Self-harm **If you are in immediate distress or feel unsafe right now, please contact the Samaritans on [116 123](tel:116123) — they are available 24 hours a day, seven days a week, and will listen without judgment.**
If you have found this page, you may be living with something that feels very hard to put into words. Perhaps you have been hurting yourself as a way to get through unbearable moments. Perhaps your emotions feel so intense, so unpredictable, that you cannot seem to find solid ground. Perhaps someone you love is struggling, and you are desperate to understand what they are going through.
Whatever has brought you here, you are welcome. This page is written without judgment, without assumptions, and with a deep respect for how difficult your experience may be.
Self-harm and emotional dysregulation are not signs of weakness, attention-seeking, or a failed character. They are signs that a person is carrying more pain than they know how to manage — and that they need, and deserve, real support.
Self-harm is the act of deliberately hurting one's own body as a way of coping with overwhelming emotional pain. It is not a suicide attempt, although the two can sometimes overlap and both deserve careful, compassionate attention. For many people, self-harm functions as a pressure valve — a way to make internal suffering feel more manageable, even temporarily.
People who self-harm often describe a sense of relief, release, or feeling "real" again after an episode. This is not because they want to suffer — it is because, in that moment, self-harm is doing something for them emotionally that they have not yet found another way to achieve. Understanding this is the starting point for any meaningful recovery, and it is the foundation on which Dr Pankhurst bases all of his work with patients seeking self-harm support in Surrey and Berkshire.
Emotional dysregulation refers to difficulty managing and modulating emotional responses. When most people experience a difficult feeling — frustration, sadness, anxiety — there is a natural arc: the emotion rises, peaks, and gradually settles. For someone with emotional dysregulation, that arc is much steeper and much harder to climb down from.
The experience might involve intense sadness that arrives without warning, explosive anger that feels impossible to contain, prolonged anxiety that does not respond to reassurance, or a persistent feeling of emptiness that is equally painful in its own way. These are not overreactions or character flaws. They reflect real differences in how the brain processes and regulates emotion — differences that can be understood and addressed through the right kind of emotional dysregulation treatment.
One of the most important things to understand about self-harm is that it almost always begins as a coping strategy, not a cry for attention. In fact, many people who self-harm go to great lengths to hide it, which is precisely why framing it as attention-seeking does such harm — it misunderstands the experience entirely and discourages people from seeking help.
Self-harm typically develops because a person is experiencing emotional pain they do not have the tools to manage. It may begin in adolescence, or it may emerge later in life during periods of extreme stress, loss, or trauma. Once established, it can feel extremely difficult to give up — not because the person lacks willpower, but because it is genuinely effective at providing short-term emotional relief. The brain learns quickly that it works, and unlearning that lesson requires time, skill-building, and consistent support.
For family members reading this: if someone you love is self-harming, it is rarely about you. It is about their inner world, and your most powerful role is to stay present without panic, without ultimatums, and without making them feel ashamed.
Self-harm and emotional dysregulation are deeply interconnected. When emotions surge beyond a person's capacity to tolerate them, the body and mind search urgently for something — anything — that will bring them back to a bearable place. For some people, self-harm becomes that something.
This is why addressing self-harm without also addressing the underlying emotional regulation difficulties tends to produce limited results. The behaviour may stop temporarily, but the emotional pain and the need to manage it remain. Lasting recovery involves learning new ways to tolerate and regulate emotions — building an internal toolkit that eventually makes self-harm feel unnecessary.
Self-harm rarely exists in isolation. It is frequently associated with a range of underlying mental health conditions, each of which requires proper assessment and tailored care.
Borderline Personality Disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD), is one of the most common conditions associated with both self-harm and emotional dysregulation. People with BPD experience intense, rapidly shifting emotions, fears of abandonment, and significant difficulties in relationships and sense of identity. Self-harm is a particularly common feature of BPD during periods of acute distress.
Depression brings with it a weight that can be numbing, hopeless, and exhausting. For some people with depression, self-harm is a way of feeling something — anything — when emotional numbness becomes unbearable.
Post-Traumatic Stress Disorder (PTSD) and complex trauma can leave a person in a state of chronic emotional and physiological hyperarousal, where the body is always braced for threat. Self-harm can serve as a means of grounding or dissociating — a response to the extreme inner turbulence that trauma creates.
ADHD is increasingly recognised as a condition with significant emotional dimensions. Emotional dysregulation, impulsivity, and the chronic frustration of living with ADHD can all contribute to self-harm, particularly when the condition has gone undiagnosed or unsupported.
A thorough, holistic assessment is essential to understand which of these — or which combination — may be present. This shapes the entire approach to treatment.
If you have tried to stop self-harming and found it harder than expected, please know that this is not a failure of willpower. Self-harm, like any established coping mechanism, becomes woven into the brain's automatic responses to distress. The neural pathways reinforcing it are real, and dismantling them takes time, patience, and the gradual building of alternative strategies.
Many people feel deeply ambivalent about giving up self-harm — even when they want to — because they are afraid of what will happen when their main coping tool is taken away. This ambivalence is completely understandable and is always met with respect in Dr Pankhurst's practice. Recovery is never about forcing someone to stop a behaviour before they have the resources to manage without it.
DBT is widely regarded as the gold-standard treatment for self-harm and emotional dysregulation, and it forms a central pillar of the therapeutic approach offered here. Developed specifically for people who experience intense emotional suffering, DBT teaches practical, evidence-based skills across four core areas.
Mindfulness forms the foundation of DBT — learning to observe thoughts and feelings as they arise, without being swept away by them. It is not about achieving calm; it is about developing a relationship with your inner experience that is curious rather than reactive.
Distress tolerance teaches skills for surviving crisis moments without making them worse. Rather than requiring that the distress disappear, these techniques help a person ride out an intense wave of emotion without acting impulsively.
Emotion regulation goes deeper — understanding what triggers emotional responses, reducing vulnerability to emotional extremes, and building a life with more positive experiences that naturally buffer against distress.
Interpersonal effectiveness addresses the relational dimension of emotional dysregulation, helping people communicate their needs, set healthy boundaries, and maintain relationships without either suppressing themselves or becoming overwhelmed.
DBT therapy in Berkshire and Surrey is available through Dr Pankhurst's practice, with a focus on integrating these skills meaningfully into each person's real life — not just as concepts to understand, but as tools to use.
CBT helps to identify the patterns of thinking that fuel emotional distress and self-harm. By gently examining the beliefs a person holds about themselves, their emotions, and their relationships, CBT creates space to develop more balanced, compassionate ways of understanding difficult experiences.
Mindfulness, woven throughout both DBT and as a standalone approach, supports a gentler relationship with one's inner world. For people who self-harm, mindfulness can be particularly powerful in creating a pause — a moment of space between the urge and the action — that, over time, grows wider.
Medication is not a treatment for self-harm itself, but it can play an important supporting role. Where underlying depression, anxiety, ADHD, or other conditions are present and contributing to emotional dysregulation, appropriate medication — carefully chosen and monitored — can reduce the intensity of the emotional storms that trigger self-harm. This is always discussed collaboratively, with the patient's preferences and concerns at the centre of any prescribing decision.
Your first appointment with Dr Pankhurst will not feel like an interrogation. There are no forms to fill in alone, no pressure to disclose more than you are ready to share, and absolutely no judgment about what has brought you here.
The session is an opportunity to talk — at your own pace, in your own words — about what you have been experiencing. Dr Pankhurst will listen carefully, ask questions that help build a fuller picture, and share his initial thoughts in a way that feels collaborative rather than clinical. Everything discussed is held in complete confidence.
You will not be told what to do. You will not be given a prescription and shown the door. The aim of the first appointment is for you to feel genuinely heard, to begin to understand your experience from a new angle, and to leave with a sense of what the next steps might look like — if and when you feel ready for them.
Recovery from self-harm is not simply about stopping the behaviour. It is about building — gradually, at your own pace — a richer set of resources for managing emotional pain, so that self-harm becomes less necessary, and eventually unnecessary altogether.
This might involve learning to recognise early warning signs of distress before they escalate, developing physical self-regulation techniques, rebuilding trust in relationships, processing old pain that has never had space to breathe, or simply learning that it is possible to feel a terrible emotion and survive it without acting on it. Progress is rarely linear, and setbacks are a normal part of the process — never a reason to give up.
If you are reading this because someone you love is self-harming, the fear and helplessness you may feel is entirely understandable. Your instinct to fix things, to make them stop, to find the right words — that comes from love. But the most powerful thing you can offer is not a solution. It is a steady, non-panicked presence. Listening without rushing to reassure. Showing that you are not frightened away by their pain. If you are unsure how to support them, Dr Pankhurst is happy to speak with family members as part of the care process.
There is no wrong time to reach out. Whether you have been struggling for years or have only recently begun to notice something is wrong, whether you are in a moment of crisis or a moment of quiet clarity — support is available, and you do not have to have all the answers before you make contact.
Dr Kevin Pankhurst offers compassionate, expert psychiatric care for adults experiencing self-harm and emotional dysregulation, with practices in Surrey and Berkshire. With over 20 years of experience and a deeply personal approach to care, he provides a genuinely safe space in which to begin — or continue — your journey towards feeling better.
Whenever you are ready, please get in touch. You deserve support, and recovery is possible.
If you are in crisis right now, please call the Samaritans on 116 123 (free, 24/7) or go to your nearest A&E.
Contact me directly to arrange an assessment — most patients are seen within four weeks, and a full written report is provided after the first appointment.
Dr. Kevin Pankhurst
Private Consultant Psychiatrist
Surrey, Berkshire & London
MB ChB; MMed (Psychiatry)
Esher: Esher Groves, 13–17 Church Street, Esher, Surrey, KT108QS
Maidenhead: Berkshire Grove Hospital, White Waltham, Maidenhead, SL6 3TN
Guildford: 3 Saxton, Guildford, Surrey, GU2 9JX
