Self-Harm: Signs, Help & Recovery Guide

What Is Self-Harm?

Self-harm, also called non-suicidal self-injury (NSSI), is when someone deliberately hurts themselves physically without the intention to die. It is typically used as a way to cope with overwhelming emotional pain, difficult memories, or intense feelings that seem impossible to handle any other way. Common forms include cutting, burning, or hitting oneself.

Self-harm is a serious mental health concern that affects millions of people worldwide. It is important to understand that self-harm is not about seeking attention or being manipulative - it is a sign that someone is struggling deeply and needs support. The behavior often develops as a way to cope with emotions that feel too intense or overwhelming to process in healthier ways.

Research shows that approximately 15-20% of adolescents and 5-6% of adults have engaged in self-harm at least once. The behavior is most common between the ages of 12 and 24, though it can occur at any age. Understanding what self-harm is and why it happens is the first step toward providing effective support and treatment.

Self-harm can take many forms, including:

• Cutting - using sharp objects to cut the skin, most commonly on arms, legs, or stomach
• Burning - using heat, friction, or chemicals to burn the skin
• Hitting or punching - striking oneself or hitting walls or other objects
• Scratching or picking - scratching the skin until it bleeds or picking at wounds
• Hair pulling - pulling out hair from the scalp, eyebrows, or other areas
• Inserting objects - pushing objects under the skin or into body openings

Self-harm is not a suicide attempt

One of the most important things to understand about self-harm is that it is typically not a suicide attempt. While both involve self-inflicted injury, the intent is different. People who self-harm usually do so to cope with or relieve emotional pain, not to end their lives. In fact, many describe self-harm as a way to keep going or survive difficult periods.

However, it is crucial to take self-harm seriously. Research shows that people who self-harm have a significantly higher risk of suicide over time. This increased risk makes it essential to seek help and develop healthier coping strategies as early as possible.

Long-term consequences

While self-harm may provide temporary relief from emotional pain, it can have serious long-term consequences. The behavior often becomes a pattern that is difficult to break, and over time, people may feel they need to self-harm more frequently or more severely to achieve the same relief.

Beyond the physical scars, self-harm can affect your self-image, relationships, and overall mental health. Many people experience shame, guilt, and isolation related to their self-harm, which can make emotional difficulties even worse. This is why seeking help early is so important - the sooner you develop alternative coping strategies, the easier recovery tends to be.

Why Do People Self-Harm?

People self-harm as a way to cope with overwhelming emotions such as anxiety, depression, emptiness, shame, anger, or grief. Self-harm may temporarily relieve emotional pain by creating physical pain, provide a sense of control, serve as self-punishment, or help someone feel something when emotionally numb. The specific reasons vary from person to person.

Understanding why people self-harm is essential for both those who are struggling and those who want to help. Self-harm is almost always a response to emotional pain that feels unbearable. When someone doesn't have other ways to cope with intense feelings, self-harm can seem like the only option available.

The emotions that lead to self-harm vary from person to person, but commonly include:

• Anxiety and overwhelming worry - feelings of panic or being unable to cope
• Depression and hopelessness - persistent sadness, emptiness, or despair
• Anger and frustration - intense anger at oneself or others
• Shame and self-hatred - feeling worthless or disgusted with oneself
• Emotional numbness - feeling disconnected or unable to feel anything
• Grief and loss - overwhelming sadness after losing someone or something important
• Trauma responses - reactions to past abuse, neglect, or traumatic experiences

A way to survive difficult feelings

For many people, self-harm becomes a way to survive moments when emotional pain feels unbearable. The physical pain of self-harm can temporarily block out or distract from emotional pain. Some describe it as a release valve - a way to let out feelings that have built up to an unbearable level.

When you self-harm, your body releases endorphins - natural chemicals that can create a temporary sense of calm or relief. This biological response is one reason why self-harm can feel addictive and become increasingly difficult to stop over time.

Regaining a sense of control

Life circumstances can sometimes make people feel completely powerless - whether due to abuse, difficult family situations, bullying, or other challenges beyond their control. Self-harm can provide a temporary sense of control: "This is something I can do. This is one thing I have power over."

While this sense of control is illusory and ultimately harmful, understanding this motivation helps explain why self-harm can be appealing to someone who feels trapped or helpless in their circumstances.

Self-punishment

Many people who self-harm struggle with intense self-criticism and feelings of worthlessness. They may believe they deserve to suffer or that hurting themselves is appropriate punishment for perceived failures or shortcomings. Trauma survivors, in particular, may blame themselves for things that were not their fault and use self-harm as a form of punishment.

Feeling something when numb

Sometimes, emotional pain can become so overwhelming that the mind shuts down emotionally as a protective mechanism. This emotional numbness - feeling disconnected, empty, or "dead inside" - can be distressing in its own way. Self-harm can serve as a way to feel something, anything, when emotions seem completely inaccessible.

Communicating pain

For some people, self-harm is a way to express pain they cannot put into words. When emotional suffering feels invisible or dismissed, physical injuries can serve as tangible evidence that something is wrong. This is not "attention-seeking" in a negative sense - it is often a desperate attempt to communicate a level of pain that cannot be expressed any other way.

What Are the Warning Signs of Self-Harm?

Warning signs of self-harm include unexplained cuts, burns, or bruises; wearing long sleeves or pants even in warm weather; keeping sharp objects nearby; withdrawal from social activities; difficulty handling emotions; and statements of hopelessness or self-hatred. Changes in mood, sleep, or eating may also indicate distress.

Recognizing the signs of self-harm can help you identify when someone you care about might be struggling. People who self-harm often go to great lengths to hide their behavior, so awareness of these warning signs is important. However, it's equally important not to jump to conclusions - these signs can have other explanations.

Physical signs

Physical signs are often the most noticeable indicators that someone may be self-harming:

• Unexplained injuries: Cuts, burns, bruises, or scars that appear regularly or that don't have a reasonable explanation
• Covering up: Wearing long sleeves, pants, or wristbands even in hot weather or refusing to change clothes in front of others
• Finding sharp objects: Discovering razors, knives, or other sharp objects in unusual places like bedrooms or bathrooms
• Frequent "accidents": Regular stories about being clumsy or having accidents to explain injuries
• Wounds that don't heal: Picking at healing wounds or having injuries in various stages of healing

Behavioral and emotional signs

Changes in behavior and emotional state can also indicate that someone is struggling:

• Social withdrawal: Pulling away from friends, family, or activities they previously enjoyed
• Isolation: Spending excessive time alone, especially in bathrooms or bedrooms
• Emotional instability: Frequent mood swings or difficulty controlling emotions
• Expressing hopelessness: Statements like "I'm worthless," "I can't do anything right," or "No one cares"
• Relationship difficulties: Problems with friends, family members, or romantic partners
• Poor performance: Declining grades at school or performance at work
• Changes in sleep or eating: Sleeping too much or too little, or significant changes in appetite

What to do if you notice these signs

If you notice these warning signs in someone you care about, the most important thing is to approach them with compassion, not judgment. Let them know you've noticed they seem to be struggling and that you care about them. Avoid ultimatums, accusations, or making them feel guilty. Instead, gently encourage them to talk and offer to help them find professional support.

If you recognize these signs in yourself, please know that help is available and recovery is possible. Reaching out to a mental health professional, trusted adult, or crisis helpline is an important first step toward feeling better.

How Can You Stop Self-Harming?

Stopping self-harm involves developing healthier coping strategies, understanding your triggers, seeking professional help, building a support network, and being patient with yourself during recovery. Techniques like delaying the urge, using physical alternatives, expressing feelings through creative outlets, and practicing self-compassion can help break the cycle.

Recovery from self-harm is possible, but it takes time, effort, and often professional support. Changing a behavior that has become a coping mechanism is challenging, and setbacks are normal. What's most important is continuing to work toward recovery, even when it feels difficult.

Understanding your triggers

One of the first steps in stopping self-harm is understanding what triggers the urge. Keeping a journal can help you identify patterns. Ask yourself:

• What situations tend to trigger the urge to self-harm?
• What emotions am I experiencing when the urge arises?
• Are there certain times of day or circumstances that make urges stronger?
• What thoughts go through my mind before I self-harm?

Understanding your triggers allows you to prepare alternative responses and develop strategies for managing difficult moments before the urge becomes overwhelming.

Delay the urge

When you feel the urge to self-harm, try to delay acting on it. The intensity of urges typically peaks and then decreases over time. Strategies include:

• Wait 15-30 minutes: Tell yourself you can revisit the urge later, but first you'll wait
• Distraction: Engage in an activity that occupies your mind - watch a video, play a game, go for a walk
• Change your environment: Leave the space where you typically self-harm
• Call someone: Reach out to a friend, family member, or crisis line

Find alternative coping strategies

Developing healthier ways to cope with intense emotions is essential for recovery. Different strategies work for different people and different emotions:

For anger or frustration:

• Intense exercise - running, punching a pillow, doing jumping jacks
• Screaming into a pillow
• Tearing up paper or squeezing ice cubes
• Writing an angry letter (without sending it)

For sadness or emptiness:

• Talking to someone you trust
• Writing in a journal
• Listening to music that validates your feelings
• Watching something comforting or spending time with a pet

For numbness or disconnection:

• Holding ice cubes or taking a cold shower
• Snapping a rubber band on your wrist
• Eating something with a strong flavor (sour candy, hot sauce)
• Smelling something strong (essential oils, coffee)

For anxiety or overwhelm:

• Deep breathing exercises
• Grounding techniques (5-4-3-2-1 senses exercise)
• Progressive muscle relaxation
• Mindfulness meditation

Practice self-compassion

Many people who self-harm are extremely self-critical. Learning to treat yourself with the same kindness you would offer a friend is an important part of recovery. When you notice harsh self-judgment, try to challenge it:

• Would you say this to a friend who was struggling?
• What would you tell someone you love who was in your situation?
• Can you acknowledge that you're doing the best you can with the tools you have?

Build healthy routines

Basic self-care can have a significant impact on emotional well-being:

• Sleep: Aim for consistent, adequate sleep
• Nutrition: Eat regular, balanced meals
• Movement: Engage in physical activity you enjoy
• Connection: Spend time with people who support you
• Meaningful activities: Do things that give you a sense of purpose or enjoyment

Remove access to means

Making it harder to self-harm can help during moments of intense urges. Consider disposing of items you use to self-harm, or giving them to someone else to hold. While this won't address the underlying issues, it can provide crucial time for urges to pass.

When Should You Seek Professional Help?

You should seek professional help as soon as possible if you are self-harming. Professional support is especially important if self-harm is frequent or escalating, if you're having thoughts of suicide, if self-harm significantly impacts your daily life, or if you've been unable to stop on your own. Help is available and effective treatments exist.

While some people are able to stop self-harming with the support of friends and family alone, professional help significantly increases the chances of successful recovery. Mental health professionals can help you understand the underlying causes of your self-harm, develop effective coping strategies, and address any co-occurring conditions like depression or anxiety.

Signs that professional help is needed

Consider seeking professional help if:

• You've been self-harming for more than a few weeks
• Self-harm is becoming more frequent or severe
• You're having thoughts of suicide
• Self-harm is affecting your relationships, work, or school
• You want to stop but haven't been able to on your own
• You're experiencing other mental health symptoms (depression, anxiety, flashbacks)
• Physical injuries require medical attention

Where to seek help

There are many options for getting professional support:

• Primary care doctor: Your regular doctor can provide an initial assessment and referrals
• Mental health professionals: Psychiatrists, psychologists, counselors, or therapists
• Crisis services: Emergency rooms, crisis hotlines, or crisis text lines for immediate help
• School resources: School counselors, nurses, or psychologists for students
• Community mental health centers: Often offer services on a sliding scale based on income

What to expect when seeking help

When you first meet with a mental health professional, they will typically ask about your history, current symptoms, and what you're hoping to achieve. Be as honest as you can - they're there to help, not to judge. They may ask specific questions about your self-harm, including frequency, methods, and triggers.

Based on this assessment, they'll work with you to develop a treatment plan. This might include therapy, medication for underlying conditions, or a combination of approaches. Remember that finding the right therapist and treatment approach sometimes takes time - if something isn't working, it's okay to try a different approach or provider.

What Treatments Are Available for Self-Harm?

Effective treatments for self-harm include Dialectical Behavior Therapy (DBT), which was specifically developed for this purpose and can reduce self-harm by 50% or more. Cognitive Behavioral Therapy (CBT), Mentalization-Based Therapy (MBT), and other approaches are also effective. Treatment often addresses underlying conditions like depression, anxiety, or trauma as well.

Several evidence-based treatments have been shown to be effective for self-harm. The most appropriate treatment depends on your individual circumstances, including the severity and frequency of self-harm, any co-occurring mental health conditions, and your personal preferences.

Dialectical Behavior Therapy (DBT)

DBT is the treatment with the strongest evidence for reducing self-harm. Originally developed for Borderline Personality Disorder (BPD), DBT has been adapted for various populations and is now widely used for anyone struggling with self-harm or emotional regulation difficulties.

DBT typically includes:

• Individual therapy: Weekly one-on-one sessions with a therapist
• Skills training group: Weekly group sessions teaching specific coping skills
• Phone coaching: Access to your therapist between sessions for crisis support

The four main skill modules in DBT are:

• Mindfulness: Being present in the moment without judgment
• Distress tolerance: Surviving crisis situations without making things worse
• Emotion regulation: Understanding and managing intense emotions
• Interpersonal effectiveness: Maintaining relationships while asserting needs

Research shows that DBT can reduce self-harm episodes by approximately 50% and significantly decrease suicide attempts, emergency room visits, and psychiatric hospitalizations.

Cognitive Behavioral Therapy (CBT)

CBT focuses on identifying and changing negative thought patterns and behaviors. For self-harm, CBT might involve:

• Identifying thoughts and beliefs that lead to self-harm
• Challenging distorted thinking patterns
• Developing healthier coping strategies
• Behavioral activation to increase positive activities
• Exposure techniques if trauma is involved

Mentalization-Based Therapy (MBT)

MBT helps people better understand their own mental states (thoughts, feelings, desires) and those of others. This improved understanding can reduce emotional reactivity and provide alternatives to self-harm as a way of managing relationships and emotions.

Treatment for co-occurring conditions

Self-harm often occurs alongside other mental health conditions. Effective treatment usually addresses these conditions as well:

• Depression: May benefit from antidepressant medication and/or therapy
• Anxiety disorders: Including social anxiety, panic disorder, or generalized anxiety
• Post-traumatic stress disorder (PTSD): Trauma-focused therapies like EMDR or prolonged exposure
• Eating disorders: Often co-occur with self-harm and require specialized treatment
• ADHD or autism: May contribute to emotional regulation difficulties

Your right to be involved in treatment decisions

You have the right to be actively involved in decisions about your treatment. Ask questions about what treatment involves, why it's being recommended, and what alternatives exist. If a treatment approach doesn't feel right or isn't working, discuss this with your provider. Finding the right fit is important for successful recovery.

How Can You Help Someone Who Self-Harms?

To help someone who self-harms, listen without judgment and express calm concern. Avoid ultimatums or demanding they stop immediately. Encourage professional help without forcing it. Learn about self-harm to better understand their experience. Don't treat it as attention-seeking. Take care of your own mental health and seek support if needed.

If someone you care about is self-harming, your support can make a significant difference in their recovery. However, it can be challenging to know how to help without making things worse. Here's guidance on how to be supportive while also taking care of yourself.

How to start a conversation

If you suspect someone is self-harming, finding the right way to bring it up is important:

• Choose a private, calm setting: Don't confront them in front of others or when emotions are running high
• Express concern, not alarm: "I've noticed you seem to be going through a difficult time, and I'm worried about you"
• Avoid accusatory language: Use "I" statements rather than "you" statements
• Be prepared for denial: They may not be ready to talk, and that's okay
• Let them know you're available: "I'm here whenever you want to talk"

What to do and what to avoid

Do:

• Listen without judgment
• Validate their feelings ("It sounds like you're going through something really difficult")
• Express that you care about them
• Encourage professional help and offer to help them find resources
• Be patient - recovery takes time
• Continue to include them in normal activities
• Educate yourself about self-harm

Avoid:

• Making them feel guilty or ashamed
• Giving ultimatums ("Stop or I'll...")
• Making them promise to never do it again
• Dismissing it as attention-seeking
• Showing disgust or horror at injuries
• Constantly checking their body for injuries
• Trying to "fix" them or solve all their problems

Taking care of yourself

Supporting someone who self-harms can be emotionally exhausting. It's important to:

• Set boundaries: You can be supportive without being available 24/7
• Seek your own support: Talk to a therapist, counselor, or support group
• Maintain your own well-being: Don't neglect your own mental health
• Accept your limitations: You cannot force someone to stop or recover