Self-Harm: Warning Signs, Causes & How to Get Help

What Is Self-Harm and Why Do People Do It?

Self-harm is the intentional act of injuring oneself without suicidal intent, typically as a way to cope with overwhelming emotional pain, trauma, or intense feelings that feel impossible to express otherwise. It affects approximately 17% of adolescents and 5% of adults worldwide.

Self-harm, also called self-injury or non-suicidal self-injury (NSSI), refers to deliberately hurting yourself as a way to deal with emotional distress. While it may seem counterintuitive, many people who self-harm describe it as a way to manage intense emotions that feel unbearable. It provides temporary relief from emotional pain, but this relief is short-lived and often followed by feelings of shame, guilt, and the original emotional distress returning.

Understanding why people engage in self-harm is crucial for providing appropriate support and treatment. The behavior serves different functions for different individuals, and recognizing these underlying needs is the first step toward finding healthier coping mechanisms. Self-harm is not a mental illness diagnosis itself, but rather a symptom that indicates someone is experiencing significant emotional pain and needs support.

Research from leading institutions including the World Health Organization (WHO) and National Institute for Health and Care Excellence (NICE) has significantly improved our understanding of self-harm in recent decades. We now know that it is far more common than previously thought, particularly among young people, and that effective treatments exist. The stigma surrounding self-harm often prevents people from seeking help, which is why education and awareness are so important.

Common reasons people self-harm

People engage in self-harm for various reasons, and often multiple factors contribute to the behavior. Understanding these reasons is essential for developing effective treatment approaches and for loved ones who want to provide support.

• Emotional release: Converting overwhelming emotional pain into physical pain that feels more manageable or controllable
• Feeling something: When emotionally numb or disconnected, self-harm can create a sense of being alive or real
• Self-punishment: Some individuals harm themselves as a way to punish themselves for perceived failures or wrongdoings
• Communication: Expressing pain that feels impossible to put into words
• Control: Gaining a sense of control when life feels chaotic or overwhelming
• Distraction: Shifting focus from emotional pain to physical sensation

It is critically important to understand that self-harm is not attention-seeking behavior. In fact, most people who self-harm go to great lengths to hide their injuries. The behavior is a genuine attempt to cope with emotional pain, and dismissing it as "just looking for attention" can be deeply harmful and prevent individuals from seeking the help they need.

Types of self-harm

Self-harm can take many forms, and understanding the different types helps healthcare providers develop appropriate treatment plans. The most common form is cutting, but self-injury encompasses a wide range of behaviors.

• Cutting: Making cuts on the skin, often on arms, legs, or stomach
• Burning: Using heat sources to create burns
• Hitting or punching: Striking oneself or objects to cause injury
• Scratching: Severe scratching that breaks the skin
• Hair pulling (trichotillomania): Compulsively pulling out hair
• Interference with wound healing: Picking at wounds or preventing them from healing

What Are the Warning Signs of Self-Harm?

Warning signs of self-harm include unexplained cuts, burns, or bruises; wearing long sleeves in warm weather; having sharp objects without clear reason; social withdrawal; emotional instability; and difficulty expressing feelings. Changes in behavior and mood may also indicate self-harm.

Recognizing the warning signs of self-harm can help you provide early support to someone who is struggling. Because people who self-harm often try to hide their behavior, the signs can be subtle. Being aware of both physical and behavioral indicators is important, though it's essential to approach any concerns with compassion rather than accusation.

The signs listed below may indicate self-harm, but they can also have other explanations. If you notice several of these signs in combination, especially alongside emotional distress, it may be worth gently expressing your concern and offering support. Remember that the goal is to open a conversation, not to confront or accuse.

Physical warning signs

Physical signs are often the most visible indicators of self-harm, though many people take great care to conceal their injuries. Being observant without being intrusive is important when you're concerned about someone.

• Unexplained injuries: Cuts, burns, bruises, or scars that don't have a clear explanation
• Frequent injuries: Regular or recurring wounds that are explained away with excuses
• Wounds in various stages of healing: Multiple injuries at different stages suggests ongoing behavior
• Covering up: Wearing long sleeves, pants, or wristbands even in warm weather
• Sharp objects: Having razors, knives, or other sharp implements without obvious reason
• Blood stains: On clothing, towels, bedding, or tissues

Behavioral warning signs

Behavioral changes often accompany self-harm and may be easier to notice than physical signs, especially when injuries are carefully hidden. These changes reflect the emotional turmoil underlying the self-harm behavior.

• Social withdrawal: Pulling away from friends, family, and activities they once enjoyed
• Isolation: Spending extended periods alone, especially in bathrooms or bedrooms
• Avoiding activities: Reluctance to participate in activities that would expose the body, like swimming
• Emotional instability: Frequent mood swings, irritability, or emotional outbursts
• Secretive behavior: Being unusually private about their activities or possessions
• Changes in eating or sleeping: Disrupted patterns that indicate emotional distress

Emotional warning signs

Emotional indicators are often the root cause of self-harm behavior. Understanding these underlying emotional struggles can help provide more meaningful support.

• Expressing hopelessness: Talking about feeling worthless, hopeless, or trapped
• Difficulty with emotions: Struggling to express feelings or identify emotions
• Self-critical statements: Expressing hatred toward themselves or their body
• Signs of depression or anxiety: Persistent sadness, worry, or loss of interest
• Relationship difficulties: Problems in interpersonal relationships

What Causes Self-Harm?

Self-harm is typically caused by a combination of factors including underlying mental health conditions (depression, anxiety, PTSD), trauma or abuse, difficulty regulating emotions, social factors like bullying or isolation, and biological factors affecting emotional processing. No single cause explains self-harm in all individuals.

Self-harm rarely has a single cause. Instead, it typically results from a complex interaction of psychological, social, and biological factors. Understanding these contributing factors is essential for developing effective treatment approaches and for providing appropriate support to those who are struggling.

Research into the causes of self-harm has expanded significantly in recent years, giving us a better understanding of why some people develop this coping mechanism while others facing similar circumstances do not. This knowledge helps reduce stigma and emphasizes that self-harm is not a character flaw or a choice, but rather a response to overwhelming circumstances.

Mental health conditions

Many people who self-harm have underlying mental health conditions that contribute to their emotional distress. Treating these conditions is often a crucial part of addressing self-harm behavior.

Depression is one of the most common conditions associated with self-harm. The overwhelming feelings of sadness, hopelessness, and worthlessness that characterize depression can feel unbearable, leading some individuals to seek relief through self-injury. Similarly, anxiety disorders can create such intense emotional states that self-harm becomes a way to cope with the overwhelming tension and fear.

Post-traumatic stress disorder (PTSD) is strongly associated with self-harm. Individuals who have experienced trauma may use self-injury to cope with flashbacks, dissociation, or the intense emotions triggered by traumatic memories. The connection between trauma and self-harm underscores the importance of trauma-informed care in treatment.

• Depression: Feelings of hopelessness and emotional pain
• Anxiety disorders: Overwhelming worry and tension
• Post-traumatic stress disorder (PTSD): Responses to traumatic experiences
• Borderline personality disorder (BPD): Emotional instability and identity issues
• Eating disorders: Body image concerns and emotional regulation difficulties
• Substance use disorders: Often co-occur with self-harm

Trauma and adverse experiences

Traumatic experiences, particularly in childhood, significantly increase the risk of self-harm. Understanding this connection is crucial for both prevention and treatment approaches.

Physical, sexual, or emotional abuse creates deep psychological wounds that can manifest in self-harm behavior. Individuals who have experienced abuse may struggle with feelings of shame, self-blame, and difficulty trusting others, all of which can contribute to self-injury as a coping mechanism.

Neglect, loss of a loved one, witnessing violence, and other adverse childhood experiences also increase self-harm risk. These experiences can affect brain development, emotional regulation abilities, and attachment patterns, creating vulnerabilities that persist into adolescence and adulthood.

Difficulty regulating emotions

One of the most consistent findings in self-harm research is the connection to emotional regulation difficulties. Many individuals who self-harm report that they experience emotions more intensely than others and struggle to manage these feelings effectively.

Emotional dysregulation can be rooted in various factors, including temperament, early attachment experiences, and learned coping patterns. When individuals lack effective strategies for managing intense emotions, self-harm can become a maladaptive coping mechanism that provides temporary relief from emotional overwhelm.

Social and environmental factors

The social environment plays a significant role in self-harm risk. Factors such as bullying, social isolation, family conflict, and exposure to self-harm in peers or media can all contribute to the development of this behavior.

• Bullying: Being victimized increases self-harm risk significantly
• Social isolation: Lack of supportive relationships
• Family dysfunction: Conflict, poor communication, or lack of support
• Academic or work pressure: Excessive stress from performance expectations
• Social media influence: Exposure to self-harm content online

How Can You Get Help for Self-Harm?

Getting help for self-harm starts with acknowledging the problem and reaching out to someone you trust—a friend, family member, or counselor. The next step is connecting with a mental health professional who can provide appropriate treatment. Creating a safety plan and building a support network are also essential parts of the recovery process.

Taking the first step to get help for self-harm can feel incredibly difficult. You might feel ashamed, worried about others' reactions, or uncertain whether you deserve help. It's important to know that seeking help is a sign of strength, not weakness, and that effective treatments exist. You don't have to face this alone.

Recovery from self-harm is a process that takes time, and setbacks are a normal part of the journey. The goal isn't perfection but rather building healthier coping strategies and addressing the underlying emotional pain. With proper support and treatment, most people can significantly reduce or stop self-harm and improve their overall quality of life.

Steps to getting help

If you're ready to seek help for self-harm, here are some steps you can take. Remember that you can move at your own pace, and any step forward is progress.

1. Acknowledge that you need support: Recognizing that self-harm is a sign you're struggling is the first step. There is no shame in needing help.
2. Talk to someone you trust: This could be a friend, family member, teacher, school counselor, or anyone you feel safe with. Sharing your struggle can provide immediate relief and open the door to getting professional help.
3. Contact a mental health professional: A therapist, psychologist, or psychiatrist can provide proper assessment and treatment. Your primary care doctor can also be a starting point for referrals.
4. Be honest in your assessment: When you meet with a professional, try to be as honest as possible about your self-harm and your emotional state. This helps them provide the most appropriate care.
5. Create a safety plan: Work with your treatment provider to develop a plan for managing urges to self-harm, including coping strategies and emergency contacts.

What to expect from professional help

Knowing what to expect can make seeking professional help less intimidating. A mental health professional will typically conduct an assessment to understand your situation and then work with you to develop a treatment plan.

During the assessment, they may ask about your self-harm history, emotional state, life circumstances, and any other mental health symptoms you're experiencing. This information helps them understand the full picture and provide appropriate care. Remember that mental health professionals are trained to discuss these topics without judgment.

Treatment will be tailored to your individual needs. It may include therapy, medication for underlying conditions, or a combination of approaches. Your treatment provider should explain their recommendations and involve you in decisions about your care.

What Treatments Are Effective for Self-Harm?

Evidence-based treatments for self-harm include Dialectical Behavior Therapy (DBT), which can reduce self-harm episodes by 50%, Cognitive Behavioral Therapy (CBT), and Mentalization-Based Therapy (MBT). Treatment often addresses underlying mental health conditions and may include medication when appropriate. The most effective approach combines therapy with a strong support network.

Effective treatment for self-harm has improved significantly thanks to decades of research. Today, several evidence-based therapies have been shown to help people reduce or stop self-harming and develop healthier coping mechanisms. The key is finding the right treatment approach for each individual's unique needs.

Treatment typically focuses on two main goals: reducing self-harm behavior in the short term and addressing the underlying emotional issues that drive the behavior for long-term recovery. This dual approach helps ensure that individuals not only stop harming themselves but also develop the skills and support they need to maintain their recovery.

Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy is considered the gold standard treatment for self-harm, with strong research evidence supporting its effectiveness. Originally developed for borderline personality disorder, DBT has proven highly effective for anyone struggling with emotional regulation and self-destructive behaviors.

DBT teaches four core skill sets: mindfulness (staying present and aware), distress tolerance (surviving crisis moments without making things worse), emotion regulation (understanding and managing emotions), and interpersonal effectiveness (communicating needs and maintaining relationships). These skills directly address the emotional difficulties that often underlie self-harm.

Research consistently shows that DBT can reduce self-harm episodes by approximately 50%, with improvements maintained over time. The therapy typically involves individual sessions, group skills training, and phone coaching for crisis situations.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy helps individuals identify and change negative thought patterns and behaviors. For self-harm, CBT focuses on understanding the thoughts and situations that trigger the urge to self-harm and developing alternative responses.

CBT is highly structured and typically time-limited, making it accessible and practical. It teaches problem-solving skills, challenges unhelpful beliefs, and helps individuals develop new behavioral patterns. Many people find the concrete, skill-focused approach of CBT helpful in gaining control over their behavior.

Mentalization-Based Therapy (MBT)

Mentalization-Based Therapy focuses on improving the ability to understand one's own and others' mental states—thoughts, feelings, desires, and motivations. This capacity, called mentalization, is often impaired in people who self-harm.

By improving mentalization, individuals become better able to understand why they feel the way they do, anticipate emotional reactions, and respond to interpersonal situations more effectively. This understanding provides an alternative to the overwhelming confusion that often precedes self-harm.

Medication

While there is no medication specifically approved for self-harm, medications may be prescribed to treat underlying mental health conditions such as depression, anxiety, or PTSD. Treating these conditions can reduce the emotional distress that drives self-harm behavior.

Antidepressants, mood stabilizers, or anti-anxiety medications may be appropriate depending on the individual's symptoms. Medication is typically most effective when combined with therapy, rather than used alone.

How Can You Help Someone Who Is Self-Harming?

To help someone who is self-harming: listen without judgment, express calm concern, avoid ultimatums or expressing shock, encourage professional help without forcing it, stay connected, and learn about self-harm. Create a supportive environment while respecting their autonomy. If they're in immediate danger, seek emergency help.

Discovering that someone you care about is self-harming can be frightening and overwhelming. You may feel shocked, scared, angry, or helpless. While these reactions are understandable, how you respond can significantly impact the person's willingness to seek help and their path to recovery.

The most important thing you can do is provide non-judgmental support. People who self-harm often feel deeply ashamed and may expect rejection or criticism. By responding with compassion and acceptance, you create a safe space for them to open up and potentially accept help.

Dos and don'ts when supporting someone

What to do:

• Listen without judgment: Let them share their experience without interrupting or criticizing
• Express concern calmly: Use "I" statements like "I'm worried about you and I want to help"
• Validate their feelings: Acknowledge that their pain is real, even if you don't fully understand it
• Encourage professional help: Gently suggest talking to a counselor or therapist
• Be patient: Recovery takes time, and setbacks are normal
• Take care of yourself: Supporting someone with self-harm can be emotionally draining; seek your own support
• Learn about self-harm: Understanding the behavior helps you provide better support

What to avoid:

• Don't express shock or disgust: This can increase shame and make them less likely to open up
• Don't give ultimatums: "Stop or else" approaches rarely work and can damage trust
• Don't make it about you: Avoid saying things like "How could you do this to me?"
• Don't ignore it: Hoping it will go away on its own is not effective
• Don't try to be their therapist: Professional help is essential
• Don't promise to keep it secret: You may need to involve others if they're in danger

If they're in immediate danger

If the person has injured themselves severely or is expressing suicidal thoughts, immediate action is necessary. Stay with them, call emergency services, and do not leave them alone until help arrives. It's better to err on the side of caution when safety is at risk.

What Are Healthy Coping Strategies to Replace Self-Harm?

Healthy alternatives to self-harm include physical activities like exercise or squeezing ice, emotional expression through writing or art, sensory techniques like cold water on the face, relaxation methods like deep breathing, and social connection with supportive people. The key is finding strategies that address the same emotional need without causing harm.

One crucial aspect of recovery is developing healthy coping strategies to use when the urge to self-harm arises. These alternatives aim to meet the same emotional needs that self-harm fulfills—whether that's releasing tension, feeling something, or gaining control—without causing physical damage.

Different strategies work for different people, and it often takes experimentation to find what's most helpful. Having multiple options available is important because what works in one situation might not work in another. Building a "coping toolbox" of various strategies increases the likelihood of successfully managing difficult moments.

Physical release alternatives

If self-harm serves as a way to release intense physical tension or emotion, these alternatives can provide similar relief:

• Intense exercise: Running, jumping jacks, or punching a pillow
• Squeezing ice: Holding ice cubes creates intense sensation without injury
• Snapping a rubber band: On the wrist (use cautiously, as it can become harmful)
• Tearing paper: Ripping up magazines or newspapers
• Screaming: Into a pillow or in an isolated place

Emotional expression alternatives

If self-harm helps express emotions that feel impossible to verbalize, these creative outlets can serve a similar purpose:

• Journaling: Writing about your feelings without editing or judging
• Art: Drawing, painting, or sculpting emotions
• Music: Listening to or creating music that reflects your mood
• Red marker technique: Drawing on your skin with red marker instead of cutting

Grounding and sensory techniques

If self-harm helps you feel present or real when dissociating or feeling numb, grounding techniques can help:

• Cold water: Splashing cold water on your face or taking a cold shower
• Strong flavors: Eating something very spicy or sour
• 5-4-3-2-1 technique: Name 5 things you see, 4 you hear, 3 you feel, 2 you smell, 1 you taste
• Holding objects: Textures like stress balls, stones, or soft fabric

Relaxation and self-soothing

When emotional distress is high, calming techniques can help reduce the intensity of the urge:

• Deep breathing: Slow, deliberate breaths to activate the calming response
• Progressive muscle relaxation: Tensing and releasing muscle groups
• Mindfulness meditation: Focusing on the present moment without judgment
• Warm bath or shower: Physical warmth can be soothing
• Comfort objects: Wrapping in a blanket, holding a stuffed animal

Can People Recover from Self-Harm?

Yes, recovery from self-harm is absolutely possible. Research shows that 70-80% of people who receive appropriate treatment significantly reduce or stop self-harming. Recovery is a process that takes time and may include setbacks, but with proper support, most people can develop healthier coping mechanisms and improve their overall well-being.

Recovery from self-harm is not only possible but common with appropriate support and treatment. Many people who once struggled with self-injury go on to live fulfilling lives without harming themselves. Understanding that recovery is achievable can provide hope during difficult times.

It's important to recognize that recovery is a process, not an event. It typically involves gradually reducing self-harm while building new coping skills, rather than stopping abruptly. Setbacks may occur, especially during times of high stress, but they don't mean recovery has failed—they're a normal part of the journey.

What recovery looks like

Recovery from self-harm doesn't mean you'll never face difficult emotions again. Instead, it means developing healthier ways to cope with those emotions and no longer needing self-harm to get through painful moments. For many people, recovery also involves addressing underlying issues like trauma or mental health conditions.

Signs of recovery progress include:

• Longer periods between self-harm episodes
• Using alternative coping strategies successfully
• Better understanding of triggers and warning signs
• Improved ability to tolerate distressing emotions
• Stronger support network and willingness to reach out
• Increased hope for the future

Handling setbacks

If a setback occurs, try not to view it as a complete failure. Instead, treat it as information about what still needs work. Analyze what led to the setback, what coping strategies might have helped, and how to prevent similar situations in the future. Discuss setbacks with your treatment provider—they can help you learn from the experience and adjust your treatment plan if needed.