The Boys Self-Harm Project

By the late seventies, self-harm was increasingly recognised as a way of regulating internal tension, or dispelling a sense of emotional deadness (Basingstoke, M. 2015), and the tools for self-harm; the razor blade and the safety pin, had become the nihilistic iconography of punk. When the cultural historian Dick Hebdige observed the punk rock ‘penchant for self-laceration’ (Hebdige, 1979), mental health never got a mention. That took another twenty years. In 1991, the Manic Street Preachers guitarist Richey Edwards, who fought very public battles with alcoholism, depression and anorexia, put mental health front and centre when he explained: 

“When I cut myself I feel so much better. All the little things that might have been annoying me suddenly seem so trivial because I’m concentrating on the pain. I’m not a person who can scream and shout so this is my only outlet. It’s all done very logically.”

Thirty years later, self-harm has become the coping mechanism of choice for one in four teenagers (Patalay, & Fitzsimons, 2020). The behaviour is now so widespread that it has been described as an epidemic, yet our understanding of what is driving this behaviour remains limited. That needs to change. Urgently. 

I feel so empty. <-> I’m just not happy with myself. I have cut myself and attempted suicide but I just don’t know why I’m not happy. Boy, 16, Tellmi

Although self-harm is usually a way of feeling better, rather than ending ones life, more than half of all young people who die by suicide have a history of self-harm (NCISH, 2017). Because the risk of dying is three times higher for boys who self-harm than it is for girls, this report focuses on the experiences of boys who self-harm. 

Current research on self-harm in boys

It is never easy to gather accurate data on behaviours that are secret or stigmatised, however data which was collected between 2018 and 2019 as part of the Millenium Cohort Study, found that by the age of 17, 28.2% of females and 20.1% of males reported having self-harmed in the previous year.  A 2018 YouGov Poll which was carried out by Self-Harm UK, The Mix and YoungMinds found that 24% of 16-25 year-olds boys in the UK had self-harmed as a result of depression, anxiety and stress.

I am almost reaching the worst point of my life, <-> I’ve been self-harming for 2 years, since I was 10 when this all began. Boy, 12, Tellmi

Research suggests that boys self-harm in different ways to girls. Girls who self-harm are more likely to cut themselves, or to overdose (Young et al., 2007), whereas boys who self-harm are more likely to punch walls, drink heavily, take drugs, or control their eating (Nada-Raja et al., 2004). Tellmi data confirms that boys self-harm in a number of different ways including burning, starving, inducing physical exhaustion, drug-taking or punching walls.  Within the Tellmi app, boys rapidly realise that they are not alone.

I want to be able to see my ribs <-> I want to punish myself by starving myself or doing too much exercise until I can see my ribs. Boy, 17, Tellmi

<->Today I punched a wall until my knuckle bled. Boy, 13, Tellmi

I've gone ages without wanting to self-harm or purposely break a bone again <-> what am I supposed to do. I’ve got enough scars as it is.  Boy, 15, Tellmi

Although boys experiment with a number of different methods of self-harm, cutting is still very widespread.

The more I self-harm the more it gets serious. <-> last night I used a meat knife and I wasn't in control because I was trying so hard i had to go to the hospital. I'm scared the next time <-> end up dying. <->. Boy, aged 18, Tellmi

I've been burning but for me cutting is <-> I'm a disappointment and a failure. Boy, aged 14, Tellmi

I feel nothing <-> I just can't feel anything, cutting is the only thing that makes me feel alive. Boy, 15, Tellmi

Because self-harm is a secret behaviour, boys find ways of hurting themselves that won’t be spotted easily. Being able to talk openly about these issues is a relief.

<-> my harm is different <-> Its not easily noticed by others <-> Boy, aged 15, Tellmi

When I was massively excessively exercising (to the point I damaged my body) <-> people knew that's what I was doing and they didn't care, but once they noticed the scars on my wrist they all got concerned? <->. Boy, aged 15, Tellmi

<->I’ve stoped eating and when I have eaten I throw it back up. Im also doing a lot of physical exercise to hurt myself <-> but no one notices. I've started cutting again and I don’t know how to stop myself <->. Boy, aged 17, Tellmi

Self-harm is essentially a mechanism for relieving stress. When boys don’t understand their own self-harm behaviours, it increases their level of anxiety, and this in turn, increases the likelihood of self-harm. Having a behaviour confirmed as self-harm by the Tellmi peer community allows boys to ‘name’ what they are doing.  

I am really confused, I think I self-harm, like I dig my nail into the side of my hand when I am really stressed and I had some kind of dissociative episode thing <-> so instinctively smacked myself in the face with a glass bc- I’m a mess and it gives me some sort of relief, but I don't cut myself. <-> Boy, 15, Tellmi

Is it healthy to hit myself/ slam my head against walls when I have anxiety attacks <-> my parents think I’m faking being scared of almost everything Boy, 14, Tellmi

Can exercise be <-> self-harm? I’ve done 11 hours on the bike this week <-> I’m in so much pain <-> Boy, 18, Tellmi

Gender roles and the stigma around mental health issues make it harder for young males to ask for help (NCB, 2016).  Boys are particularly unwilling to talk to adults about self-harm and they are reluctant to seek help for psychological distress (Gulliver, Griffiths, & Christensen, 2010). The Tellmi app is an anonymous, genderless, social media space, where usernames are randomly generated within the app, and all visual hierarchies have been stripped out. This makes it much easier for boys to be honest about issues such as self-harm.

I want to talk to people about how I feel <-> I have anxiety <-> I self-harmed <-> but I just don’t know what to do now - I’m not close to any teachers at school & I don’t feel comfortable talking to my mum about it - I feel like I’m stuck :(  Boy, 15, Tellmi

I want to talk to someone about my self-harm and feelings and other stuff but i don't know who or how. <-> I don't want to upset or make anyone angry/disappointed”  Boy, 14, Tellmi

I've felt so shit 24/7 for the past year it's got to the point where I started sh again and my depression has just takin over completely. I want to get help but I can't tell my parents, <->   I literally have nobody I can talk to. <-> ❤️ Boy, 16, Tellmi

Boys who self-harm don’t get the help they need

When boys do ask for help, the system fails them. Tellmi data shows that a great deal of self-harm is kept secret in boys and since many acts of self-harm do not come to the attention of healthcare services, hospital attendance rates do not reflect the true scale of the problem (Hawton et al., 2002a; Meltzer et al., 2002b). Caroline Clements research suggests that the number of incidents of self-harm episodes recorded by hospitals is underestimated by 60% (Clements et al., 2016) because A&E attendances that don’t result in admissions are not recorded. However it also relates to the way that presenting symptoms are coded. Because self-harm is a behaviour rather than a diagnosis the presenting symptoms might read ‘cut’ for self-injury, or ‘stomach pain/nausea’ for overdose. 

“When boys present with injuries at accident and emergency units self-harm should be proactively investigated”

Misrecording at A&E is particularly pertinent to boys because research shows that when a young male turns up at A&E having punched a wall, or drunk a bottle of vodka, they are not asked about underlying issues or given a psychiatric assessment. Depending on the extent of the injury they are either sent home, or referred to a fracture clinic where their physical injuries will improve, but their mental health issues won’t (Oxley et al., 2017).

In 2017, the Paediatric Mental Health Team at the Whittington Hospital reviewed the medical records of young people under 18 who presented at A&E that year. Results showed that boys with punch injuries outnumbered girls 4.57 to 1 and 44% of patients presenting with punch injuries were discharged without follow-up. There were no records of liaisons with, or new referrals to CAMHS (Oxley, C., Roberts, J.E., Kraemer, S., & Armstrong, G., 2017).

We know that boys find it difficult to ask for help, and when they do, their cries for help are often mislabeled as accidental injury, or aggressive behaviour. When boys present with injuries at accident and emergency units self-harm should be proactively investigated and boys who can’t explain their injuries should be assessed by the psychiatric team as a matter of routine.

School policies on disclosure stop boys asking for help. When self-harm is discovered or disclosed at school, teachers are legally obliged to inform the boy’s parents, unless there is reason to believe that this might make things worse for the boy. This policy is well intentioned, but it is perceived as a huge barrier to support for boys who self-harm.

I self-harm and <-> I want to tell my teacher but I can't let my parents find out, can I ask them to keep it a secret, or do they have to tell someone?  Boy, 14, Tellmi

<-> I've started self-harming again, my pastoral support teacher in school asked if I did it and I lied. it's like if I say yes they would call my mum <->. Boy, 16, Tellmi

Went to the school counselor today, Idk why I am too afraid to tell him that I am cutting. <-> just afraid of what he will do about it Boy, 14, Tellmi

Disclosure to parents doesn’t necessarily help. The reaction a boy gets when he first tells someone about his self-harm is a very important factor in helping him to decide whether or not to get help. Boys who hide their self harm are often hiding other aspects of their lives so it is important to explore issues around parental support thoroughly before picking up the phone.

<->my cutting has got a bit worse and I told a teacher about me being depressed because of my mum always shouting at me <-> and he called her and she said she didn't do any of what I said <-> I'm going to go into school and be painted a liar? Boy, 14, Tellmi

<-> I recently self-harmed and mam saw the cuts all down my arm, <-> all she said was “next time I see you do that again I’m going to get a belt and do the same to your ass Boy, 13, Tellmi

I have sh for 4 years now, and I wrote a suicide note to my parents.<-> They have told me to just “man up” and that I don’t need any help.<->. Boy, 15, Tellmi

I cut myself for the first time because of <-> my parents call me things like a fucking retard and threatened to break my nose after arguments and I just want to go. Boy, 16, Tellmi

The fear of being labelled ‘attention seeking’ stops boys disclosing their self-harm to anyone. Even though it is a secret behaviour which young people go to great lengths to hide, the idea that self-harm is a form of attention seeking is deeply ingrained. Tellmi mitigates against the possibility of a disclosure of self-harm being labelled as attention seeking by moderating every post and reply before they are allowed through to the feed to eliminate all bullying, judgement or humiliation.

firstly i want to say in sorry for the people who think im attention seeking <-> i feel like im getting closer and closer to the end and i feel like SH again. im really sorry for wasting your time pls forgive me. Boy, 16, Tellmi

<-> self-harming <-> I’ve tried talking to my friends and family about it but they just tell me to get over it and that I’m doing it all for attention.<-> Boy, 14, Tellmi

So I got called a attention seeker because I cut my wrist. But I done it for a reason because I’m getting bullied <-> I want to die <-> Boy, 19, Tellmi

Getting boys to disclose self-harm requires more proactive enquiry. The fears that boys have around disclosure are both real and legitimate, but ultimately, most boys who self harm realise that they need help; they just can’t bring themselves to ask for it. When self harm is suspected, you can lay the groundwork by simply talking about it, without probing too much. Showing boys that you are informed and that you understand self harm, makes it easier for them to be open.

<->I can’t talk to my counsellor about it because I’m scared my sh urges will go on my medical record and telling an adult makes it “real” <-> I don’t wanna have to disclose it to people when I’m older. Boy, 15, Tellmi

how do I cover sh cuts? I<->I had pe today and before school I asked the school nurse to bandage my arm up and I lied when she asked how I got them. I said it was from a cat <-> she didn’t say anything, but she said I could always come and talk to her about anything that was worrying me.  Boy, 14, Tellmi

I always think that next time a teacher talks to me about sh I will tell the truth <-> but every time I just lie and say everything’s fine Boy, 14, Tellmi

Boys who self-harm have a higher risk of suicide 

Although self-harm is often referred to as non suicidal self injury, more than half of all young people who die by suicide have a history of self-harm (NCISH, 2107). 

My mums gonna find out that I still self-harm tomorrow <-> but every time I’ve tried to stop I’ve either planned suicide or attempted it I’m so scared <-> Boy, 15, Tellmi

A University of Oxford study of 9,173 young people (6,828 girls and 2,345 boys) aged 10-18, who attended hospital a total of 13,175 times between 2000-2013, found that the 12-month incidence of suicide for the self-harm cohort was more than 30 times higher than the expected rate in the general population of individuals aged 10–18 years in England (Hawton et al.,2020).

Suicide is a risk for all young people who self-harm, but whether it happens by accident or by design, the risk of dying is substantially higher for males. In teenagers, 2.6 boys die by suicide for every girl. By the age of 20, there is a male to female ratio of  3.7:1.

I've struggled with SH since I was 12 years old. I've been trying to quit since my first suicide attempt when I was 13. I'm 15 now. <-> I'm so disturbed that I still struggle. Boy, 16, Tellmi

Since suicide is now the leading cause of death for young people in the UK (ONS, 2016), and males account for 75% of all suicides (ONS, 2019), providing boys with access to safe support is crucial. 

How Tellmi helps boys who self-harm 

Anonymity makes it much easier for boys to talk about difficult things. Many of the boys who use Tellmi spend time watching the app before they pluck up the courage to engage. They might make some test posts and once they realise that the community is safe, supportive, and truly anonymous, they pluck up the courage to open up.

this is the only place I felt like I could say this, I've been self-harming <-> I do not have the confidence <-> to ask for help, I want to tell someone but I don’t know who I am best telling? Boy, age 16, Tellmi

Cause I don’t really have anyone to talk to I'll confess my stuff on here. <-> we both regularly would SH, she cheated we broke up but she then threatened to kill herself and blamed it all on me <->. Boy, age 17, Tellmi

When boys do open up on Tellmi, moderation makes sure that they only receive helpful or supportive replies. Every post on the app receives an average of three replies, but a team of trained Super Peers make sure that posts about issues such as self-harm always get an informed response.

So i just cut for the first time ? I just needed to say it to someone <->. Boy, 14, Tellmi

Never said this before, but I'm pretty sure that I've become addicted to self-harm <->I've been trying to stop, but I keep doing it to myself. It's the fact that it helps me feel better that stops me from stopping. <-> Boy, 17, Tellmi

The Tellmi directory provides boys with access to a wide range of additional resources. Besides psychological support and practical advice from peers and super peers, the Tellmi directory provides boys with access to a wide range of educational resources about self-harm. Through the directory they can connect to crisis support or specialist helplines. They can also find rated apps, websites, books, videos Ted talks and read personal stories from other young people just like them.

I am going to stop self-harming <-> what are the best ways to stop I.e distractions.  Also wanted to thank everyone who has helped me throughout the time I have been on the app. Boy, 15, Tellmi

Is there any way that I can help my scars fade faster? Like some sort of cream or oil? And if there is, how often would I use it? I’m going on holiday to <->want to try and help my scars fade faster. Thank you? Boy, 15, Tellmi

I wish someone told me about this app sooner. The support i get and the <->  directory helps me so so much. If you know other people that need help you shld tell them 2 download it. Boy, 17, Tellmi

Tellmi shows boys who self-harm that things can, and do, get better. Reading other peoples stories reassures boys that they are not the only one and that the feelings they are struggling with won’t last forever. Things can, and do, do get better.

Anyone thinking of self-harming. I did it a lot. If you want to stop but can't, write the names of the people you love where you do it, also those who wouldn't want you to do it. It really helps, wanted to share the tip. Boy, 15, Tellmi

I didn't mean this and I haven't realised but I've been clean from self-harm so long!! wtf this is so amazing! 

I don't even get urges to do it or even think about it :)this is such amazing news I can't stop smiling. ☺️☺️ Boy, 18, Tellmi

I’ve never told anyone this but <-> used to have depression, never had a diagnosis, or ever asked for help, but I would cry myself to sleep, punch myself, hit my head against things, hate my existence <->  from 16 probably to late 17. I feel better now <-> looking back <-> I see how much of a wreck I was. Boy, 17, Tellmi

Knowledge is the gift that keeps on giving. Boys are also using the app to seek advice on how to support friends and people they know who self-harm. Tellmi is an incredibly supportive community where everyone is willing to draw on their own personal experiences to help others.

My best friend just told me he's started to cut himself <->. Not rly sure what to do as all I feel I can do is say not to do it. <->❤️ Boy, 15, Tellmi

my friend still self-harms an stuff <-> he asked if i have bandages.<-> does anyone have advice on how i can help him? <-> i dont know what to do. Boy, 14, Tellmi

Tellmi gives boys the confidence to ask for the help they need. Ultimately, opening up within the app builds confidence and gives boys the courage to open up when they are ready.   We consistently see a relationship between users disclosing difficult issues, getting good support and subsequently finding the confidence to ask for help in the real world.

Told my mum and dad everything about my depression, self-harm and suicide attempts <-> Wrote them a letter and it was the bravest thing I think Ive ever done. They've been crying a lot <->I think everything is going to be ok now <-> Boy, 14, Tellmi

so today i opened up to my mum about self-harming <-> I've got myself to the doctor's because i started hearing voices in my head telling me to harm myself more and kill myself at some points <-> Boy, 17, Tellmi

What schools and parents can do to help boys who self-harm

Boys self-harm in a number of different ways, including burning, starving, extreme exercise, dieting, self poisoning or abusing drugs and alcohol and punching walls. Cutting is very prevalent too. Activities such as dieting and extreme exercising may be passed off as ‘healthy’ behaviours, but are actually forms of self-harm. Boys are often confused about whether their behavior actually constitutes self-harm and they may feel that their injuries, or their feelings, are not serious enough to merit asking for help. This is not helped by the fact that accident and emergency departments are more likely to mislabel self-harm by boys as accidental injury.

“The reaction a boy gets when he first tells someone about his self-harm is a very important factor in helping him to decide whether or not to get help”

Besides obvious ‘injuries’, boys who self-harm may wear trousers and long sleeves to cover up and they may avoid sports or swimming. Boys who self-harm may become very secretive, locking their bedroom door and hiding equipment. They may also become emotionally volatile, and look tired, or become very withdrawn.

Parents or teachers who suspect self-harm should proactively educate themselves about the subject before attempting to discuss it. The reaction a boy gets when he first tells someone about his self-harm is a very important factor in helping him to decide whether or not to get help, so keep calm and be kind. Lay the groundwork by talking openly about self-harm. Show that you are informed, that you understand that it is a coping mechanism and that you know how common it is. The fear of being labelled as attention seeking is a barrier to disclosure, so explain that you understand it to be the opposite of attention seeking because it is a secret behaviour which is carried out on parts of the body that can’t be seen. Be sensitive, be kind and focus on de-escalating anxiety and building trust, rather than extracting an admission. Be patient and recognise that disclosure might take more than one conversation.

Within schools, policies around disclosure to parents, prevents boys opening up to teachers or school counsellors.  If self-harm is suspected, cornering the boy and trying to force him to talk will be counter productive. Although teachers  are legally obliged to inform parents if a student is self-harming, there are other options and these should be discussed. If a boy wants to disclose self-harm to someone who will maintain confidentiality, they can talk to their GP. Their GP may want to refer the boy which will mean that parents are eventually involved but taking the issue away from the school site may be preferable for some boys.

Boys can also be signposted to apps such as Tellmi where they can disclose their self-harm anonymously. The app enables them to ask difficult questions and get advice. They can learn about self-harm and they can also access crisis or specialist support through the directory. Ultimately, support within the Tellmi app is designed to give boys the confidence to talk to someone face to face.

Finally, it is important to have realistic expectations about self-harm. Self-harm is a coping mechanism that boys come to rely on and ‘stopping’ is not a simple matter of will power. Quitting any behaviour that has become a way of managing stress never happens overnight, and even if a young person stops completely, they may return to self-harm in stressful situations. Making it clear that you understand this can take some of the pressure off. Because there is no magic wand to make self-harm disappear, education and self-help are often the best long term support strategies for young people.