What is self-harm?

The NHS describes self-harm as follows:
 
'Self-harm is when somebody intentionally damages or injures their body. Self-harm is most often described as a way to express or cope with emotional distress.'

People may use one or more ways to self-harm. They may do it once or twice, or more regularly. There may be many different reasons why people self-harm and some people may not know why they self-harm. Reasons may include:

• dealing with intense feelings or distress
• trying to feel in control
• self-punishment
• wanting to feel something when emotionally numb. 

What are the signs of self-harm?

The signs of self-harm can be hard to see if the person hides them. Any changes in mood, habits and behaviour might be a key indication. Signs can include:  

• keeping fully covered around others 
• unexplained injuries, usually on the wrists, arms, thighs and chest   
• unexplained blood stains on clothing or tissues 
• signs of pulling out hair 
• signs of low self-esteem and becoming very withdrawn   
• avoiding activities where they have to change clothing, such as swimming 
• expressing feelings of failure, uselessness, or hopelessness   
• signs of depression - low mood, tearfulness or a lack of motivation or interest.
   

What are the causes of self-harm?

Common causes of self-harm for both autistic and non-autistic people can include:  

• underlying mental health conditions such as depression and anxiety
• struggling with stress and worries  
• trauma and difficult experiences (such as relationship breakdown, job loss, or illness);  
• being around others who self-harm.  

The reasons why autistic people self-harm can be different to non-autistic people. Daily life can be more challenging for autistic people. They may experience differences in understanding social situations and relationships. They may be misunderstood or not accepted by non-autistic people. This can lead to social isolation, rejection and loneliness, possible causes of self-harm. 

Other reasons can include: 

• sensory differences – trying to regulate/manage sensitivity to sound, light, texture and touch 
• difficulties recognising, managing and regulating emotions (alexithymia)  
• difficulties with transition, for example, changes at school, home or work 
• increased likelihood of co-occurring mental health conditions.
   

What is the difference between self-harm and self-injurious behaviour?

Some autistic people may hurt themselves in various ways, such as banging their head on surfaces, biting their hands or arms or pulling their hair. This is known as self-injurious behaviour. Harm is not the intent. It is the result of an attempt to regulate or express immediate physical pain or discomfort, or communicate a particular need. 

Self-harm is intentionally causing physical pain or harm to yourself, often as an attempt to manage difficult emotions or distress. It doesn’t necessarily mean that someone wants to end their life, and can also be called non-suicidal self-harm (NSSI). 
 

How common is self-harm for autistic people?

Self-harm can affect anyone. Some studies suggest that:  

• autistic people are more likely to self-harm than non-autistic people 
• autistic women are more likely to self-harm than autistic men.  

Self-harm and suicide

Self-harm can be a coping mechanism, without suicidal intent. However, evidence shows that those who have self-harmed in the past have a higher risk of suicidal thoughts and attempts. 

Self-harm carries significant risks to your physical and emotional wellbeing. If you are self-harming or have thoughts about harming yourself, it is important to seek professional support and treatment as early as possible.
 

How do I get help for self-harm?

In an emergency you should call 999. If there is no immediate risk to life, and for non-urgent support, you should speak to a GP.  

Your GP will be able to assess you and discuss treatment options. The GP will also check any injuries you have concerns about. 

Treatment and support for self-harm usually involves talking therapies and can involve medication. Your GP may also refer you for further assessment with a community mental health team. A full assessment of needs and risks is recommended. 

Support should address the underlying causes of the self-harm. 
 

Therapies

You might find it helpful to go for counselling. You can access this through your GP or privately. There are various types of talking therapies suggested for self-harm, such as cognitive behavioural therapy (CBT). This can be effective for some autistic people if adapted to their needs.  

Other recommended therapies include: 

• mindfulness-based cognitive therapy (MBCT)  
• dialectical behaviour therapy (DBT) 
• psychodynamic therapy.  

Some autistic people have found that CBT helps them to understand why they self-harm and how to reduce it. It does this by:  

• improving self-esteem and confidence 
• tackling self-criticism 
• teaching practical strategies to cope with difficult feelings. 

Other autistic people have found occupational therapy useful in regulating sensory differences that may be related to self-harm.  

Ideally, all treatments should be delivered by a professional with a good understanding of autism. More importantly, support should be adapted to a person’s specific needs to make it accessible and effective. Visit our Seeking help with mental health page for more advice. 

In England, there is statutory guidance that states autistic adults should have support adapted to their needs if they have a mental health difficulty.   

Search our Autism Service Directory for details of counsellors and therapists in your area with experience of working with autistic people.
 

Medication

Medication is not recommended as a treatment to reduce self-harm. However, you may be offered medication, such as anti-depressants, to treat underlying depression or anxiety. Although guidelines consider antidepressants are generally useful and safe, there is very little research into whether they help treat depression in autistic people. Existing research suggests autistic people may be more likely to experience side effects such as drowsiness, irritability and reduced activity.  

Antidepressants should be carefully considered and closely monitored by a medical professional.
 

Strategies and advice

Some strategies you could try include: 

• talk to trusted friends or family about your concerns  
• learn to recognise triggers – including keeping a diary to help you understand what feelings might lead you to self-harm    
• wait before self-harming – gradually build up the gaps between each period of self-harm (any self-harm carries a risk to your physical health)
• learn techniques to help manage and regulate emotions (such as calming exercises, writing down feelings and distraction) 
• find out about mental health and wellbeing – including help for stress, anxiety and depression.

Autistic people’s experience of self-harm

Please note: the following has content that you may find distressing.  

• Seeing double, understanding autism (2021): Autism and self-harm
• Aucademy (2021): Harmful stims and self-harm with David Gray-Hammond