Is self-harm linked to attention-seeking?

Is self-harm a cry for help, or a form of attention-seeking? Here we explain why young people self-harm, and how to respond to a young person who is engaging in deliberate self-harm. First and foremost, be non-judgmental. It's often difficult for students to talk about their DSH, particularly when people haven't reacted well to it previously.

Deliberate self-harm (DSH) is an issue that tends to divide clinicians and parents alike. Many people cannot understand what would drive someone to deliberately hurt themselves regardless of how much pain they are feeling. I mean, creating pain to manage pain seems stupid right? So the purpose of it must be attention-seeking? Is self-harm a cry for help, or a form of attention-seeking?

Clinical psychologist Liesje Donkin explains why young people self-harm, and how to respond to a young person who is engaging in deliberate self-harm.

Why do young people self-harm?

Labelling DSH as attention seeking is invalidating and potentially dangerous. Whilst some people who DSH may do so to communicate their distress, they can also do it for a number of other reasons. These reasons include to help them feel when they are emotionally numb; to distract themselves from the pain they are experiencing emotionally; to regulate themselves emotionally; to punish themselves; or to disfigure themselves. Importantly, DSH is not intended as a way to end their lives. However, there is an increased risk of suicide in those people that do DSH with the risk of suicide increasing with episodes of DSH. For these reasons, DSH carries very real risk and should not be considered as attention seeking.

What should I do if a young person discloses self-harm?

First and foremost, be non-judgmental. It's often difficult for young people to talk about their DSH, particularly when people haven't reacted well to it previously. Many are also concerned that their parents or carers might get told. Referring the young person to the school counsellor is a helpful step, as they will be able to further assess the risk to the young person, and help them address the issues leading to DSH.

Checking safety is also key. Young people who self-harm frequently also experience suicidal thoughts, so it is helpful to ask about this.

Treatment options

It's important that young people who are self-harming receive treatment to help reduce their distress - this will usually be from a counsellor or psychologist. It can be useful for you to be aware of some of the common, practical approaches that are used by counsellors in addressing self-harm. These include:

• Working with the young person to create barriers to self harm, such as removing objects from the location which the young person engages in DSH or reducing the time they spend alone

• Working out what purpose the DSH serves so that an alternative behaviour can be substituted for it. For example, if the behaviour provides a physical distraction then high intensity exercise may work as a substitute

• A counsellor will generally aim to develop a range of strategies that is specific to the individual. Ensuring that a safety plan is in place to help the young person when they are feeling distressed.