Self-harm and autism - a guide for professionals

Some autistic people use self-harm as a way to cope with or express overwhelming emotional distress.

If you work with autistic people, and are concerned that someone you support is self-harming, this guide explains signs to look out for and how to seek help. For medical and mental health professionals, we explore treatment options.

What is self-harm?

“Self-harm is when somebody intentionally damages or injures their body. It's usually a way of coping with or expressing overwhelming emotional distress.

Sometimes when people self-harm, they feel on some level that they intend to die. More than half of people who die by suicide have a history of self-harm.

But the intention is more often to punish themselves, express their distress, or relieve unbearable tension. Sometimes it's a mixture of all three.

Self-harm can also be a cry for help.”

The NHS website

Researchers suggest three stages or reasons that may underlie the self-harm: 

predisposing factors – these are the factors which underlie the problem, may be specific mental health issues, for example, anxiety, depression
precipitating factors – this is the actual event which triggered the self-harm 
perpetuating factors - this is the reason why the person may continue to self-harm.

Causes of self-harm in autistic people

Autistic people can find it difficult to communicate and understand others. This can include things like making sense of their own feelings, communicating how they feel and interacting and socialising with others. These challenges can mean they are more likely to experience anxiety and depression, which may make autistic people more vulnerable to self-harm. It is important that autistic people are able to access support to help with these challenges in order to prevent any future difficulties.

Research has found there are potential triggers that might lead an autistic person to self-harm, these include:

feeling socially isolated or rejected
being bullied
pressures from workload or responsibilities at school, work or home.

Signs of self-harm

Young Minds sets out some signs that may mean a young person is self-harming:

unexplained cuts, bite marks, burns
bald patches 
keeping covered, avoiding swimming 
bloody tissues in bins 
becoming more isolated and withdrawn 
expressing feelings of failure and self-blame.

What to do if someone you support is self-harming

If someone you support is self-harming, support them or their parents to contact their GP to get any injuries checked, or get a referral to their local mental health service team.

They can ask their GP for an emergency appointment or the out of hours team. You can also contact NHS 111 (England, Scotland and Northern Ireland) or NHS Direct 0845 46 47 (Wales) to get out of hours advice.

You can also visit our mental health support page for more information about seeking help.

It is very important to seek help as early as possible. Self-harm, alongside depression, is a risk factor for suicidal behaviour. Early intervention and management of the causes of self-harm is very important and will help to prevent self-harm in the future.

There are different services and online support resources about self-harm available, such as Mind, that include useful advice, helplines and contacts.

If the person you support is finding it difficult to talk to you or others about what is happening, you might want to suggest they contact a helpline:

Self-injury Support

0808 800 8088 or 0780 047 2908 (text support) - information and support for women and girls affected by self-harm

lifesigns.org.uk - user-led self-harm information and support network
The Samaritans – a free helpline for anyone struggling to cope 116 123

Treating and supporting autistic people who self-harm

NICE guidelines (2011) explain how to support individuals who are aged eight and over and who self-harm. This includes:

Offer a psychosocial assessment of needs and risks.
Treatment and management of self-harm is the responsibility of local mental health and psychiatry teams for adults and CAMHS for children.
Intervention should be tailored to individual need, and could include cognitive-behavioural, psychodynamic or problem-solving elements. 
Provide psychological, pharmacological and psychosocial interventions for any associated conditions.

Helping the person to identify, understand and manage emotions is essential to addressing any mental health problems that may underlie the self-harm.

Cognitive behavioural therapy can be useful for autistic children if it is adapted, as it can improve awareness of emotional states and the links between thoughts, feelings and actions.

Advice to professionals from autistic people suggests a need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers.