Self-harm is when a person deliberately injures themselves. The methods used to cause the injury can take many forms. It has been reported that up to half of autistic people show self-harming behaviour.

Why might someone self-harm?

There are lots of reasons why someone might self-harm, and the reasons given by autistic people are similar to the reasons given by the general public:

• to regulate depression or numbness
• to express or cope with emotional distress
• to feel a sense of control
• to punish themselves
• to relieve unbearable tension
• to cry for help (this is not the same as attention seeking)
• to distract from intrusive thoughts

Many autistic people find it difficult to recognise, manage and express their emotions. This is known as alexithymia. It can mean that autistic people who experience alexithymia are more likely to feel frustrated, anxious and depressed, and less able to effectively cope with these emotions. Higher levels of alexithymia are linked to higher levels of self-harm in autistic people.

Self-harm may also be linked to bad experiences that are happening to a person now, or in their past. Sometimes the reason is unknown. One study found that approximately half of their autistic sample did not view self-injury as a problem in their lives. For some, it was viewed as coping behaviour. This shows the diversity of experiences and feelings across the community in relation to self-harm.

Some people worry that people who self-harm are suicidal. Research with autistic adults has shown that some people who self-harm have no intention of killing themselves. Self-harm does not necessarily correspond with desire to die, but research suggests it may be linked to a greater risk of suicide in future. For this reason, it’s important to take self-harm seriously.

Where to get help for self-harm

If you are struggling with self-harm and want to stop, it is important to talk to someone about how you’re feeling.

See your doctor

Autistic people tell us that going to the doctor can be stressful because they feel that health professionals do not understand their needs. But seeing your doctor when you’re concerned about self-harm is an important step towards looking after yourself.

Before you see your doctor, it might be worth writing some of your thoughts down so that you can refer to them during your appointment. It may be helpful to know the types of situations or feelings that make you feel like hurting yourself. When you’re calm, it might be helpful to think about the kind of instances when you have self-harmed, and the feelings you had at the time, if you’re aware of those feelings.

Your doctor may be able to offer you options, which may help you feel better about aspects of your life that feel difficult at the moment and might be triggering you to you want to self-harm.

Contact a free listening service

You may also find it helpful to speak to a free listening service or support organisation. These services offer confidential advice from trained volunteers. You can talk about anything that's troubling you, no matter how difficult:

• Call 116 123 to talk to Samaritans, or email: jo@samaritans.org for a reply within 24 hours
• Text "SHOUT" to 85258 to contact the Shout Crisis Text Line, or text "YM" if you're under 19

If you're under 19, you can also call 0800 1111 to talk to Childline. The number will not appear on your phone bill.

If you prefer a webchat, these services are available during set hours:

• Self Injury Support webchat (for women and girls) is open Tuesday, Wednesday and Thursday from 7pm to 9.30pm
• CALM webchat (for men) is open from 5pm to midnight every day

These organisations offer information and support for anyone who self-harms or thinks about self-harm, or their friends and family:

• Mind – call 0300 123 3393 or text 86463 (9am to 6pm on weekdays)
• Harmless – email info@harmless.org.uk
• Self-injury Support (for women and girls). They also host a resource library
• CALM (for men)
• YoungMinds Parents Helpline – call 0808 802 5544 (9.30am to 4pm on weekdays)National Self Harm Network forums

How to help someone who is self-harming

It can be hard to know how to support a loved one who self-harms. If you’ve just found out, you may feel shocked, helpless, angry, responsible or a mixture of difficult emotions. Try to remember that self-harm is often used as a way to manage very hard experiences or feelings. Although it is often very frightening, it does not necessarily mean that a person intends to kill themselves. It is important to stay calm, aware and in control of your own emotions. Try to understand their emotions and experiences, without judging them, rather than focusing on and reacting to their self-harm.

Do

• encourage them to speak to their GP or a free listening service that understands self-harm
• ask how they would like you to support them
• let them be in control of their decisions, but do get them medical attention if it is needed
• let them know you're there for them
• remind them of their positive qualities

Don’t

• do not try to force them to change what they're doing
• do not threaten to take away their control
• do not insult them, for example by saying they're attention-seeking

If you're supporting someone who self-harms, you may be feeling worried about them, pressure to do the right thing and doubt about how you will support them. It’s important that you make sure you take care of yourself too.

These organisations offer information and advice for friends and family (Some of the links do include information on self-harm methods that may be challenging to read about).

• Mind – for friends and family of someone who self-harms
• YoungMinds – parents' guide to self-harm support
• British Medical Association – coping with self-harm: a guide for parents and carers (PDF, 3MB)
• University of Nottingham – It's Okay to Talk about Self-harm leaflet

Thank you to Dr Rachel Moseley who gave time and feedback on this article. Find out more about her work.