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Introduction to adolescent mental health
Introduction to adolescent mental health

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5 Self harm

Similar to eating disorders, self-harm is an expression of emotional distress. People who self-harm tend to use it as a coping strategy for handling intense feelings such as anger, distress, fear, worry, depression or low self-esteem (SelfharmUK, 2020a and b). Have a look at the statement from the Royal College of Psychiatrists:

Self-harm happens when you hurt or harm yourself. You may:

  • take too many tablets – an overdose
  • cut yourself
  • burn yourself
  • bang your head or throw yourself against something hard
  • punch yourself
  • stick things in your body
  • swallow things.

It can feel to other people that these things are done calmly and deliberately – almost cynically. […]Some of us harm ourselves in less obvious, but still serious ways. We may behave in ways that suggest we don’t care whether we live or die – we may take drugs recklessly, have unsafe sex, or binge drink. Some people simply starve themselves.

Royal College of Psychiatrists (2016)

Activity 6: Reactions to self-harm information

Timing: Allow about 10 minutes
Select the answer for
Activity 6: Reactions to self-harm information

Read the statement from the Royal College of Psychiatrists again and note your immediate responses, selecting from the list below. Use the text box to record any further thoughts or reflections you may have. Please note, there are no right or wrong answers.

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Difficult to fully grasp.


It must be attention seeking behaviour.


I know someone who has done this.


Perhaps they don’t feel the pain like others do.


I wouldn’t know how to help someone with this problem.

The correct answers are a, b, c, d and e.

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Some people have described self-harm as a way to express something that is hard to put into words; to reduce overwhelming emotions or thoughts; a means of escaping traumatic memories; a way to communicate to other people that you are experiencing severe distress; and/or to have a sense of being in control. As you will see in the next activity, the physical pain is real and self-harm is rarely a deliberate ‘attention-seeking’ act.

According to the charity Young Minds, self-harm affects up to 1 in 5 young people. An analysis of medical records has indicated that instances of self-harm are rising (Morgan et al., 2017). Self-harm is mainly done in private and is often hidden, and it is a very sensitive topic, so the reliability of data about young people who self-harm has to be considered carefully. For example, has there been a genuine increase in self-harm over the past few decades, or merely more reporting, help seeking and acknowledgement of the issue?

The charity YoungMinds has written a summary of warning signs for self-harm:

There are many signs you can look out for which indicate a young person is in distress and may be harming themselves, or at risk of self-harm, the most obvious being physical injuries in which:

  • you observe marks on more than one occasion
  • they appear too neat or ordered to be accidental
  • the marks do not appear consistent with how the young person says they were sustained.

Other warning signs include:

  • secrecy or disappearing at times of high emotion
  • long or baggy clothing covering arms or legs even in warm weather
  • increasing isolation or unwillingness to engage
  • avoiding changing in front of others (may avoid PE, shopping, sleepovers)
  • absence or lateness
  • general low mood or irritability
  • negative self-talk – feeling worthless, hopeless or aimless.

‘At first we thought he was just accident prone, it was easy to miss, he always had an explanation as to how he’d got hurt.’

(Source: Young Minds, 2020, p.3)

You will see some similarities with other mental health problems such as eating disorders, and it is important to realise that the accumulation of signs should raise warning signals.