I am 27 years old and I self-harm, which I have been doing on and off since I was about 13. My parents hated each other - and I don't think they liked me or my brother very much either. They would get so wrapped up in their own arguments that I think they used to forget that me and my brother had feelings and emotions of our own. I used to get very badly bullied at school because I was so quiet and really found it hard to socialise, which led me to attempt suicide at the age of 15. Then I started self-harming by cutting my body, because I believed that by doing that I would be able to release the anger and problems that were inside me without having to let anyone know. My parents divorced when I was 21 and I eventually ended up disowning my dad - he is an alcoholic with mental health problems and has often been sent to hospital after an overdose. He has also been physically and mentally violent and very aggressive. Eventually I saw a psychologist. I stopped self-harming at Christmas last year and was so proud of myself for doing so, as I now understood it and how to cope with it all. I was ready to go and be the new confident me, which I was, but because I started speaking and became assertive, no one liked it and I lost a lot of friends.

I have now started self-harming again and really don't know what to do. I am so ashamed of myself. I have no one to talk to, I think I am just losing the plot. Thank you so much though, for reading my e-mail, I am sorry if I have bored you in anyway.

Sal

Your letter is full of despair and reflects the experiences of many. As I wrote in The Times yesterday, the rates of self-harm in the UK are estimated to be 4 per 1,000 people - the highest in Europe, with a history of self-harm 20 times more likely in those with a history of mental health difficulties.

As you describe, most self-harmers have a troubled and unhappy early history which includes loss, relationship trauma, being bullied, physical or sexual abuse, illness or disability and general problems with family, and friends. After talking to those who self-harm, it is clear that this is their coping strategy - some describe a numbing of the rising and overwhelming emotional pain that they feel; others see it as a cry for help.

There are some who say that it perversely gives them a sense of “control” over their feelings. Having been abused by others, harming themselves is their choice and they can control when to begin the harm and when to end it.

However, you and others are coping in a destructive and dangerous way - using behaviour that offers temporary relief, but can, and often does, lead to long-term difficulties including permanent damage to skin and nerves. Self-injurious behaviour can never be a healthy way to manage what are clearly big emotional and psychological issues stemming from early childhood. The challenge is to enable you, and others like you, to feel empowered to move from a physical “maladaptive” way of coping to one that is verbal and, with support, allows you to move on to a life that is not stuck in the sadness and pain of the past.

It is easy to say get help - it is much more difficult to actually find a way of doing that. Let me offer you a planned approach which I'd like you to try. I'd also like you to send me e-mail updates so that I know how you are doing. First, monitor your behaviour. Keep a diary of all episodes of harm and note what triggered the behaviour; where did it happen, what was going on, what were you thinking and feeling, what you did and what you thought and felt at the time of harming and, finally, the outcome. Really understanding your self-harm will enable you to begin to think about reducing it at certain times and finding other ways of coping.

Finding support is essential and it is clear that you have found the behaviour of those you know critical and threatening. As a result, you find it difficult to work out how to be assertive without it causing problems in relationships. The web can help you here and I would recommend a wonderful website: www.recoveryourlife.com which offers advice, forums, support, chat, information, companionship and understanding from people who are living or have lived with self-harm. One brilliant suggestion from them is what they call the The Butterfly Project, where a butterfly is drawn on the site of harming and if it fades without harm then it has lived and has flown away. If it is harmed then it can be washed off and another butterfly could try and live at that place without harm coming to it.

Other strategies I have found helpful with those I have worked with to defeat their impulse to self-harm are: squeezing ice cubes until your fingers go numb; eating chilli; hitting a pillow or punching bag; putting a strong vapour rub under the nose which will sting and bring tears to the eyes; getting legs waxed; having a freezing cold shower and drawing or writing in red pen over the body. These are all alternatives to actual harm and will offer temporary relief while you work with support to find longer term solutions and emotional peace with your past.

Possibly the most heartbreaking part of your letter was at the end when you apologised for boring me. This reflects your loss of perspective on how life is just so very tough for you and also a profound lack of self- esteem. You are not to blame for how you feel, nor for the feelings that currently swamp you in ways that leave you very self-critical. There are many ways to try and boost self-esteem, from listing what your positives are (or asking someone trusted to do so), to finding a class or activity that is creatively enjoyable and gives a feeling of pride and satisfaction. Regular exercise alongside a good sleep pattern boosts our “feel good” brain chemicals.

Always have helpline numbers by the phone for use in moments of crisis - Samaritans 08457 90 90 90 (www.samaritans.org) and SANEline 0845 7678000 (www.saneline.org); see also www.selfinjury.org.uk. If you do need to harm yourself, set out limits and harm only to that point - reduce those limits gradually over time. Speak to your GP and explore a referral for counselling or psychological therapy.

Today, you begin your journey towards recovery. It will be a long process that will be hard at times, so make sure you find those to travel alongside you and to hold you when you feel you are slipping. You haven't bored me, you've inspired me to write about an important issue and in doing so you have enabled others in your situation to begin their healing journey too. That makes you a strong and courageous young woman and already you have my respect.

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