Expert chat: Self-harm

Steve: What can cause someone to self-harm?

Rachel: Self-harm is a physical response to emotional distress. Because emotions are so far-reaching, there could be any number of reasons why someone would choose to self-harm. When you are struggling emotionally, a physical pain can feel preferable; a bit like finding a broken leg easier to deal with than a bereavement. We understand physical pain much better.

Michelle: What counts as self-harm?

Rachel: : Self-harm is not just about cutting - it could be any behaviour, action or habit which harms us, from depriving ourselves of sleep to wearing shoes which are too small on purpose. If it's not in your best interests and is happening to meet an emotional pain, then it can be classed as self-harm. This isn't always physical behaviour, it can be emotional too. Deliberately isolating yourself from others or sabotaging things that you know will make you happy can also be self-harm. It's a very complex subject.

Frank: I'm going on holiday this year which means my body will be on show. Do you have any tips for how to hide my scars or how to talk to people about them?

Rachel: : There are two ideas you could try. You could cover up using camouflage make-up (which is sometimes available on prescription with colour match for skin tone). This can really reduce the appearance of scars and some of it is waterproof. Or you can leave your scars on display and, if people ask, come up with some ready-made answers. Stand tall and proud and know that your scars are your survival stripes and they are nothing to be ashamed of. There's something very beautiful about being proud of who you are. Remember: your scars are other peoples' problem - not yours.

Celine: How do you talk about self-harm with other people? I've had bad experiences in the past and don't feel like I can turn to anyone. What do you say?

Rachel: : Talking doesn't have to mean talking. I find it hard to say things out loud but because I like writing, I find it easier to be honest by letter or email. Think about how you're happiest communicating. Next, if someone isn't being helpful, then let them know how you feel. Sometimes people fumble for responses and don't realise they're getting it wrong. Tell them what you need and they might just do it! Be assertive, and in the process you'll feel more in control. Also, you need to turn to people who you can trust. You can know someone who also knows about self-harm, but if you don't trust them, there's no point. It's better to have someone you feel safe with and you can learn together as you go along.

Bob: I haven't harmed for a while but I've been having some problems recently which have made me really angry. I've been having vivid images of harming myself again. It's affecting everything and I'm really worried I'll start again. Is this normal?

Rachel: : It's good that you've recognised what's bothering you right now and that you're trying to process the anger that you're feeling. Self-harm always stems from a difficult emotion; rather than focusing on the act itself, we need to focus on how the person is feeling. What you're experiencing is totally normal and the best thing you can do to stay safe is try and identify helpful ways to process and express your anger. Often, people find it easier to process anger through physical things - go running, screw paper up into balls and throw them as hard as you can etc. And remember: a relapse is just a relapse. It doesn't undo anything you've achieved.

Naomi: How can you help someone who's struggling with self-harm when they live far away from you? I'm always unsure of how to help them or what to suggest.

Rachel: : The biggest bit of advice I give when delivering training is to listen. The most powerful thing you can do for someone is to listen. When we feel heard, we feel more empowered and validated. It can be hard when there's distance, so thank goodness for Skype, FaceTime, mobile phones, texts. There's often not a lot we can do physically anyway, so don't worry about the distance. I'd rather have a good friend I can properly talk to less often than be surrounded by people I can't be honest with. Start by asking what your friend wants and try to be led by them. They might not know what they want, but they'll be more empowered to think about it knowing that you'll hear them.

Ashley: I'm hoping to get a tattoo on my wrist, where my scars are. I'm scared of showing the tattoo artist my scars as I don't like anyone seeing them. Do you think I should get my first tattoo there, as it's a pretty permanent solution?

Rachel: : A lot of tattoo artists will already have seen people with self-harm scars, so you won't be the first. These are people who ink for a living, over every inch of people's bodies, so don't be afraid of them seeing. I'd suggest having a consultation and being brutally honest. Worst case scenario is that you find a different tattoo artist.

Harriet: What should people do when they've harmed themselves? Do they need to go to hospital every time?

Rachel: : It depends on the type of injury. Not everyone who self harms needs to go to Accident & Emergency, but if in doubt you should seek advice. Treatment will depend on the kind of injury. Some departments will treat you with very little questioning and you're not obliged to say anything if you don't want to - they won't withhold treatment. You can learn how to self-treat injuries, but please make sure you know what you're doing. A&E departments are there to help, not judge, so don't be afraid to ask for help.

James: : There's an article on The Mix about going to A&E for self-harm here.