Having thoughts of hurting yourself?

Is the urge to hurt yourself changing?

Thoughts of self-harm are thoughts or impulses to intentionally cause physical harm to oneself.

These questions show how the urge changes and what comes before it:

• When did thoughts of self-harm first appear?
• How often do they return, and are they getting stronger?
• What situations, emotions or events usually precede them?
• Is there a feeling of inner tension, emptiness, anger or emotional numbness?
• Do you have a desire to punish yourself?
• How difficult is it to switch away from the impulse to harm yourself?

Even one answer is enough to begin with; a professional will ask about the rest.

Self-harm and risk to life

Thoughts of self-harm do not always mean wanting to die, but suicide risk can also be present. A professional assesses urges, intention and the ability to stay safe. Seek help before thoughts become actions.

Low mood and loss of interest in what used to matter, against the background of these thoughts, are a reason to consider depression as well. Still, these thoughts do not yet mean that you have depression, and a doctor will listen to you with or without a diagnosis.

Both took care of themselves in time

An urge and unwanted images differ, but help is needed in both cases. During a consultation, you can rely on the list in the section “Is the urge to hurt yourself changing?”.

Before things get worse

Recurring thoughts of self-harm are worth discussing with a mental health professional – even when you are not currently harming yourself and have no suicidal intent.

Emergency help is needed if:

• there is an immediate risk of serious harm to yourself;
• the impulse cannot be controlled;
• self-harm has already occurred and medical attention is required;
• suicidal thoughts, intention or plan appeared at the same time;
• you are not sure that you can maintain your own safety.

In such a situation, call 103 or 112 in Ukraine or go to the nearest emergency department. If possible, do not be alone. Immediate risk requires emergency help; a routine appointment cannot replace it.

To picture the first visit, open the initial psychiatric consultation page. The clinic’s team is presented on a separate page.

A safety plan with a professional

You do not have to cope with thoughts of self-harm on your own. Even if you are sure you do not want to die, it is worth bringing this to a psychiatrist, psychotherapist or other mental health professional.

First, together identify the situations and emotional states that usually precede an impulse. Then choose safer ways to reduce tension.

In a moment of strong impulse, one of these can help:

• increasing your distance from potentially dangerous objects;
• moving to a safe place near other people;
• contacting a loved one;
• grounding;
• slow breathing;
• switching your attention to neutral physical activity.

These methods become part of a safety plan, which also includes three components:

1. signals that warn of a crisis;
2. names and numbers of people and services who will help;
3. changes that make the space around you safer.

If depression comes with these thoughts, show your family the article “How to help someone with depression”.

Easy to confuse

Some states resemble an urge to harm yourself, so they are worth mentioning at a consultation:

• Suicidal thoughts. At the centre are thoughts of ending one’s life; if they appear together with an urge to self-harm, emergency help is needed.
• Emotional numbness. Feelings seem switched off, and this happens even without a wish to hurt yourself.
• Intrusive negative thoughts. An image or thought comes against your will and frightens the person themselves.

At times they come together, and then describing each one matters even more.

Weighing the urge

1. If there is an immediate risk of serious harm to yourself, the impulse cannot be controlled, self-harm has already occurred, suicidal thoughts have appeared at the same time, or you are not sure you can maintain your own safety, call 103 or 112 in Ukraine or go to the nearest emergency department.
2. If the thoughts become more persistent, episodes of self-harm are already occurring, you turn to them more and more often to cope with emotions, or you feel a loss of control, do not put off contacting a psychiatrist or psychotherapist.
3. If the thoughts return but you are not harming yourself, start with the steps gathered in the section “A safety plan with a professional”.
4. If your thoughts are more like unwanted images that frighten you, look at the point about intrusive thoughts in the section “Easy to confuse”.