Self-Harm Is Not ‘Attention-Seeking’, It’s ‘Attention-Needing’

Warning: This article discusses sexual assault, abuse and self-harm in a way that may be distressing to some readers.

"It got to the point where I couldn’t deal with it on my own but couldn’t speak to anybody. I just broke." 

Amanda*, now 35, was in a long-term relationship with an abusive partner. During the 13-year relationship she says she lost her confidence and self-esteem, got into about £4,000 worth of debt and became isolated from family and friends. 

"Before, I was very much a family-orientated person," Amanda says. "I was the life and soul of the party, very sociable. But in the relationship, I wasn’t able to see my family without being grilled about where I was going, I would have to have my mobile phone on me constantly. I lost a lot of friends. I became very shy and meek."

Amanda began using self-harm as a coping strategy.

There are many myths surrounding self-harm and who it affects: that all self-harm is suicidal ideation, that it's attention-seeking, that only teenagers do it. None of this is true. While it’s thought to affect young people most, self-harm is a behaviour that can affect anyone, including adults. And the stigma associated with self-injury gets stronger for adults who fall outside the expected demographic. 

This stigma can keep people who need support from reaching out for help, which is more urgently needed than ever. As the cost of living crisis persists, experts are bracing for a rise in self-injury. Back in October 2022, Mind reported a 40% increase in calls to its helpline about financial stress. In a survey published at the time, the charity found that one in five people were seeing their support network less, and one in four planned to cut back because of the cost of living crisis.

Samantha*, 35, began to experience chronic health problems aged 16 and began self-harming. 

"It became a coping mechanism that I used to get through the worst times. It was never to take action on suicidal thoughts – more the opposite: to try to take the mental pain away."

Over time, Samantha turned to self-harm when she felt overwhelmed by other issues besides her physical health. 

"The health problems were the trigger but then it became a way of dealing with things like stress. It’s where my mind would go whenever I was finding things hard."

Like Amanda, she felt isolated and kept the self-harm private. 

"I genuinely didn’t tell anyone about it. I’ve always found it really embarrassing and feel like people don’t really understand. Some people call it attention-seeking but it’s far from it, as most people who do it don't want people to know they are doing it. But I think if people are harming themselves, there’s a reason why they need attention."

In a 2020 Samaritans survey about sources of help for people who self-harm, only half reported seeking help after harming themselves. Although many respondents agreed that family and friends played an important role in supporting their mental health, they also described "a risk of stigma". Those surveyed reported that peer support (i.e. from people with similar experiences) – often found online – helped them to understand their triggers and find strategies to cope with the urge to self-harm. 

The report also found that of the 19% who sought help for self-harm from a GP, only two-thirds got advice, follow-up support or referrals. The same report warned that people who self-harm often fall between the cracks – too high-risk for primary care services, not risky enough for secondary care. 

Dr Nihara Krause is a consultant clinical psychologist and helped to develop Calm Harm, a free app designed to help users manage or resist the urge to self-harm. Dr Krause says that although the app was originally designed for teenagers, developers know from self-provided information that it is well used by people over 25. 

"There's a number of challenges for adults who self-harm," she says. "Firstly, the fact that it's not necessarily identified as an adult issue means that identifying which service to go to and what might be available is itself difficult. Secondly, there's an enormous amount of shame, I think, for adults who self-harm, because people believe it's a teenage issue, 'you should have grown out of that', which stops people also from accessing services. There's greater secrecy, perhaps in terms of fear of friends and family finding out what might be happening."

She explains that self-harm is a behaviour, not a diagnosis in itself. "If you don’t treat the underlying issue – depression, trauma, eating disorders – the behaviour will emerge again," she says. "If there's unsurmountable stress that people experience, then they may well just self-harm to feel a little bit more in control of something."

Dr Krause recognises Amanda's feeling that she couldn’t speak to anybody about what was happening. "People talk about self-harm being 'attention-seeking' but I would say to them, please see it as 'attention-needing'. It’s not about making some kind of big statement but rather making a statement about or indicating something that can't be put into words, that probably carries a huge amount of confusion for the person expressing it."

She warns that pressure on the NHS also contributes to a lack of access to services, and a lot of self-harm support now seems to have fallen to charities. In its 2020 survey, Samaritans found that only 12% of people they spoke to got help from voluntary or community sources such as helplines. 

Dr Julia Coakes is a consultant clinical psychologist and has worked with women who self-harm throughout her nearly 20-year career. 

"The treatment options in the NHS are very small," she says. "For example, DBT [dialectical behaviour therapy] is one of the recommended treatments for self-harm but the number of DBT services is shrinking and shrinking.

"I get so many requests week in, week out for DBT. I tried to find an in-patient one for a patient the other day and found one that looked like it was open on the internet but when I contacted them, they're shut. Almost all the in-patient versions, for people who self-harm severely, are shut."

Dr Coakes says the cost of living crisis that Mind reported on has now hit patients in her private therapy practice. "We've had lots of people who were weekly [change treatment] to fortnightly and for them obviously the treatment is going to take longer," she says. "On my list of 10 things to do before you self-harm, one is to contact a friend – human connection is a protective factor – but that's only going to work for you if you can afford the phone or Wi-Fi bill, or the transport cost."

It can make a huge difference to show you understand the challenges that friends and family might face when disclosing self-harm urges or behaviour. Katie Hardcastle, senior research manager at Samaritans, says: "Reducing the stigma around self-harm is important in order to encourage and empower people to talk about what they are going through and ask for help. One way that we can do this is by showing non-judgemental support. Helping someone to feel listened to and cared for can help someone recover. Our website has some tips on how to support someone who might be self-harming." 

Both Amanda and Samantha managed to recover from the stress they experienced. 

Samantha still struggles with the urge to self-harm but now uses distractions like going for a walk to help her deal with stress differently. She is now a Samaritans volunteer and says she feels motivated to provide the support that she needed when she was struggling in her teens. 

When Amanda was in crisis she called Samaritans for support. She then visited a friend, who encouraged her to tell her parents – who had no idea what Amanda was going through. 

Talking therapy and art therapy helped Amanda cope and she’s now on a 16-week course of therapy to treat her trauma. Since recovering, she’s become the first person in her family to go to university and is now back in work. 

"When you’re in that situation, the barriers are up and you can’t see the light at the end," she says. "If I saw myself five years ago, there’s just no way it would be possible. My confidence is back."