This post contains triggers. Trigger warnings here include discussion of motivations behind self-harm, examples in writing and in real life, outside reactions to self-harm (both negative and helpful), and care and healing after acts of self-harm. There is one brief mention of suicide as well in this post.
This post has been written with neurodivergent individuals in mind and therefore includes sections that are bullet pointed where possible, and I’ve given as many examples as I can think of, despite it being a nearly endless topic.
The following is compiled from my own personal experiences, chats with friends and loved ones who have self-harmed (whether recurring or one-off incidents), chats within mental health communities online, and talks with professionals (including proofreading of this post).
Defining self-harm
The most important thing here, which I cannot stress enough, is that it’s all about mentality. You cannot call something a character does “self-harm” without it fitting certain criteria, including it being a purposeful act, inflicted by an individual upon themself, for the purpose of coping or expressing some form of internal pain. My point is, that the single cut you see a character create to get blood for the ritual they’re performing (looking at you Sam and Dean Winchester) is not self-harm, as those characters do not fit the mentality for it to be classified as self-harm. Mind.org.uk has a fantastic article going into what self-harm entails, which I highly recommend.
Obviously, it’s incredibly nuanced, as with all mental health topics. But I’m going to attempt to explain it as best I can here, and cover the important stuff for you to be mindful of when creating a character who copes using self-harm, and do justice to an incredibly serious topic within mental health.
Terminology you may also see used interchangeably with self-harm is “self-injury”. Personally, I don’t like using that term, as it excludes a lot of lesser known or acknowledged types of self-harm which contribute to prejudices within mental health communities. Self-harm is any kind of harm done with intent to cause harm, as explained above, but this means that it doesn’t just include cutting, which is often what most people think of. It is anything harmful, not necessarily causing acute injury. Similarly, cutting can include cutting various parts of the body, not just wrists as we often see in media and popular culture. Where and how your character chooses to or is driven to self-harm is dependent on their personality, as well as their character arc, and often outside influences as well.
Why is your character self-harming?
You need to have a clear reason for a character to be self-harming, otherwise it’s easy for readers to see it as a tokenistic representation or a fall-back symbol of how a character’s life is falling apart. Keep in mind that readers tend to be averse to “trauma porn” or watching a character fail/ go through traumas in a way that is exploitative of the traumatised group portrayed.
Writing these arcs are supposed to be empowering, therefore, it’s important that you not only understand the topic, but see it through to the end. Even if they don’t overcome self-harm or get through it on their own strength, getting help is still bold, and brave, and a type of overcoming or winning for your character!
Self-harm can be an option for a coping mechanism for your character for a variety of reasons, including, but not limited to:
They’ve done it before and are reminded that it helps,
They’re in such emotional distress that they aren’t processing things from a logical state of mind,
Someone abusive challenged them to self-harm, and their defences and self-worth are so lowered that they act upon the suggestion,
They have chronic physical pain and self-harm provides an acute distraction to override the chronic pain,
They’ve dissociated and a repetitive action is happening outside of their awareness which is causing harm,
They are in such a low place in life they are using it as a cry for help, for someone to take their pain seriously and offer to help them.
Remember, “doing it for attention” doesn’t exist – it’s an excuse people attribute to the act in order to dismiss the severity of the act of self-harm. One can go on self-harming for days, weeks, even months before ever choosing to show someone what they’ve been doing, and when they do (assuming it is a choice), it is often a cry for help, meant to convince whomever they’re telling that they need help badly and are becoming desperate. We need to stop writing and encouraging the stereotypical teenager who self-harms for attention!
How does self-harm start and escalate?
The act of self-harm is, for a character who has never done it before, usually going to be one of their last resorts. Oftentimes it’ll be like anything they haven’t tried before: they’re hesitant, confused, sometimes conflicted, and will try what they know. (These are fantastic emotions to represent in your writing!) This also means that if the character has a friend they know has relied on cutting before, they’ll probably try that first to see if it has the same result for them. However if their exposure to self-harm has been through someone who uses burning, they may try this first instead.
Note that the result, in these cases, isn’t about blood or what anyone can see, but is internal. It’s about converting an (often unidentifiable) internal pain into external pain, gaining that rush of chemicals in the brain (often endorphins), and the calm of a come-down from the aftermath. Sometimes the first chosen method won’t have the desired effect, and they’ll turn to something they’ve seen represented elsewhere in media, or heard people talk about, or even seen healed-over scars from on others.
After a few tries, a sort of domino effect will begin, however it takes a while to go through all the following steps:
The first is that a character will find their comfortable method, the one that brings the most comfort. This will become their go-to option which they’ll keep repeating in order to continue to gain the same effects.
Second, the effects will, after a time, most likely lessen. They’ll need to cut deeper, or burn hotter or for longer, push their body further in some way. This will mean two things. They will often start to become better at hiding their patterns, their tool/s, and the area of skin they cover. And the neural pathways will strengthen, making it easier for one’s brain to jump from catastrophe = self-harm, until it becomes emotional discomfort = self-harm. However, these sorts of pathways take a lot of repetition to form, but, if the character has a history of self-harm, it’ll be a more likely option for them to return to it.
They may form a ritual, which will likely happen around aftercare, but can also be about anything from disinfecting the tool they use beforehand, to accidentally conditioning themself to a certain time of day or event. It could be like a drink of alcohol where they do it after a particularly difficult day at work, and the aftermath helps them relax into the evening and feel soothed.
From here, a character may form a dependence, or even an addiction. If you think about it, it makes a lot of sense: addiction forms because the brain latches onto something that dulls the pain of life and makes it easier to cope with, like alcohol, opiates, even over-exercising or binge eating. They all create endorphins and ease one’s experience of life. Self-harm does the exact same thing.
How and where would your character self-harm?
There’re a tonne of ways in which a character may choose to self-harm, and this isn’t limited by a list. Whatever you think a character might do in order to take out their emotional pain on their body, it’s a valid and true form of self-harm. It doesn’t have to come from a handbook.
One of my favourite representations of a less acknowledged form of self-harm in literature comes from the gorgeous young adult romance with an ethnic twist, A Cuban Girl’s Guide to Tea and Tomorrow by Laura Taylor Namey. The story starts off in Miami where, after suffering several life-changing losses in a very short period of time, the main character takes her hobby of running to clear her head too far. The breaking point for her family is when they find her having gone out without telling anyone and running 20 miles, suffering awful physical effects as a result (obviously). They decide she could do with a change of scenery and send her for a mental health break to live for a few months with extended family in England, where the majority of the story takes place. During this time, we see the main character’s emotional growth as she addresses the harm she inflicted on her body, understanding that she took it too far and was using the idea of exercise to clear her head or get out of the house as an excuse, and eventually eases back into her hobby of running in a safe and healthy manner, with her love interest alongside her.
A lot of times, someone who is about to self-harm – or take it up again after a period of time “clean” (free from self-harming behaviours) – will start by planning. That isn’t to say it can’t be done on impulse, in which case the character is likely to be acting on a very strong action-urge to do something dangerous, like touch a hot thing while cooking. However, like with suicide, the character will often plan ahead in order to hide the behaviour for as long as possible.
This planning can be pretty much any number of things you reasonably think they may do, and can last any amount of time, but for some examples, planning behaviours can include:
Stocking up on long-sleeve tops or long pants,
Checking supplies in a first-aid kit ahead of time or adding a first-aid kit to their car,
Checking what tools are around the house that may constitute options for your character to self-harm with,
Hiding a chosen tool away ahead of time to test if anyone notices it missing,
Stocking up on aftercare or storing a small amount of aftercare with their chosen tool, or
Doing small, tester cuts or burns, for example, to check the potential of a pre-selected tool.
A character with enough presence of mind to plan ahead like this will also be more likely to have planned out when and how they’ll carry out their form of self-harm, often considering things like where on their body would be easiest to hide given work or school uniforms, the season, upcoming events, or any tattoos or other forms of body art they’re proud of. Again, this is all dependent on the character’s personality, character arc, and the outside events that are the catalyst to their self-harming. They will, however, try to self-harm in the same place each time so that they only have to be mindful of hiding one area (e.g. one section of one arm/ leg/ stomach, etc.).
Healing acute injury: the immediate aftermath
In most cases, this will be up to you to research depending on the method of self-harm your character will have chosen. Practically speaking, treat it like any other wound or injury one might accidentally acquire.
Open, sliced wounds may require steristrips or butterfly bandages, or if that’s inaccessible or bleeding doesn’t let up for some time, sometimes an icepack can help slow bleeding and encourage clotting.
Broad, flat injuries such as from burning or repeated scratching often require an enclosed, moist environment, but are a very high infection risk.
After the main character of Tea and Tomorrow’s 20 mile run, she was badly sunburned, feet blistered, and chafed in various areas, which all required addressing (and her family helped her heal physically).
Punching a brick wall repeatedly may break open the skin which would need antiseptic given walls aren’t often known to be sterile, and ice for swelling is recommended.
There are also hotlines in many countries which your character could call for immediate, over-the-phone advice, if your characters are set in our world.
Also keep in mind that while a character’s body is healing, particularly if the self-harm is repeated within a short timeframe or becomes a habit, the body’s defences will be lowered and they may be more prone to illness (especially around cold and flu season if you’re setting is our own world). This authenticity lends itself nicely to plot bunnies, whether you’d like to experiment with the “one bed” trope as a partner or love interest is determined to look after the unwell character and prove their love/ worth. Or perhaps it could be cause for conflict if the unwell character was at a large event and is blamed for bringing illness into the house when they knew it would be a hotbed of illness, especially if they live with someone immunocompromised.
Maybe the character is all alone and it furthers their desire to find a partner or housemate, or mend bridges with a recently lost friend. There are heaps of ways to play out this aftereffect, whether in a minor scene to further characters’ personalities, or as a major catalyst or hint at something ahead.
How to bring your character out of a self-harm spiral
Once again, this is extremely nuanced and there are a lot of factors, so I’ll try to touch on a few things that are important to keep in mind. If you’d like to ask more specific questions of someone you might know who has had this experience in their lives, refer to my post on How to respectfully consult people with lived experiences on sensitive topics.
Bringing someone out of this sort of mental health dilemma is mostly hinged on why the character is turning to this method of self-soothing in the first place, or what they’re getting out of it. For example, if they become desperate enough to tell or show a loved one what they’ve been doing – or even if their mood has dipped so low that they no longer care about covering up while changing, for instance, and a loved one sees it as a result of the character’s carelessness – the easy answer is usually to get them professional help such as therapy where they can talk out what’s bothering them and get out of the rut they’re stuck in.
As another example, if they’re hanging onto the routine aspect of the actions – maybe they have a sort of ritual before and after, or even cover it up in a certain way which has become tied to that ritual, such as always showering after – the way to alter their state of mind might be around replacing that ritual with something comparative physically, and fulfilling mentally. Maybe they could go for a run for the endorphins, then shower afterwards? Or take up manifestation rituals that end in a similarly symbolic cleansing that speaks to their personality?
Whatever you choose to do to address the situation, remember that simply seeking help or telling someone they trust is a resolution in itself for readers. But, also try to keep in mind that you’re representing a huge percentage of real people, with real mental illnesses, addictions, and harmful coping behaviours. You don’t want to give your characters a cop-out resolution that will be internalised by readers without first-hand experience of self-harm. Set a positive example of struggle, vulnerability, and bravery, and not one of condemnation, blame, and toxic positivity.
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