself or damaging your body in some way.

When people hear the words “self-harm”, they often think immediately of cutting. Cutting can be part of self-harm, but self-harm is not limited to that. It is not always visible. It is not always obvious. It is not always what other people expect.

People may harm themselves in a number of ways, including:

• Cutting, scratching, picking or reopening wounds.

• Hitting, punching, biting or pinching themselves.

• Burning or scalding their skin.

• Pulling out hair or deliberately damaging their body.

• Interfering with healing, for example by repeatedly aggravating an injury.

• Taking an overdose or misusing medication with the intention of causing harm.

• Ingesting substances or objects that are harmful.

• Deliberately putting themselves in dangerous situations because they feel they deserve harm, want to feel something, or are indifferent to their safety. This can include high sexual risk and promiscuity without protection, or driving fast and recklessly.

• Deliberately depriving themselves of basic needs, such as food, sleep or medical care, as a form of punishment or emotional coping.

• Using alcohol or drugs in a deliberately harmful or self-punishing way.

Not every harmful behaviour is automatically self-harm. The key issue is often the person’s intention and function. Is the behaviour being used to punish the self? To numb? To regulate? To escape? To feel something? To express distress? To turn emotional pain into physical pain?

That distinction matters because self-harm can be missed when people look only for visible injuries. Sometimes the most important question is not, “What exactly did the person do?” but, “What was happening inside them when they did it?”

It is also important to say that self-harm is not always the same thing as a suicide attempt. Many people who self-harm do not want to die. They may be trying to cope, release emotion, interrupt numbness, punish themselves, or survive an urge.

However, the distinction is not always neat. Sometimes self-harm and suicidal thoughts overlap. Sometimes the person themselves may feel uncertain about whether they wanted to die, wanted to disappear, wanted the pain to stop, or simply did not care in that moment whether they lived.

This is why self-harm should never be dismissed. Even when it is not a suicide attempt, it tells us that the person is struggling and needs support. It can also be associated with increased future risk, which is why proper assessment matters.

It is not a competition about whether it is “bad enough” or “serious enough”. Any desire to hurt yourself signifies something. Instead of asking, “Is this serious enough to matter?” we would usually be better asking, “What pain is this showing us, and what support is needed now?”

Why do people self-harm?

There is no single reason why people self-harm. That matters because simplistic explanations often lead to simplistic responses.

Some people self-harm when they feel emotionally flooded. The emotion might be anxiety, panic, shame, rage, grief, humiliation, despair or fear. It builds and builds until the person feels they cannot contain it any longer. Self-harm may then create a brief sense of release.

Some people self-harm when they feel numb, unreal or disconnected. They may be dissociated or shut down. In those moments, physical sensation can cut through the numbness and create a temporary sense of being real, present or grounded.

For others, self-harm is linked to self-punishment. The person may carry harsh beliefs about themselves. They may feel disgusting, guilty, bad, contaminated, unworthy or responsible for things that were not their fault. Self-harm can become a way of expressing anger towards the self.

For some people, self-harm is connected to communication, but not in the dismissive way people often mean when they say “attention seeking”. Sometimes distress becomes too big to hold privately and words do not feel adequate. The body ends up speaking what the mouth cannot.

For others, self-harm is linked to trauma. The body may carry states of alarm, shame, freeze, disgust or helplessness that are difficult to verbalise. The self-harm may not be about the present moment alone, but about old survival states being reactivated.

For many people, it is a combination of all of these things.

This is why good therapy does not only focus on the behaviour itself. It looks at the whole chain around the behaviour. What happened before? What was the person feeling? What did the situation mean to them? What did their body do? What urge followed? What happened afterwards? What was reinforced?

The behaviour is important, but the behaviour is not the whole story.

Self-harm as emotion regulation

One of the most helpful ways to understand self-harm is through emotion regulation.

Emotions are not just thoughts. They are whole-body events. When we feel an emotion, the brain, nervous system, hormones, muscles, breathing, heart rate, gut, attention and memory all become involved.

When someone is highly distressed, the nervous system may move rapidly into threat. The amygdala, which is involved in detecting threat and emotional salience, becomes more active. The body prepares for action. Stress chemistry increases. The person may feel agitated, hot, tense, trapped, unreal, panicky or desperate.

At the same time, the parts of the brain involved in reflection, inhibition, future thinking and problem-solving may become less available. This is not because the person is stupid or not trying hard enough. It is because high emotional arousal changes how the brain works.

When we are inside a threat state, the brain does not prioritise nuance. It prioritises survival.

This is why, in the moment, self-harm may feel like the only option. The person may know, logically, that they do not want to hurt themselves. But logic is not always the part of the brain driving the urge. The urge is often coming from a more primitive, body-based, immediate need to change state.

Self-harm can change state very quickly.

·       For someone who is flooded, it may bring relief.

·       For someone who is numb, it may bring sensation.

·       For someone who feels unreal, it may bring focus.

·       For someone who feels shame, it may feel like punishment.

·       For someone who feels overwhelmed, it may create a sense of control.

·       For someone who cannot cry, it may create a physical expression of pain.

The problem is that the relief is usually temporary, and the cost is high.

Afterwards there may be shame, secrecy, injury, fear, medical risk, relationship difficulty, or more self-criticism. The original pain may still be there, but now it has another layer added to it.

This creates a cycle.

·       Distress builds.

·       Self-harm reduces or shifts the distress briefly.

·       The brain learns that it “worked”.

·       Shame follows.

·       The person feels worse.

·       The next urge becomes more likely.

This is one of the reasons self-harm can become repetitive. It is not because the person is being difficult. It is because the brain learns from relief. Behaviour that is followed by relief is more likely to be repeated, especially when the person has not yet developed other strategies that work quickly enough.

That is not hopeless. It simply means that telling someone to “just stop” is rarely enough. The brain has learned one route to relief. Therapy has to help the person build other routes.

Why the body matters so much

A purely cognitive explanation of self-harm is not enough.

Many people who self-harm are not sitting there calmly weighing up pros and cons. They are often in a body state that feels unbearable. Their chest may feel tight. Their skin may feel agitated. Their stomach may churn. Their muscles may be full of restless energy. Their throat may feel blocked. Their head may feel foggy or split off from reality.

For some, the urge to self-harm is not experienced first as a thought. It is experienced as a sensation.

This matters because many well-meaning responses are too verbal and too slow. “Think about your future.” “Remember how loved you are.” “Write down three reasons not to.” These may be helpful later, but when someone is at peak arousal or dissociation, their nervous system may need something more immediate and body-based.

This is where nervous-system regulation becomes important.

If the person is in a high-arousal state, they may need skills that reduce activation. This might involve cold water on the face, paced breathing, grounding, stepping outside, reducing sensory input, contacting someone safe, or using dialectical behaviour therapy (DBT) distress tolerance skills.

If the person is in a shutdown or dissociated state, they may need skills that gently increase connection to the present. This might involve textured objects, strong but safe sensory input, music, movement, naming objects in the room, holding something warm, or orienting to the environment.

If the person is in a shame state, they may need something relational and compassionate. Shame thrives in secrecy. Sometimes the most regulating thing is not a technique, but the experience of being met calmly by another human being.

This does not mean that body-based skills are a cure. They are not. But they can help create enough space for choice to return.

And space is often the beginning of change.

It is not usually about “attention seeking”

The phrase “attention seeking” has done a lot of harm.

People often use it as though it explains something, but in reality it usually shuts understanding down. It carries the implication that the distress is exaggerated, manipulative, childish or less deserving of care.

But let us be honest. There are far easier ways to get attention than hurting yourself.  Could you cut yourself, or put yourself in danger? 

A more accurate phrase is often “connection seeking”, “care seeking”, “distress signalling”, or “attachment need”. Human beings are supposed to seek attention when distressed. Babies cry when they need help. Children reach for adults when frightened. Adults call friends, partners, therapists, doctors or emergency services when they cannot cope alone.

We are wired for connection and co-regulation. The human nervous system is not designed to manage all distress in isolation.

That does not mean every behaviour is healthy. It does not mean there should be no boundaries. It does not mean supporters must become endlessly available. But it does mean contempt is not a treatment.

If someone’s distress has reached the point where they are hurting themselves, the question should not be, “Are they doing this for attention?” The better question is, “What kind of pain has become impossible to communicate safely?”

Sometimes self-harm does communicate distress. But communication is not manipulation by default. It may mean the person has run out of language, hope, skill or confidence that anyone will hear them.

A compassionate response does not reward self-harm. It reduces shame and increases the chance that the person can ask for help earlier next time.

Shame often keeps the cycle going

Self-harm is rarely just about the moment before it happens. It is also about what happens afterwards.

Many people feel intense shame after self-harming. They may feel weak, disgusting, childish, frightening, manipulative, broken or beyond help. They may hide injuries. They may lie about what happened. They may avoid people who care about them because they cannot bear the possibility of being judged.

That shame then becomes part of the next cycle.

The person was already struggling. They self-harmed to cope. Then they felt ashamed for self-harming. Now they are carrying the original pain, plus secrecy, plus self-attack.

This is one of the reasons compassionate responses matter so much. A calm response can reduce escalation. A shaming response can increase danger.

Shame says, “There is something wrong with me.”

Compassion says, “Something in me is struggling and needs help.”

That shift may sound small, but clinically it is huge.

People rarely recover by hating themselves into safety. They are much more likely to recover when they can understand the function of the behaviour and develop safer ways to meet the underlying need.

Self-harm and the learning brain

The brain is a prediction machine. It learns from patterns.

If a person feels unbearable distress and self-harm creates relief, even briefly, the brain stores that learning. Next time a similar body state appears, the urge may return faster. This is not necessarily conscious. The person may not think, “I will use self-harm because it worked before.”

Their body may simply move towards the familiar route.

This is how coping strategies become habits.

A habit is not always something we enjoy. It is something the brain has learned to repeat because, at some point, it served a function.

That is why recovery often involves slowing the chain down. The aim is to help the person notice earlier warning signs before the urge reaches its peak.

·       What made me vulnerable today?

·       Did I sleep badly?

·       Have I eaten?

·       Have I been drinking?

·       Was there conflict?

·       Did I feel rejected?

·       Did I feel trapped?

·       Was I reminded of something old?

·       Did I spend time online in spaces that intensified the urge?

·       What did I feel in my body first?

·       What did I tell myself it meant?

·       What did I need at that moment?

This is not about blaming the person. It is about mapping the route. Once we can map the route, we can begin to place exits along the way.

Self-harm and social learning / social contagion

This is a sensitive area, but it matters and it needs careful handling.

Yes, self-harm can be influenced by social contagion and social learning. Humans are social creatures. We notice what others do. We absorb language, rituals, meanings, and behaviours from our environment especially when we are young, distressed, lonely, impressionable, highly identified with a group, or searching for language to explain our internal experience.

This can happen in schools, friendship groups, inpatient settings, online spaces and social media communities. Seeing others describe, discuss or show self-harm can make the behaviour feel more imaginable, more normalised and available as an option. It can give people a script for distress. It can make self-harm feel like a shared identity, a signal of pain, or a way of belonging.

It can also intensify urges, increase identification with self-harm, or make it harder to move away from it.  A few years ago we saw a massive increase in self-harm in schools and amongst teenagers, as it became a way for teenagers to express their feelings, in some cases feel a sense of belonging, and to ensure they were ‘seen’. 

This does not mean the distress is fake.

That point is crucial.

It can mean that society needs a social contagion for each age. Social learning does not mean someone is “copying for attention”. It means that human distress is shaped by context. The way people express pain is influenced by culture, peers, language, online content and what feels recognisable or validated in a particular environment.

A teenager who self-harms after seeing peers do so is not necessarily pretending. They may be genuinely distressed and have learned a particular route for expressing and regulating that distress. A person in an online community may feel understood for the first time, while also becoming more identified with harmful coping. Both things can be true.

The current social contagion appears to have moved to a focus on self-harm to gender right now.  I want to say it is important that there is a social contagion because that is how people get to express themselves, to have a sense of commonality and to be heard.  It is just important we acknowledge it as such, and understand the needs behind it.

The difficulty is that these spaces can be comforting and risky at the same time. They may reduce isolation, but they may also intensify urges. They may offer language, but they may also normalise self-harm or behaviours not thought through. They may create belonging, but sometimes belonging becomes attached to staying unwell.

This is why we need thoughtful openness.

We should not shame people into silence. Silence increases secrecy and risk. But we also should not sensationalise self-harm, describe methods graphically, romanticise it, or turn it into an identity. The aim is not panic and not avoidance. The aim is careful, compassionate, non-graphic conversation that keeps the focus on distress, safety, support and recovery.

Why self-harm can become part of identity

For some people, especially young people, self-harm can become more than a behaviour. It can become part of how they understand themselves.

This is not because they are choosing an identity lightly. It is often because the behaviour has become attached to pain, belonging, visibility, survival, shame or being understood.

• If someone has felt invisible for a long time, self-harm may become proof that their pain is real. If someone has struggled to explain their emotions, self-harm may become a form of language.

• If someone has found online spaces where self-harm is openly discussed, it may become part of a community identity.

• If someone has been repeatedly invalidated, the visible sign of distress may feel like evidence that cannot be dismissed.

The problem is that when self-harm becomes part of identity, recovery can feel frightening. The person may wonder who they are without it. They may fear that if they stop, people will think they are fine. They may worry that their pain will no longer be taken seriously.

This is why recovery cannot simply be framed as “stop doing that”. It often has to include helping the person build a wider identity.

Self-harm, trauma and dissociation

Self-harm can sometimes be connected to trauma.

For some people, traumatic experiences leave the nervous system primed for threat. The body may move quickly into fight, flight, freeze or shutdown. The person may feel overwhelmed by sensations, images, memories or emotions that do not feel fully connected to the present.

Self-harm can then function as an attempt to manage trauma-related states.

·       It may interrupt dissociation.

·       It may bring the person back into the present.

·       It may express anger that could not be expressed at the time.

·       It may punish the self for shame that actually belongs elsewhere.

·       It may create a sense of control over a body that once felt powerless.

·       It may turn invisible emotional pain into something visible and concrete.

This is why trauma-informed care matters. If self-harm is treated only as “bad behaviour”, we miss the survival logic underneath it.

Trauma-informed work asks, “What happened to you?” and “How did your nervous system learn to survive?” It does not remove responsibility for safety, but it places behaviour in context.

For some people, trauma-focused therapy may eventually be important. But timing matters. If a person is actively self-harming and highly dysregulated, the first phase of therapy may need to focus on stabilisation, safety, emotion regulation and building capacity before intensive trauma processing.

Good therapy does not rush the nervous system. It builds the foundation first.

Self-harm, attachment and relationships

Self-harm can also sit within relational patterns.

This does not mean it is done “to” other people. It means relationships can trigger powerful emotional states, especially when someone has a history of abandonment, rejection, invalidation, bullying, trauma, emotional neglect or unstable care.

·       A small rupture can feel enormous.

·       A delayed reply can feel like abandonment.

·       A disagreement can feel like rejection.

·       A look, tone or silence can activate old shame.

The person may move very quickly from “something feels wrong” to “I am unwanted”, “I am too much”, “I ruin everything”, or “I cannot survive this feeling”.

In those moments, self-harm may become a way of managing attachment panic.

This is why responses from others matter. Panic, anger, punishment and withdrawal can intensify the cycle. Calm boundaries, validation and consistent support can help reduce it.

That does not mean supporters should tolerate unsafe behaviour without limits. It means the limit needs to be held without contempt.

For example, instead of saying, “You are doing this to manipulate me”, a steadier response might be, “I care about you and I am taking this seriously. I cannot be the only support for this, so we need to involve professional help. Right now, let us focus on keeping you safe.”

That kind of response combines care with structure. Both are needed.

How DBT helps

Dialectical Behaviour Therapy, or DBT, can be incredibly useful for self-harm.

DBT was originally developed for people struggling with chronic suicidality, self-harm and severe emotion dysregulation. One of the reasons I value it is that it is both compassionate and practical. It does not shame the behaviour, but it does not collude with it either.

DBT holds two truths at the same time:

1.      You are doing the best you can.

2.      And you need to learn new ways to cope.

That balance is powerful. Too much validation without change can leave people stuck. Too much demand for change without validation can feel shaming and impossible. DBT tries to hold both.

One of the most useful DBT tools is chain analysis. This means looking carefully at the sequence that led to self-harm.

·       What were the vulnerability factors?

·       What was happening earlier that day or week?

·       Was the person tired, hungry, overwhelmed, lonely, hormonal, intoxicated, rejected, criticised or reminded of something painful?

·       What was the prompting event?

·       What thoughts followed?

·       What emotions showed up?

·       What body sensations appeared?

·       What urges came next?

·       What did the person do?

·       What happened afterwards?

·       What relief or consequences reinforced the pattern?

This replaces shame with curiosity and structure.

DBT also teaches skills. This matters because people are often told to “use healthier coping strategies” without being shown what that actually means when their body is screaming at them.

DBT skills include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. They help people notice emotions earlier, survive crisis urges, reduce vulnerability, communicate needs, tolerate distress without making it worse, and build a life that feels more worth living.

The aim is not simply to remove self-harm. The aim is to create a life in which self-harm is no longer needed in the same way.

Other therapies can help too

DBT is not the only therapy that can help.

CBT can be useful where self-harm is linked to beliefs such as “I cannot cope”, “I deserve pain”, “nothing will help”, or “I ruin everything”. It can also help with rumination, avoidance, problem-solving and behavioural cycles.

Compassion Focused Therapy can be especially powerful where self-harm is linked to shame, self-attack, disgust or harsh inner criticism. Some people do not only need coping strategies. They need to change the internal relationship they have with themselves.

ACT, or Acceptance and Commitment Therapy, can help people relate differently to urges, thoughts and emotions. Rather than fighting every internal experience, ACT helps people notice what is happening inside them while making choices based on values rather than threat, shame or impulse.

Mentalisation-based approaches can be helpful where self-harm is closely linked to relationship ruptures, rapid misunderstandings, attachment panic or sudden shifts in how the person sees themselves and others.

Trauma-informed and trauma-focused therapies may be important when self-harm is connected to traumatic memories, dissociation, bodily overwhelm or old survival responses.

For some people, family work or systemic support is also important, especially with young people. The person may need individual therapy, but the environment around them may also need more understanding, better communication and safer responses.

In practice, what matters most is not simply the therapy label. It is the formulation. We need to understand what function self-harm serves for this person, what keeps it going, what risks are present, what strengths exist, and what safer alternatives could realistically meet the same need.  It is also important to get a clinician trained to the correct level – and that really matters!!

What about practical alternatives like ice, red pen or elastic bands?

People often want practical strategies, and understandably so. If someone is in the middle of a strong urge, deep psychological insight may not be accessible. They may need something that helps them get through the next ten minutes.

Strategies such as holding ice, drawing red lines on the skin, taking a cold shower, using strong sensory input, or snapping an elastic band are often suggested as harm-minimisation or substitution strategies.

Some people find these useful. They may create enough sensation, pause or interruption to reduce immediate risk.

But we need to be honest. These strategies are not a perfect answer, and they are not helpful for everyone.

For some people, holding ice may provide strong sensation without injury and help them ride out the urge. For others, it may feel invalidating or insufficient. For some, drawing with red pen may externalise distress without harm. For others, it may keep them too close to the ritual. Something like snapping an elastic band can sometimes become another form of self-harm rather than a genuine alternative.

So the question is not, “Is this a popular strategy?” The question is, “Is this actually reducing harm, creating space, and helping this person move towards safer coping?”

A strategy is only useful if it works for the function of the urge.

Matching alternatives to the function of the urge

The best alternatives are usually the ones that match what the self-harm is doing.

If the urge is driven by panic, the person may need regulation. This might include cold water on the face, paced breathing, grounding through the senses, stepping outside into cool air, holding something solid, or contacting a safe person.

If the urge is driven by anger or pressure, the person may need discharge. This might include fast walking, shaking out tension, stomping, tearing paper, scribbling hard on a page, pushing against a wall, or using movement to give the body somewhere to put the energy.

If the urge is driven by numbness or dissociation, the person may need safe sensory grounding. This might include sour sweets, textured objects, music, strong scents, orienting to the room, naming objects, wrapping in a blanket, or placing feet firmly on the floor.

If the urge is driven by shame or self-punishment, the person may need compassionate interruption. This might mean reading a pre-written crisis card, sending a message to a safe person, writing down what the inner critic is saying and responding from a kinder voice, or delaying action for ten minutes while doing something physically containing.

If the urge is driven by loneliness or attachment panic, the person may need connection. That might involve sending a simple message such as, “I am not safe with myself right now. Can you stay with me for a bit?” or using a previously agreed support plan.

If the urge is driven by feeling out of control, the person may need structure. This might include a written plan, removing means, changing rooms, sitting near another person, calling a helpline, or following a step-by-step crisis card.

There is no single strategy that works for everyone because self-harm does not serve the same function for everyone.

This is why generic advice is often limited. A personalised plan is usually far more useful.

A personalised plan is better than a random list from the internet

A helpful plan asks specific questions.

·       What usually happens before I want to self-harm?

·       What am I usually feeling in my body?

·       What emotion am I trying to reduce, express, punish or escape?

·       What does self-harm do for me in the short term?

·       What happens afterwards?

·       What makes urges worse?

·       What makes urges slightly easier?

·       Who can I contact before I reach crisis point?

·       What do I need others to do?

·       What do I need others not to do?

·       What helps me feel more real, more soothed, more connected or more in control?

·       What are my early warning signs?

·       What are my later warning signs?

·       What needs to happen when risk escalates?

This kind of plan treats self-harm as understandable rather than random. And once something becomes understandable, it becomes more treatable.

A plan also needs to include risk. If someone has access to means, is escalating, is using substances, is feeling hopeless, is dissociating heavily, has suicidal thoughts, or feels unable to stay safe, the plan needs to involve more support.

Self-harm should not be managed by coping strategies alone when risk is high.

If you support someone who self-harms

It can feel frightening to know that somebody you care about is self-harming. Many people panic, lecture, plead, or demand promises in the hope that this will stop it. Usually, what helps most is steadiness.

Try to stay calm. Try not to react with shock or anger. Try not to make it all about your fear, even though your fear is understandable. Listen. Acknowledge that things must feel very painful if the person has got to that point. Avoid jumping straight to judgement or interrogation.

Phrases such as “I’m glad you told me”, “it sounds as though things have been really hard”, or “let’s work out what you need right now” are often more helpful than “why would you do that?” or “promise me you won’t do it again”.

It is also important not to shame the person into stopping because sometimes self-harm stops more suicidal behaviours.

It is also important to remember that one parent, partner, friend or colleague cannot become the entire safety plan. Supporters need support too. Professional involvement may be necessary, especially where self-harm is escalating, injuries are serious, suicidal thoughts are present, or the person cannot reliably keep themselves safe.

Care matters, but care alone is not always enough.

When to seek extra help

Self-harm deserves support at any stage, but extra help is especially important if it is becoming more frequent, more severe, more secretive, more medically risky, linked to suicidal thoughts, happening alongside substance use, or associated with increasing hopelessness, isolation or dissociation.

Urgent help is needed if someone has significant injuries, has taken an overdose, may have ingested something harmful, cannot stay safe, is actively suicidal, or is in immediate danger.

Even when it is not an emergency, self-harm should be taken seriously. A GP, psychologist, psychiatrist, mental health nurse, therapist or crisis service can help with assessment, risk management, formulation, therapy planning and safer coping strategies.

People often fear that asking for help will lead to judgement. Sadly, that fear is understandable because many people have had invalidating experiences. But good support should not shame you. It should help you understand what is happening and build something safer.

Final thoughts

Self-harm is rarely about making a fuss. Much more often, it is about trying to survive a feeling, a memory, a body state, a relationship rupture, a shame spiral, or a level of distress that feels too much to hold.

Sometimes it is about emotion regulation. Sometimes it is about numbness. Sometimes it is about self-punishment. Sometimes it is about trauma. Sometimes it is about attachment panic. Sometimes it is about shame. Sometimes social learning is part of the picture too.

Whatever the route in, the answer is not blame.

The answer is understanding the function of the behaviour, reducing shame, assessing risk properly, and helping the person build safer ways to cope over time.

This is where skilled psychological support can make such a difference. As a Chartered Clinical Psychologist, I have worked extensively with emotional dysregulation, trauma, shame, self-harm, suicidal distress, neurodivergence, anxiety, dissociation, and the nervous-system patterns that can leave people frightened of their own reactions. My work is grounded in evidence-based psychological therapies, including DBT, CBT, ACT, Compassion Focused Therapy, mindfulness-based approaches and trauma-informed care.

What I offer is not judgement, panic or simplistic advice. I help people understand what is happening beneath the behaviour: the emotional chain, the nervous-system state, the beliefs, the trauma responses, the relationship patterns, the unmet needs, and the learned coping loops that may be driving the urge to self-harm. From there, we can build a clear, personalised plan for safety, regulation and recovery.

For some people, this means learning DBT skills to survive urges without acting on them. For others, it means working with shame, self-criticism, trauma, dissociation, anxiety, neurodivergent overwhelm or long-standing patterns of emotional pain. Often, it means helping the person move from “what is wrong with me?” to “what has my mind and body been trying to survive?”

If you recognise yourself in this, I want to say gently: you are not ridiculous, weak or beyond help. Something in you has been trying to cope. The task now is not to shame that part of you, but to help it find safer ways through.

If you are supporting someone who self-harms, your calm, steadiness and willingness to understand matter. You do not have to get every word right. But try to lead with care rather than fear, and remember that you do not have to hold this alone either.

And if self-harm is part of your story, you deserve support that is serious, compassionate and skilled. Not judgement. Not panic. Not silence. Skilled care, proper understanding and hope.

My hope from this blog is for anyone reading this to understand it just a little more than before, and to feel curious and compassionate.

As always until next time

Carla