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

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

Self-harm (also known as self-injury or non-suicidal self-injury/NSSI) is when someone deliberately hurts themselves as a way to cope with difficult emotions, trauma, or overwhelming situations. Common forms include cutting, burning, hitting, scratching, or other methods of physical injury. Self-harm is not a suicide attempt but a way of managing emotional pain.

Self-harm is a complex behavior that serves as a coping mechanism for many people struggling with intense emotions. When emotional pain becomes unbearable, some individuals find that physical pain provides temporary relief or a sense of control. This behavior is much more common than many people realize, affecting approximately 17% of adolescents and 5% of adults at some point in their lives.

Understanding why people self-harm is crucial for providing effective support. The behavior is not attention-seeking or manipulation it is a genuine attempt to cope with overwhelming feelings. People who self-harm are often dealing with emotions they find impossible to express or manage in other ways. The act of self-harm can create a temporary sense of release, control, or even numbness that provides relief from emotional distress.

It is important to recognize that self-harm and suicide are different, though related, concerns. While self-harm itself is not a suicide attempt, it does indicate significant emotional distress and can increase the risk of suicidal thoughts over time. This is why early intervention and support are so important.

Common reasons people self-harm

Research has identified several psychological functions that self-harm serves. Understanding these can help both individuals and their support networks address the underlying needs in healthier ways. The reasons are often deeply personal and may include multiple factors.

• Emotional regulation: To release or reduce intense feelings like anxiety, anger, sadness, or emotional numbness
• Self-punishment: To express self-criticism or feelings of worthlessness through physical pain
• Feeling something: To feel alive or real when experiencing emotional numbness or dissociation
• Communicating distress: To show others the depth of emotional pain when words feel inadequate
• Gaining control: To feel a sense of control when other aspects of life feel chaotic or uncontrollable
• Processing trauma: To cope with memories of past abuse, neglect, or traumatic experiences

Long-term consequences of self-harm

While self-harm may provide temporary relief, it often leads to more difficulties over time. The relief is short-lived, and many people find they need to self-harm more frequently or severely to achieve the same effect. This can create a cycle that becomes increasingly difficult to break without professional support.

Self-harm can affect self-esteem and self-image, often reinforcing negative beliefs about oneself. It may lead to social isolation as individuals hide their behavior from others due to shame or fear of judgment. Relationships can suffer as the secrecy and emotional distance grow. Physical complications including scarring, infection, and accidental severe injury are also significant concerns.

Perhaps most importantly, relying on self-harm as a coping mechanism prevents the development of healthier emotional regulation skills. Without intervention, individuals miss opportunities to learn and practice alternative ways of managing difficult feelings, making recovery more challenging the longer the behavior continues.

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; social withdrawal; keeping sharp objects nearby; expressions of hopelessness; difficulty managing emotions; and changes in eating or sleeping patterns. If you notice these signs in yourself or someone else, it is important to seek support.

Recognizing the warning signs of self-harm can be challenging because many people go to great lengths to hide their behavior. However, being aware of potential indicators can help you identify when someone may need support. It is important to approach any concerns with compassion rather than judgment.

Physical signs are often the most noticeable, though many who self-harm become skilled at concealment. You might notice unexplained injuries such as cuts, burns, bruises, or scratches that appear regularly. These injuries often occur in patterns or in areas that are easily hidden by clothing. Someone who self-harms may make excuses for these injuries or become defensive when asked about them.

Behavioral changes can also indicate self-harm. Wearing long sleeves, pants, or wristbands even in warm weather may be an attempt to cover injuries. Withdrawal from social activities, friends, and family is common, as is spending increased time alone, particularly in bathrooms or bedrooms. You might notice blood stains on clothing, towels, or bedding, or the presence of sharp objects like razors or knives in unusual places.

Physical warning signs

• Unexplained injuries: Cuts, burns, bruises, or scratches that appear regularly without clear explanation
• Scars: Collections of scars, often in patterns, on arms, legs, abdomen, or other areas
• Frequent accidents: Claiming to be accident-prone or clumsy to explain injuries
• Bandages or dressings: Regularly wearing bandages or refusing to remove them
• Healing wounds: Wounds in various stages of healing appearing over time

Behavioral and emotional warning signs

• Covering up: Wearing concealing clothing regardless of weather or situation
• Social withdrawal: Pulling away from friends, family, and activities previously enjoyed
• Mood instability: Frequent mood swings, irritability, or emotional outbursts
• Expressions of hopelessness: Statements about feeling worthless, hopeless, or like a burden
• Isolation: Spending long periods alone, especially in bathrooms or bedrooms
• Changes in routine: Altered eating or sleeping patterns, declining academic or work performance

What Increases the Risk of Self-Harm?

Risk factors for self-harm include mental health conditions (depression, anxiety, PTSD), history of trauma or abuse, difficulty regulating emotions, social isolation, bullying, family conflict, substance use, and having friends who self-harm. Understanding these factors can help identify those who may need additional support.

Self-harm does not have a single cause. Rather, it develops from a complex interaction of psychological, social, and environmental factors. Understanding these risk factors can help identify individuals who may be more vulnerable and ensure they receive appropriate support before self-harm begins or escalates.

Mental health conditions significantly increase the risk of self-harm. Depression, anxiety disorders, post-traumatic stress disorder (PTSD), eating disorders, borderline personality disorder, and substance use disorders are all associated with higher rates of self-harm. These conditions often involve difficulty managing intense emotions, which may lead someone to seek relief through self-injury.

Traumatic experiences, particularly in childhood, are strong predictors of self-harm behavior. Physical, emotional, or sexual abuse, neglect, witnessing violence, or experiencing significant losses can all contribute to the development of self-harm as a coping mechanism. The trauma does not need to be recent; childhood experiences can affect coping patterns well into adulthood.

Psychological risk factors

• Mental health conditions: Depression, anxiety, PTSD, borderline personality disorder, eating disorders
• Emotion dysregulation: Difficulty identifying, understanding, or managing emotions
• Low self-esteem: Persistent feelings of worthlessness or inadequacy
• Perfectionism: Setting impossibly high standards and harsh self-criticism when failing to meet them
• Impulsivity: Tendency to act without thinking through consequences

Environmental and social risk factors

• Trauma history: Past physical, emotional, or sexual abuse or neglect
• Family difficulties: Conflict, dysfunction, or poor communication within the family
• Peer relationships: Bullying, rejection, or having friends who self-harm
• Social isolation: Lack of supportive relationships or feeling disconnected from others
• Stressful life events: Loss, relationship breakdown, academic or work pressure
• Exposure to self-harm: Through media, social networks, or personal contacts

How Can You Stop Self-Harming?

Stopping self-harm involves understanding your triggers, developing alternative coping strategies, building a support network, and often seeking professional help. Recovery is a process that takes time, and setbacks do not mean failure. Evidence-based therapies like DBT and CBT have shown significant success in helping people stop self-harming.

Recovery from self-harm is possible, and many people successfully stop this behavior with the right support and strategies. The journey is rarely linear there may be setbacks along the way but each step forward is progress. Understanding that recovery takes time and patience is an important first step.

The process of stopping self-harm typically begins with increasing self-awareness. This means learning to recognize your personal triggers the situations, thoughts, or feelings that precede urges to self-harm. Keeping a journal can help identify patterns. You might notice that urges increase during certain times of day, after specific interactions, or when experiencing particular emotions.

Developing alternative coping strategies is essential. These are healthier ways to manage the intense emotions that previously led to self-harm. The most effective alternatives often provide some of the same sensory or emotional relief as self-harm but without causing injury. What works varies from person to person, so it is important to try different strategies and find what helps you.

Questions to ask yourself

Reflecting on your self-harm behavior can provide valuable insights for recovery. Consider writing your answers to these questions:

• What situations or feelings typically trigger urges to self-harm?
• What emotions are you experiencing just before you self-harm? Look beyond the obvious there may be multiple feelings present
• What does self-harm provide for you? What need is it meeting?
• What other ways could you meet that same need?
• Are there aspects of your daily life (sleep, nutrition, exercise) that could be improved?
• Who in your life could you talk to about how you are feeling?

Build healthy daily habits

Physical wellbeing significantly affects emotional regulation. When your body is well-cared for, you are better equipped to handle difficult emotions. Consider these foundational habits:

• Sleep: Aim for consistent, adequate sleep. Poor sleep makes emotions harder to manage
• Nutrition: Eat regular, balanced meals. Blood sugar fluctuations can affect mood
• Exercise: Physical activity releases endorphins and helps process emotions. Even a 30-minute walk helps
• Limit substances: Alcohol and drugs can intensify emotions and reduce inhibitions, increasing self-harm risk
• Routine: A regular daily structure provides stability and reduces uncertainty

Remove access to means

Reducing access to items you typically use for self-harm is an important practical step. This does not mean you need to eliminate all potentially harmful objects from your life, but creating barriers can give you time to use coping strategies when urges arise. Consider giving items to a trusted person, storing them somewhere difficult to access, or disposing of them entirely.

What Are Healthy Alternatives to Self-Harm?

Healthy alternatives to self-harm include distraction techniques (holding ice, exercise, calling a friend), grounding exercises (5-4-3-2-1 technique), emotional expression (journaling, art, music), and physical alternatives that provide sensation without injury. The key is finding strategies that meet the same need self-harm was meeting.

When urges to self-harm arise, having a toolkit of alternative coping strategies can make all the difference. The most effective alternatives are those that address the same underlying need that self-harm was meeting. If you self-harm to release intense emotions, you need strategies that provide emotional release. If you self-harm to feel something when numb, you need strategies that create sensation.

It is helpful to prepare your coping strategies in advance, before you are in crisis. When you are in the midst of an intense urge, it is hard to think clearly and come up with alternatives. Having a written list of strategies you can refer to makes it much easier to use them when needed.

Remember that urges, while intense, are temporary. They typically peak and then decrease, like a wave. If you can ride out the wave using coping strategies, the urge will usually pass. Setting a timer for 15 or 30 minutes and committing to trying alternatives during that time can be helpful.

Distraction techniques

Distraction works by redirecting your attention away from the urge and the emotions driving it. These techniques are most helpful when you need to get through an immediate crisis:

• Call or text a friend: Social connection can shift your focus and provide support
• Physical activity: Go for a run, do jumping jacks, dance vigorously, or punch a pillow
• Watch something engaging: A movie, TV show, or funny videos can redirect attention
• Play a game: Video games, puzzles, or card games that require concentration
• Clean or organize: Physical activity plus visible results can feel productive and calming
• Cook or bake: Following a recipe requires focus and results in something tangible

Grounding exercises

Grounding techniques help bring you back to the present moment, which is especially helpful when you are feeling disconnected, dissociated, or overwhelmed:

Physical alternatives that provide sensation

If you self-harm to feel physical sensation or to make emotional pain feel more tangible, these alternatives can provide intense but safe sensory experiences:

• Hold ice cubes: The intense cold provides strong sensation without injury
• Snap a rubber band on your wrist: Creates a sharp but harmless sensation
• Take a very cold shower: The shock of cold water can interrupt intense emotions
• Bite into a lemon or chili pepper: Strong taste can provide sensory focus
• Draw on your skin with red marker: Can simulate the visual aspect of self-harm without injury

Emotional expression

Finding healthy ways to express the emotions that drive self-harm urges can provide lasting relief:

• Write in a journal: Putting feelings into words can help process them
• Create art: Drawing, painting, or sculpting can express emotions non-verbally
• Listen to music: Music that matches your mood can help you feel understood
• Write poetry or lyrics: Creative writing can give voice to difficult feelings
• Cry: Allowing yourself to cry is a healthy emotional release
• Scream into a pillow: Safe way to release anger or frustration

When Should You Seek Professional Help?

Seek professional help as soon as possible if you are self-harming. Immediate medical attention is needed for severe injuries. Mental health support is crucial when self-harm is frequent, urges are increasing, you have thoughts of suicide, daily functioning is affected, or self-help strategies are not working. A healthcare provider can assess your situation and recommend appropriate treatment.

While self-help strategies can be valuable, professional support often makes a significant difference in recovery from self-harm. Mental health professionals have specialized training in understanding and treating self-harm, and can provide evidence-based treatments that have been proven effective.

You do not need to wait until self-harm is severe to seek help. In fact, earlier intervention typically leads to better outcomes. If you have started self-harming, or if you are having frequent urges to self-harm, reaching out to a healthcare provider is a positive and important step.

There are several situations where seeking help is particularly important. If your injuries ever require medical attention due to depth, bleeding, or infection risk, you should see a healthcare provider. If self-harm is becoming more frequent or more severe over time, this escalation indicates a need for professional support. If you are experiencing thoughts of suicide alongside self-harm, immediate help is essential.

Where to seek help

There are multiple pathways to accessing professional support for self-harm. The right choice depends on your situation, location, and preferences:

• Primary care physician: Your regular doctor can provide initial assessment and referrals
• Mental health services: Psychiatric clinics, community mental health centers, or private therapists
• Crisis services: Crisis helplines, crisis centers, or emergency departments for urgent situations
• School or university counseling: If you are a student, counseling services are often available on campus
• Employee assistance programs: Many workplaces offer confidential mental health support
• Support organizations: Organizations dedicated to self-harm support can provide resources and guidance

What Treatment Options Are Available?

Effective treatments for self-harm include Dialectical Behavior Therapy (DBT), which can reduce self-harm by 50-70%; Cognitive Behavioral Therapy (CBT); Mentalization-Based Treatment (MBT); and other evidence-based psychotherapies. Treatment addresses underlying emotional difficulties and teaches healthier coping skills. Medication may help when co-occurring mental health conditions are present.

Several evidence-based treatments have been developed specifically for self-harm or have been adapted to address it effectively. The right treatment depends on individual needs, the presence of co-occurring mental health conditions, and personal preferences. A mental health professional can help determine the most appropriate approach.

Psychotherapy (talk therapy) is the primary treatment for self-harm. These therapies help you understand the function self-harm serves, develop alternative coping skills, address underlying emotional difficulties, and work through past trauma if relevant. Treatment is typically provided by psychologists, psychiatrists, or other trained mental health professionals.

It is important to know that you have the right to be involved in decisions about your treatment. If something does not feel right, or if you do not connect well with a particular therapist, it is okay to ask questions or request a different provider. The therapeutic relationship is an important part of successful treatment.

Dialectical Behavior Therapy (DBT)

DBT was originally developed for borderline personality disorder but has become one of the most effective treatments for self-harm. Research shows it can reduce self-harm behaviors by 50-70%. DBT teaches four core skill sets:

• Mindfulness: Being present in the moment without judgment
• Distress tolerance: Coping with crisis situations without making things worse
• Emotion regulation: Understanding and managing intense emotions
• Interpersonal effectiveness: Communicating needs and maintaining relationships

Standard DBT includes individual therapy, group skills training, phone coaching for crises, and a consultation team for therapists. Modified versions are available for different settings and populations.

Cognitive Behavioral Therapy (CBT)

CBT helps identify and change negative thought patterns and behaviors that contribute to self-harm. It focuses on the connection between thoughts, feelings, and actions. CBT for self-harm typically includes:

• Identifying triggers and warning signs
• Challenging unhelpful thoughts
• Developing coping strategies
• Problem-solving skills
• Behavioral activation

Other treatment approaches

• Mentalization-Based Treatment (MBT): Focuses on understanding your own and others mental states
• Emotion-Focused Therapy: Helps process and transform difficult emotions
• Trauma-focused therapies: If past trauma contributes to self-harm, approaches like EMDR may be helpful
• Family therapy: Can improve family communication and support, especially for young people

What to expect when seeking help

When you first seek help for self-harm, you will typically have an assessment where you are asked about your current situation, history, and goals. You may be asked about how you are feeling, how long you have been self-harming, what triggers it, and what you have already tried. Be as honest as you can this information helps determine the best treatment approach.

The level of support offered will depend on your individual needs. Some people benefit from weekly outpatient therapy, while others may need more intensive support. Treatment plans should be developed collaboratively, with your input and agreement.

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 demands to stop, encourage professional help without forcing it, educate yourself about self-harm, be patient as recovery takes time, and take care of your own mental health. Your support can make a significant difference in their recovery.

Discovering that someone you care about is self-harming can bring up many difficult emotions shock, fear, sadness, confusion, or even anger. These reactions are understandable, but how you respond can significantly impact the person who is struggling. With the right approach, you can be an important source of support.

The most important thing you can do is listen without judgment. Many people who self-harm feel deep shame about their behavior and fear rejection if others find out. Creating a safe space where they can talk openly, without fear of criticism or overreaction, is invaluable. You do not need to have all the answers simply being present and accepting can be powerful.

Avoid ultimatums such as "stop self-harming or else" or extracting promises to never do it again. These approaches rarely work and can damage trust. Self-harm is a coping mechanism, and simply demanding someone stop without addressing the underlying issues or providing alternatives is unlikely to be effective and may drive the behavior underground.

What to say and do

• Express concern calmly: "I've noticed you seem to be going through a difficult time. I care about you and I'm here if you want to talk."
• Listen actively: Give your full attention, reflect back what you hear, and ask open questions
• Validate their feelings: "It sounds like you're dealing with a lot right now. That must be really hard."
• Avoid trying to fix everything: Sometimes people need to be heard more than they need solutions
• Encourage professional help: "Would you consider talking to a counselor? I could help you find someone."
• Offer practical support: Help them research therapists, accompany them to appointments if helpful
• Stay connected: Continue to reach out and include them in activities

What to avoid

• Do not panic or overreact: Stay calm even if you feel worried
• Do not minimize or dismiss: "It's not that bad" or "just stop doing it" are not helpful
• Do not make it about you: "How could you do this to me?" increases guilt and shame
• Do not give ultimatums: Threats rarely help and may damage trust
• Do not promise to keep it secret: If you are worried about safety, you may need to involve others
• Do not treat them differently: Continue to see them as a whole person, not just their self-harm

Is Recovery from Self-Harm Possible?

Yes, recovery from self-harm is absolutely possible. Many people who once self-harmed no longer do so. Recovery involves learning new coping skills, addressing underlying issues, building support networks, and developing a life that feels meaningful. Setbacks may occur but do not mean failure. With time and appropriate support, life can get better.

One of the most important messages for anyone struggling with self-harm is that recovery is not only possible it is common. Many people who once relied on self-harm to cope have found other ways to manage difficult emotions and no longer engage in self-injury. The journey may be challenging, but a different way of living is achievable.

Recovery from self-harm is not simply about stopping the behavior, though that is an important goal. It is about building a life where self-harm is no longer needed. This means developing healthier ways to cope with emotions, addressing underlying mental health conditions, processing past trauma, improving relationships, and finding meaning and purpose.

It is important to have realistic expectations about recovery. It rarely happens overnight, and there may be setbacks along the way. A slip or relapse does not mean you have failed or that you are back at square one. Each time you use a coping strategy instead of self-harming, each day you manage without self-injury, is progress. Recovery is about the overall direction of travel, not perfection.

What recovery can look like

Recovery is personal and looks different for everyone. Some aspects that people commonly experience as they recover include:

• Longer periods between self-harm episodes
• Urges becoming less intense or less frequent
• Being able to use alternative coping strategies more often
• Feeling more able to talk about difficult emotions
• Having more hope for the future
• Engaging more fully in relationships and activities
• Better understanding of what triggers difficult feelings
• Increased self-compassion